ACG in Sweden

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ACG in Sweden
2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007

• Facts and findings

Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
Sectors of interest
Hospitals In-patient care at hospitals In-patient
and out-patient care at hospitals In-patient and
out-patient care at hospitals In-patient and
out-patient care at hospitals In-patient and
out-patient care at hospitals Primary
care Primary health care
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
1980-89 the DRG intro
Hospitals in-patient care Medical
departments Surgery Geriatric care? Psychiatric
care? Hospitals out-patient care Costs! Performa
nce?
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
1990-95 DRG peak
Hospital departments Comparison between clinics
and hospitals Ambulatory care Costs AND
performance (still at hospitals) Primary
Care Access to care! How to organise? ACG at
Primary Health Care Centre Feasibility?
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
1995-99 Health care system
Primary care reforms Family physician Health care
team Health Economics Drugs ACG at Primary
Health Care Centres Feasibility! Validity?
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
2000-07 - complexity
Organising health care system Performance and
competition Drugs and financing Primary
level First tier and specialty care Shortage of
staff (budgeting limit) ACG at County
Councils Coding inaccuracies Allocation of
resources vs quality aspects
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
Developing period 1993 - -
Iceland
EU- project
Dalarna - Gagnef -96--06

• Stockholm
• Nynäshamn -94
• Sorunda -94
• Norrtälje -06--

Skaraborg - Södra Ryd -94 - Tibro -99
Älvsborg - Gråbo -94

• Östergötland
• Ryd -03
• Ödeshög -03

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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
ACG introductory years
1994 Gråbo 1990-92 Feasibility PHCC Nynäshamn
1991-92 Time window Sorunda 1991-92 Seasonal
variations 1995 S Ryd (Skövde) 1992 Coding
routines Iceland 1991 Computer systems
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
Pilot projects (1999 - 2005)
Gävleborg -04 - Sandviken
Dalarna -05 - Mell. distr.
Västmanland -02 - Public PHCCs (50)
Stockholm -99 - Södertälje
Halland -03 - Kungsbacka
Blekinge -01 - Public PHCCs (90)
Skåne -04 - Sample PHCCs
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
ACG implementing period
1995 Gagnef 1993-94 PHCC and Public
Health 1998 Gagnef (Tibro) 1996-97 Quality
Improvement 2005 Blekinge 2003-05 County
Council level
Lennart Carlsson
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
SoS Pilot study 1999-2000
Västerbotten - Holmsund
Dalarna - Gagnef

• Uppsala
• Möllan
• Bålsta

Värmland - Arvika

• Stockholm
• Vaxholm
• Segeltorp

Bohuslän - Stenungsund
Östergötland - Ryd
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
On-going contract (Sept 2007)
(Dalarna) (2008 - -)
Halland 2004 - -
Blekinge 2003 - -
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
Carlsson L, Börjesson U, Edgren L. Patient based
burden-of-illness in Swedish primary health
care. Applying the Johns Hopkins ACG Case-mix
System in a retrospective study of electronic
patient records. International Journal of Health
Planning and Management 200217269-282.
Engström SG, Carlsson L, Östgren C-J, Nilsson GH,
Borgquist, LA. The importance of comorbidity in
analysing patient costs in Swedish primary
care. BMC Public Health 2006636
Carlsson L, Strender L-E, Fridh G, Nilsson
G. Types of morbidity and categories of
patients in a Swedish county. Applying the Johns
Hopkins Adjusted Clinical Groups System to
encounter data in primary health care. Scand. J.
of Primary Health Care 200422174-179.
Carlsson L, Strender L-E, Fridh G, Nilsson
GH. Clinical categories of patients and
encounter Rates in primary health care a
three-year study in defined populations. BMC
Public Health 2006635
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
ACG research initiatives
2006 Kungsbacka 2005 Primary-secondary
care 2007 Norrtälje 2005 Coding
quality 2007 Skaraborg (25 years) Longitudinal
health care 2008 Stockholm 2007 Drugs
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2007 European ACG Conference, Karlskrona, Sweden
18-19 Sep, 2007
ACG in Sweden - Summing up
Hospital sector dominance Growing ambition to
developing PHC ACG for profiling at PHC Centre
level ACG for allocation of resources in PHC
Lennart Carlsson