Case #637

Generell Anestesia affects the grouping incorrect

Added by Ralph Dahlgren 2 months ago. Updated 28 days ago.

Status:AcceptedStart date:2019-02-24
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:NordDRG 2020
Initiator:Sweden Target year:2020
Case type:Minor Owner / responsible:National organisations
MDC:MDC01 Old forum status:
Target Grouper:SWE

Description

Problem
Patients are grouped into A60A Serious traumatic brain injury, very complicated but if adding ZXH60 General anesthesia (i) that is preformed during the stay the patient will be grouped to DRG A39N Procedures during major anesthesia in neurological problems except infections & tumors.
This is out of a medical description not acceptable which was pointed out to us from the users.
The result depends on the order in DRGlogic and how the drglogic lines are constructed.
The DRG A39N only requires a diagnosis in MDC 01 and a procedure code with the grouping property 00X10.
Since we want to solve the problem we have to move the DRG A39N down quite far. What happens is that the DRG A39N will be "drained" on all patients that have DGCAT located above the new position with / without general anesthesia.
To solve the initial problem we want to move DRG A60A / E to be above DRG A39N. DRG A39N has to be located above DRG A56A / C / E Cramps and headaches.
The patient with cramps that needed to have generell anastesia needs more resources than those who were not anesthetized.

Analysis
The National Board of Health and Welfare Sweden Organization – 2019-02-24
Conclusion: This migration of DRG works because there are few changes in number (110), Improved medical description (patient cases are grouped inte the right DRG), resources does not change mucg and that icludes VC (see tab Processed difference).
Also there are not much deterioration economically in different DRG.
The Weighted CV Difference improve with 977%.
See Excel-file ‘Appendix with grouping material to Forum on case C794.xlsx.’
Suggestion
The National Board of Health and Welfare Sweden Organization – 2019-02-24
We will move DRG A39N down quite far. But to solve the initial problem we want to move DRG A60A / E to be above DRG A39N. DRG A39N has to be located above DRG A56A / C / E Cramps and headaches since DRG A39N includes the patient with cramps that needs to have generell anastesia. These patients requires more resources than those who were not anesthetized
The Technical changes is in the Excell-file ‘Technical Changes C794 Generell Anestesia affects the grouping incorrect’.
Decided changes
The National Board of Health and Welfare Sweden – 2019-02-24
Sweden wants this to be introduced for the Swedish NordDRG 2020
DRG change
In our cost data 110 patiens will relocate to totally 9 diffent DRGs.
This gives an improved medical description. Definitely not much deterioration different economically in the involved DRG.
The Weighted CV Difference improve with 977%
Technical change
The technical changes is shown below:
OUT/IN ord drg rtc icd mdc or dgcat1 compl dgprop1
OUT 401D2700001 A60A 0 + 01 N 01M14 2 01X01
OUT 401D270009 A60E 0 + 01 N 01M14 01X01
OUT 401D073010 A39N 0 + 01 00X10
IN 401D2603001 A60A 0 + 01 N 01M14 2 01X01
IN 401D2604001 A60E 0 + 01 N 01M14 01X01
IN b 401D2605001 A39N 0 + 01 00X10
For technical changes se Excel-file ‘Technical Changes C794 Generell Anestesia affects the grouping incorrect’.

Appendix with grouping material to Forum on case C794.xlsx (11.3 MB) Ralph Dahlgren, 2019-02-24 13:25

Technical Changes C794 Generell Anestesia affects the grouping incorrect.xlsx (13.6 KB) Ralph Dahlgren, 2019-02-24 13:25

Technical changes case #637.xlsx (14 MB) Martti Virtanen, 2019-03-08 11:38

Economic analysis Sweden case #637.xlsx (11.3 MB) Martti Virtanen, 2019-03-08 11:39

History

#1 Updated by Kristiina Kahur about 1 month ago

Finnish National DRG-Centre 2019-3-7

Currently, in Finnish version DRG 027 Serious traumatic brain injury is not split based on CC and therefore we cannot analyze the proposal the same way as based on Swedish data. The rationale behind the proposal is understandable though.
What we learned from our data is that mean cost of DRG 531 General anaesthesia for neurological problem is twice as high as mean cost of DRG 027 and therefore we would not make any changes at the moment (ca 9400 EUR vs ca 4300 EUR).
Thus, before changing the hierarchy of the rules in logic table, we have to analyze the possible split of DRG 027 and then consider the proposed change. As the deadline of proposal for 2020 has passed already, we possibly will come up with our suggestion next year.

#2 Updated by Martti Virtanen about 1 month ago

2019-03-08 NCC (MV)
The proposal affects only NordDRG Swe because the moved rules are specific to Swe.
The technical changes allows to see the changes also for the other versions. The logic rules that would be mover are maked with green.
The Finish cost data indicates that cost of brain injury cases (A60A+A60E vs 027) in Sweden is round 50% higher than in Finland (6600€ vs 4300€), wheras the cost of the aneshesia cases (including trauma with anaesthesia A39N vs 531N) is round the same (9900€ vs 9400€). Dividing DRG 027 would hardly solve the problem.
It is also good to note that the number of cases in DRG A39N diminishes in Sweden with 110 cases but A60A inceases with 2 and A60E with 12 cases. This change is mostly about moving cases from anaesthesia group to DRG's in between, which is reported int Swedish analys table but not in wording.
The expert group needs to decide whether the change is recommended to all countries or only Sweden.

#3 Updated by Martti Virtanen 28 days ago

  • Status changed from Active to Accepted

2019-03-11 Expert group
The changes were accepted for Sweden.

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