A new grouping logic for psychiatric care in NordDRG 2005

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A new grouping logic for psychiatric care in
NordDRG 2005

• Mona Heurgren
• Senior Economist/Project leader
• Swedish Federation of County Councils
• Centre for Patient Classifications

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Agenda

• Introduction of the project
• Objectives in our work
• Methods
• Results
• Discussion

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Introduction

• The need of a case-mix system in mental health
  care has increased over time in Sweden
• There are psychiatric groups in NordDRG but the
  existing groups are not used in psychiatric care
• There was no international case-mix system for
  mental health care in use that was suitable for
  Sweden
• Sweden has no national classification for
  psychiatric procedures

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Why did we not have any case-mix system in
psychiatric care?

• The problem is the two main criteria for case-mix
  systems
• A case-mix system must be both medically
  meaningful and cost homogeneous

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SK-PSYK - Sweden

• A new project for Patient Classification in
  Psychiatric care

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Objectives

• To develop a new grouping logic for mental health
  care for both inpatient- and outpatient care
• To develop a method to define episodes of care
• - The system will in Sweden mainly be used to
  better describe performance and analyse medical
  practise in mental health care.

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Grouping principals in mental health care

• The framework of the NordDRG-system should be
  used
• The new system must meet the demands for a PCS
• Only variables present in the National Discharge
  Register can be used
• The grouping shall be based on the aggregated
  diagnosis groups developed by representatives for
  Swedish psychiatry
• The system shall mainly be designed to better
  describe and analyse mental health care
• The grouping system must comprise the care of
  children

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The projects three phases

• To develop and implement a new grouping logic for
  psychiatric inpatient care. The new logic will be
  introduced in the NordDRG-system version 2005.
• To develop and implement a new grouping logic for
  psychiatric outpatient care. The new logic shall
  be introduced in the NordDRG-system version 2006.
• To suggest how the groups in the NordDRG-system
  can be used in grouping of episodes of care
  (finished by the end of 2006).

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Statistic demands for the new groups

• The change has relevance for the the whole system
  and it is supposed to be functional even in the
  future
• Increased cost homogeneity (at least 5 reduction
  in standard deviation)
• Difference in resource utilisation (mean expenses
  between two groups should differ at least 20)
• Minimum group size is at least 3 of the original
• Clinical relevance is not essentially reduced

From the NordDRG manual
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Key Questions

• Indirect visits conferences, telephone etc
• Long stays
• Medical practise
• A system for all actors in health care
• Acuity of stay
• Classification of Procedures in mental health
  care
• Cost data
• The understanding for patient classification in
  mental health care

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Results

• A grouping logic that comprises 26 groups for
  mental health inpatient care
• Fusion of MDC 19 and 20 to one MDC Mental
  Diseases and disorders and drug/alcohol abuse)
• The explanatory value of the system (R2) is 23
• The system only uses variables from the national
  Discharge register
• Reference group from Swedish psychiatry

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Aggregated diagnosis groups and used logic for
splitting
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New groups in NordDRG 2005
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Examples of grouping 2002

• Data from the National Discharge Register

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The future

• The project will continue with the development of
  a grouping logic for psychiatric outpatient
  visits
• The outpatient groups will hopefully be
  introduced in NordDRG 2006
• The outpatient groups will mainly use procedures
  for grouping

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Discussion

• Is everybody in Swedish mental health care happy
  with the new system?
• How do we get from grouping cases to the grouping
  of episodes of care?
• How will we continue will the work to get better
  cost data in mental health care?
• How can we combine cost and DRG-data with quality
  data?

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Home pages

• www.sos.se/epc/cpk
• www.lf.se/kpp