Functional status in casemix applications a Nordic pilot project

1
Functional status in casemix applications- a
Nordic pilot project
2
Contents

• Measuring functional status in casemix studies
• American case-mix and Australian case-mix
• Nordic pilot project
• Aims, timetabell

3
Defining the connection of DRG and case-mix

• Diagnose Related Groups
• A system for classifying patient care by relating
  common characteristics such as diagnosis,
  treatment, and age to
• an expected consumption of hospital resources and
  length of stay.
• Its purpose is
• to provide a framework for specifying case mix
  and to
• reduce hospital costs and reimbursements and
• it forms the cornerstone of the prospective
  payment system
• From National Library of Medicine, MesH database
• http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbm
  esh

4
Demands to functional measurement in DRG content

• Basic idea of DRG
• Medically meaninful groups
• Cost-homogenity
• Validity and reliability of measurement research
  background
• What to measure to be consired
• Wideness - ICF (example on slide 6)
• Acute, subacute setting
• Ward, ambulatory care
• Basic Activities of daily inving (B-ADL) ,
  congnitive, communication (M Stineman, J Shea, A
  Jette, C Tassoni, K Ottenbacher, R Fiedler and C
  Granger1996)
• Agegroups children - adult - aged
• Easy to take to everyday clinical use
• Education
• Data system

5
Demands to functional measurement in DRG content

• When to measure
• On admission
• On disharge
• Sensitive
• Different patientgroups (ICD-10)
• To change
• in functional capacity
• In time
• Predictive
• Costs of rehabilitation
• Resources,
• Length of stay

6
Example of analyzing measurement based on ICF
7
To take into account

• Quality of care and rehabilitation
• readmission
• Outcome of rehabilitation
• gain in functional capacity
• Structure of services
• Possibilities to continue or discharge
• Aim to discharge home, better outcome (Leeds L,
  Meara J, Hobson 2004)
• Punishment methods for longer stay in ward (J
  Schoenman, C Mueller 2005)

8
Earlier casemix applications

• Known groupings based on FIM Functional
  Independence measurement (www.udsmr.com) and
  Barthel
• FIM
• Evaluation of Basic Activities of Daily Living,
  communication and congnitive functions
• Points 18-126
• Summarized in one or in three different
  evaluation area
• USA FRG (function reklated groups)-CMG groups
• Australian National Sub-acute and Non-acute
  patient casemix classification (AN-SNAP)

9
Example of classification of stroke
patients,USA-CMG case mix groups ½-
rehabilitation 95 groups- stroke 14 groups
10
Example of classification of stroke
patients,USA-CMG case mix groups 2/2-
rehabilitation 95 groups- stroke 14 groups
11
Example of classification of stroke
patients,Australian-ANAP- rehabilitation 32
overnight groups, 15 ambulatory care- stroke and
burns five groups
12
Recommeded reading

• Rural implications of Medicare's post-acute-care
  transfer payment policy. J Schoenman, C
  Mueller.J Rural Health. 2005 Spring21(2)122-30.
  
• M Stineman, R Ross, S Williams, J Goin and C
  Granger.A functional diagnostic complexity index
  for rehabilitation medicine Measuring the
  influence of many diagnoses on functional
  independence and resource use.Arch Phys med
  rehabil 2000 81(5) 549-557
• Lowthian P, Disler P, Ma S, Eagar K, Green J, de
  Graaff S. the Australian national sub-acute and
  non-acute Patient casemix Classification
  (AN-SNAP) its application and value in a stroke
  rehabilitation programme. Clin Rehabil 2000.
  14(5)532-7.
• Leeds L, Meara J, Hobson. The impact of discharge
  to a care home on longer term stroke outcomes.
  Clinical rehabilitation 200418924-928.
• Eakar K et al (1997) Australian sub-acute and
  non-acute patient classification AN-SNAP report
  on national Sub-Acute and Non-Acute Case-Mix
  Classification Study. Centre for health service
  development University of Wollogoing.
• M Stineman, J Shea, A Jette, C Tassoni, K
  Ottenbacher, R Fiedler and C Granger. The
  Functional independence measuretests of scaling
  assumptions, structure and reliability across 20
  diverce impairement categories. Arch phys med
  rehabil.1996,77(11)1101-8

13
A Nordic pilot project
14
Work group
15
Present grouping of rehabilitation patients in
NordDRG
16
Rehabilitation diagnosis
17
Process of the development work

• For the first
• Defining the patientgroup
• When patient is ready to discharge concerning the
  acute care
• Reason to stay in hospital is rehabilitative
• To analyze patiendata of FIM measurements
• Sweden, Finland, (Norway?)
• To develop a method to measure activity and
  participation of the patient at specialcare in
  ward
• Nordic assesment System (NAS)
• Later on
• Wider perspective to the functional capacity
  quality of life, instrumental activities of daily
  living (IADL), pain etc
• Documenting links to ICF terminology

18
Aim of the project

• Better (medical economist) grupping of patients
  who have got rehabilitation
• Standard casemix tool
• For rehabilitation in the Nordic countries
• Will lead to
• Rational
• Adequate funding of
• The rehabilitation phase of care
• Adapted from Lowthian P, Disler P, Ma S, Eagar
  K, Green J, de Graaff S. the Australian national
  sub-acute and non-acute Patient casemix
  Classification (AN-SNAP) its application and
  value in a stroke rehabilitation programme. Clin
  Rehabil 2000. 14(5)532-7.

19
Settings

• Admission to rehabilitation

Diffrent kinds of interventions To affect to
Activity and participation
Evaluation of Activity and participation
Acute/Subacute Hospitalcare
Group 1
Group 2
Group 3
Group 4
Group 5
20
Timetabell

• 2004
• Definitions
• Pilot data from Sweden and Finland
• 2005
• Data-analysis
• Conclusions
• Next meeting in Uppsala 31.5.05
• 2006
• Recommendation of new grouping to NordDRG manual
  year 2007
• Implication on NAS to hospitals (education and
  material of NAS)
• 2007
• Evaluation of NAS grouping
• Wider perspective work continues

21
NASNordic Assesment System

• Data based on FIM measuremant
• Defined dataset (59 parameters)
• Data from
• Sweden n2000 (Göteborg, 6 years)
• Finland n8000 (2 years)
• Created new groups for rehabilitation patients
  based on diagnoses (ICD-10)
• Costlength of stay (LOS) in days
• Analysis which variables of functional capacity
  explain the length of stay

22
Conclusions

• Activity and participation assesment of a patient
  has to be done if better grouping is wished
• Workgroup will create new Nordic grouping of
  rehabilitation patients
• More information
• tuula.talvinko_at_efeko.fi

23
Thank You for your interest!