Australian Coding Standards
Average Length of Stay
The National Casemix Programme is moving towards collecting every patient encounter with hospitals. Activity is categorised as admitted patients (inpatients and day cases) and non-admitted patients (emergency dept and out-patients).
Care provided to patients who are not hospitalised. It also relates to services or technology used directly to support basic clinical services, including diagnostic radiology; radiation therapy; clinical laboratory and other special services.
The National Casemix Programme includes significant audit of data before it is included in Casemix. Audit includes activity audit, costs audit, on-site audit, off-site audit. The National Casemix Programme alters (or requires agencies to alter) data to conform to national standards before it is included in the budget modelling process.
The Irish Casemix system uses the Australian Refined Diagnosis Related Group system (AR DRGs) of which there are presently 698.
The portion of a hospital’s budget related to their peer group performance.
Costs associated with the use of capital facilities and equipment including depreciation and interest expenses
The comparison of activity and costs between hospitals. The National Casemix Programme presently operates in the largest 39 acute hospitals which accounts for €4.87 billion of expenditure (based on 2008 costs) and 98% of all HIPE hospitals acute admissions
Case Mix Adjustments
The amount which the Casemix programme deems the hospital to be over or under budget based on the actual patients treated following a Peer Group comparison.
The CMI represents the measurement of the relative complexity of the patients treated by the hospital.
A patient who is admitted to a hospital (under the care of a consultant), on an elective basis for care and/or treatment which does not require the use of a hospital bed overnight and who is discharged as scheduled. The National HIPE Programme collects an abstract of clinical and demographic data relating to these patients. These cases are using the AR DRG grouper. However, significant modifications are made when using the AR DRG Grouper to classify these cases.
Diagnosis Related Group (DRG)
Group of patients which share similar clinincal attributes and consume similar levels of resources.
The Economic and Social Research Institute. The ESRI's Hospital Information and Research Division manages the Hospital Inpatient Enquiry and the National Perinatal Reporting System on behalf of the Health Service Executive.
A patient who attends a designated emergency department of an acute hospital. From a Casemix perspective, non-admitted patients (those not requiring a hospital bed overnight) are classified as "new" or "return." Patients who require an admission to hospital are designated as inpatients. Patients who require an admision to hospital are designated as inpatients. Data on attendance is collected by the Specialty Costs Section of the National Casemix Programme.
The grouper is a specially designed computer software that assigns groups patients to DRGs
Health Service Executive
Hospital Inpatient Enquiry (HIPE)
HIPE is a computer-based discharge abstracting system designed to collect demographic, clinical and administrative data on discharges and deaths from acute general hospitals nationally.
The International Statistical Classification of Diseases and Related Health Problems – 10th Revision- Australian Modification is the Australian standard for coding data on diagnoses and procedures for all discharges from acute hospitals. ICD-10-AM Version 6 was adopted for use in Ireland in January 2009.
Irish Coding Standards
A patient who is admitted to a hospital (under the care of a consultant) for care and/or treatment requiring the use of a hospital bed overnight. Non-elective inpatients who are discharged on the day of admission are classified as statistical day cases. The National HIPE Programme collects an abstract of clinical and demographic data relating to these patients. These cases are using the AR DRG grouper.
Services provided to patients who are hospitalised
LOS (Length of Stay)
The length of time (in days) that a patient spends in hospital before discharge.
Major Diagnostic Categories (MDCs)
MDC is primarily based on the organ system or the specialty that would usually provide patient care. There are currently 25 MDCs.
National Centre for Classification in Health (NCCH)
The National Centre for Classification in Health (NCCH) is the Australian agency that supports the development of ICD-10-AM and undertakes training in the use of this system.
A patient who attends for a specific consultation, treatment, procedure, or test but does not require to be admitted to hospital. Data on attendance is collected by the Specialty Costs Section of the National Casemix Programme.
PCS (Patient Classification System)
A system for summarising hospital activity into groups on the basis of common clinical characteristics and levels of resource use.
Principal Diagnosis (PDx)
The condition that after study was found to be chiefly responsible for that patient’s episode of care
Principal Procedure (PPx)
The most significant procedure that was performed for the treatment of the principal diagnosis.
Hospital Payment Programme where rates are set prior to the period during which they apply and where the hospital incurs some financial risk
A payment method in which hospitals are paid their incurred costs of treating patients after the treatment has occurred.
Relative Values (RV)
A Relative Value may be used to determine the average cost of treating a patient in one DRG relative to the average cost of treating patients in all DRGs.
A trim point is a boundary applying to a distribution, e.g. days spent in hospital. The upper and lower trim point for length of stay would be used to defined cases where the length of stay were consider 'exceptional' (or 'outliers'). A case might have an exceptionally long or an exceptionally short length of stay. For such cases, a statistical adjustment has to be applied within the casemix model to ensure that the resource requirements for such cases are fairly determined.