Development initiative #72
Primary care grouping
|Initiator:||Nordic Casemix Centre||Target year:|
|MDC:||Owner / responsible:||Nordic Casemix Centre|
|Target Grouper:||Old forum status:|
#1 Updated by Kristiina Kahur over 1 year ago
- Initiator Nordic Casemix Centre added
Overview of primary health care patient classification system in Finland
The aim of primary health care patient classification system is to describe service production so that it can help:
• to design the production of social and health services
• to allocate resources in accordance with the need for services
• to organize the services in accordance with the agreed clinical practices
• to follow the implementation of clinical practices and the cost of services
• to monitor the impact of changes on service provision, incl. on costs
Uniform patient classification and cost accounting supports the transparency of activities, comparability of data and the ability to estimate the cost of services up front.
In 2000s, two different outpatient primary health care patient classification and production systems were developed in Finland; 1) pDRG (primary care DRG), and 2) APR (outpatient patient classification)
pDRG was based on patients’ reasons for encounter (RFE) (ICPC2) and diagnosis (ICD10), for cost accounting CPP (cost per patient) method was used. The system was developed by FCG.
APR was based on RFE and diagnosis, and procedures. Cost accounting was based on cost-weights of procedures. The system was developed by DMS.
In both systems, different visits of the same patient were combined into one outpatient episode. Later, APR were developed to EPR (episode based classification) which consisted of inpatient primary health care services, specialized health care services and services for elderly-/disabled people.
Also in pDRG system the episode-based approach was used for which the cut-off times of single contacts were used.
Two systems were combined and merged in 2016-2017. As a result, pDRG for primary health care and EPR for describing the regional care pathways was introduced.
Currently, pDRG is a patient classification and production system for primary health care. The grouping is based on the diagnoses and RFE associated with visits and other contacts (calls, etc.). The cost accounting of the groups is based on CPP methodology. Treatment of diseases can be considered both, as individual contacts and as episodes. pDRG system includes a unified grouping and cost accounting logic as well as the guidelines for coding and cost accounting.
EPR is a classification system for reviewing the whole care pathway. The episodes consist of services provided in primary and secondary care services, but also in social care (home and residential care). The grouping is based on RFE and diagnosis information coded during the visits and hospital admissions. Grouping logic of EPR is similar to one of pDRG but the place of the treatment has impact on grouping (e.g. inpatient care). For grouping the information of calendar year is used.
The nature of the episodes can be:
• short-term episodes, cut-off time less than one year
• long-term episodes, cut-off time is one year
• episodes of preventive health care, by nature health promoting episodes
• symptoms and unspecified conditions
• no information about the RFE or diagnosis
As of 2018, in total, there are 86 different episodes and 46 pDRG-groups.