Case #92

Case 2013-MDC14-06 Revising the assignment rules of abortion cases

Added by Anonymous over 7 years ago. Updated about 7 years ago.

Status:AcceptedStart date:2013-10-17
Priority:MajorSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2013
Initiator:Finland Target year:2014
MDC:MDC14 Owner / responsible:National organisations
Target Grouper: Old forum status:

Description

Initiated: 2011
Initiator: Helsinki University Hospital
Sent to NordDRG Forum (date): 27.1.2013

Expert Network 2013-03-12: No change recommended, further analysis necessary
Board 2013-03-27: No change


Problem

Finnish national DRG-center got several proposals from Helsinki University Hospital with respect that DRGs in MDC 14 should be revised and analyzed. The main problem was related to DRG 373 also other groups were considered problematic.

During several meetings a working-group of clinical and economical experts was revised all DRGs in MDC 14 and came up with 6 proposals.

Analysis

The analysis was performed on cases in MDC 14 in a combined data from year 2011 in all five Finnish university hospitals. For grouping Finnish 2011 Full version was used, in case of DRG 379 CC-grouper was used.

Suggestions:

Revising the assignment rules of abortion cases

In order to make clear difference of costs between cases related to abortion (mainly DRGs 381O and 814P) we divided these cases into four groups and analyzed the costs. The cases were divided as follows:

A.Insertion of IUD after abortion

▪cases with property 14X31 (Abortion) and NCSP TLC00 (Insertion of intrauterine contraceptive device

▪these case are currently assigned to following DRGs

B.Abortion w procedure – aspiration, curettage or hysterotomy (outpatient and inpatient)

▪cases with proc property 14S05 (OR procedure in abortion)

▪these case are currently assigned to following DRGs

C.Drug induced abortion

▪cases with dx property 14X31 (Abortion) and NCSP LCH11 (Peroral introduction of abortifacient, in NCSP+ LCXH12)

▪these case are currently assigned to following DRGs

D.Spontaneous abortion w/o procedure

▪cases with dx O03.0-.9 as principal diagnosis, w/o 14S05

▪these case are currently assigned to following DRGs

The cost data of these four groups are as follows (comparison of every alternative is given with DRG where the biggest proportion of the case has been assigned):

Base on the analysis we propose to create new DRG for abovementioned four groups of cases.

Swedish comment 2013-03-07

DRG 381O = DRG P22O (Kirurgisk abort, öppenvård) in the Swedish NordDRG version. We could not find cases with insertion of IUD in this group (undercoding?). However, according to Finnish cost data the cost difference is too small (only 8 %) to motivate a split of DRG 381O/P22O and we do not think that it is very important in a medicostatistical perspective to have a separate group for IUD cases. Thus, we do not support such a split.

DRG 814P = P23O (Farmakologisk eller spontan abort, öppenvård) in the Swedish version. We have understood that the suggestion means a split of this group into “drug induced” and “spontaneous”.

In the Swedish grouping logic there is only one procedure code that indicates “spontaneous”, and that is ZL006 (Hemabort). Swedish cost data (KPP 2011) is presented in the table below.

The number of “Other cases” is very small, only 1,5 % of the original group which is too small for a split. Probably drug induced abortions are complemented with some kind of exeres in most cases and then the cases are grouped to DRG P22O (Kirurgisk abort, öppenvård). If so, it is rather meaningless to divide abortions into surgical or medical. In a medicostatistical perspective we think that it is more important to divide them into “spontaneous” and “planned”, irrespectively of the method for the planned abortion. Such a grouping logic is not analyzed yet, however. For the moment we do not support the suggestion to split DRG 814P/P23O.

Discussion

Expert group 2013-03-12

The four groups proposed by Finland were

  • Abortion with IUD insertion
  • Abortion with other procedure
  • Drug induced abortion
  • Spontaneous abortion (without any intervention?)

Sweden proposed division to:

  • Induced abortion (legal abortion)
  • Spontaneous abortion (irrespective of intervetions)

However Sweden had not had time for analysis of resource use of all possibilities.

The expert meeting decided that the analysis of resource use of the options is necessary before decision and postponed the case.

Finland shall take a lead in the analysis and ask Sweden for analysis for the define options for new groupings to be presented with the Finnish data.

Comments

Comment Finnish National DRG Centre Minna-Liisa Sjöblom / Kristiina Kahur 2014-03-18:

After having reviewed and analysed the case we decided not to go on with further analysis and suggest closing the case.

MDC14-06_1.png (7.38 KB) Anonymous, 2013-10-17 12:41

MDC14-06_2.png (19.4 KB) Anonymous, 2013-10-17 12:46

MDC14-06_3.png (8.34 KB) Anonymous, 2013-10-17 12:48

MDC14-06_4.png (4.92 KB) Anonymous, 2013-10-17 12:50

MDC14-06_5.png (19.1 KB) Anonymous, 2013-10-17 12:52

MDC14-06_6.png (9.84 KB) Anonymous, 2013-10-17 12:54

History

#1 Updated by Martti Virtanen about 7 years ago

  • Status changed from Further active to Active
  • Case type changed from Major to Further active

#2 Updated by Anonymous about 7 years ago

  • Priority changed from Normal to 23
  • Target version set to Expert Group 2014
  • Target year 2015 added

#3 Updated by Anonymous about 7 years ago

  • Assignee set to Martti Virtanen

#4 Updated by Anonymous about 7 years ago

  • Description updated (diff)
  • Status changed from Active to Accepted
  • Priority changed from 23 to Major
  • Target version changed from Expert Group 2014 to Expert Group 2013
  • Case type deleted (Further active)
  • Old forum status deleted (FURTHER ACTITEM - Further active item)
  • Assignee changed from Martti Virtanen to Anonymous
  • Target year 2014 added

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