abf data quality - hpo · 2017. 5. 23. · national sepsis programme • in order to optimize the...

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ABF Data Quality

What a Change in 2 years! – Clinical Coding11th May 2017

ABF DRG Complexity Level 2014 v 2016 (excl Z DRGs)

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13.3%

46.2%

5.6%

0.8%

14.5%

46.0%

6.0%

0.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

A B C D

ABF 2014

ABF 2016

Hosp A - DRG Complexity Level 2014 v 2016 (excl Z DRGs)

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10.4%

58.4%

6.5%

0.6%

15.3%

53.6%

5.5%

0.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

A B C D

Hosp A 2014

Hosp A 2016

What a change in 2 years!% of B70 Stroke & Oth Cerebral disorders cases in A complexity (2014-2016)

0%

5%

10%

15%

20%

25%

30%

Hosp A ABF hosps ave Highest Dublin teaching hosp

2014

2016

5

0

1000

2000

3000

4000

5000

6000

7000

2015 2016 2017

58806068

1538

469 450

147

I64 Stroke; not

specified as

haemorrhage or

infarction

I63 Cerebral

infarction

What a change in 2 years!

Specificity of codes for stroke 2015-2017

DRG Complexity Level 2014 v 2016 –E75 Other Respiratory System Diagnosis

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12.3%

37.2%

50.5%

14.6%

34.1%

51.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

A B C

2014

2016

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National Sepsis Programme

Source: National Sepsis Outcome Report 2016

0

500

1000

1500

2000

2500

2015 2016 2017

What a change in 2 years!

No. of Discharges with SIRS (R65) as any Dx (2015-2017)

• Systemic

Inflammatory

Response

Syndrome

(SIRS) (R65).

• New code in

2015

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HADx

Hospital Acquired Diagnosis

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

2012 2013 2014 2015 2016

Percentage of in-patient discharges with any HADx flag,

2012-2016

Note on Australian data: “For hospitals reporting the COF, an estimated 10% of episodes have at least one

hospital-acquired diagnosis reported”

Source: Health Policy Analysis 2013, Analysis of hospital-acquired diagnoses and their effect on case complexity

and resource use – Final report, Australian Commission on Safety and Quality in Health Care, Sydney.

Audit resultsPavilion Audits 2015 HPO Audits 2016-17

AR DRG Profile

Original

Coding

%

Audit Coding

%

Original

Coding

%

Audit Coding

%

A 15.5 16.5 12.6 13.6

B 44.5 43.5 44.5 44.8

C 8.1 8.2 11.8 11.5

D 0.5 0.4 1.3 1.1

Z 31.4 31.5 29.8 29.0

TOTAL 100.0 100.0 100.0 100.0

Data Quality Tools

Level Data Quality Tool Description

1 Data Entry level Data entry edits built into HIPE portal

2 Checker© HPO tool to check data against a set of 160 checks

3 HCAT© HPO tool for Chart based audit

4 HIPE Reporter Review/interrogate HIPE data

5 Benchmark reports Qlikview tool to analyse ABF data – activity & cost data

Hospital Use of Checker Tool

Data Quality Strategy

The HPO acknowledges the data quality work

undertaken by Hospitals

A joint effort between the clinician and clinical coder is

essential to achieve complete and accurate

documentation, code assignment, and reporting of

diagnoses and procedures.

Source: Australian Coding Standards, NCCH ICD-10-AM, July 2004, July 2008 & July 2013, Volume 5, P.1.

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Changes in 2 years!

Working together to improve data

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HIPE Data

Working together to improve data

Changes in 2 years!

Changes in 2 years

• Clinicians & the wider system– Using, reviewing and presenting HIPE Data

– Linking in with HIPE coders & HPO team

– Increased engagement with HIPE system

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• College of Anaesthetists of Ireland

• National Sepsis Programme

• National Stroke Programme

• National COPD and Pneumonia Programme

• National Critical Care Programme

• NOCA – NAHM

• NOCA – Irish Hip Fracture Database

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College of Anaesthetists of Ireland

Annual report on the

quality of ASA score

recording captured in

HIPE.

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College of Anaesthetists of Ireland

• A steady reduction in the number of

anaesthetic record sheets presented to HIPE

where no ASA status was indicated (ASA 9)

• Corresponding increase in the number of ASA 2

and ASA 3

• 27% of anaesthetic record sheets still do not

indicate the patient ASA status.

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College of Anaesthetists of Ireland

Source: NCPA/HPO Annual Report 2014 & 2015

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National Sepsis Programme

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National Sepsis Programme

Source: National Sepsis Outcome Report 2016

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National Sepsis Programme

Source: National Sepsis Outcome Report 2016

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National Sepsis Programme

• In order to optimize the quality of data, seven sepsis workshops for coders

were held and more than 95% of clinical coders attended.

• These workshops introduced the sepsis screening forms, included a sepsis

education presentation and had robust question and answer sessions.

• Coders can code off this form when used and signed by the treating doctor.

Using these forms facilitates documentation and optimises data quality.

• Further questions were invited by email and addressed in the form of a

feedback report to participants.

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National Sepsis Programme

“The challenges for Systemic

Inflammatory Response Syndrome

(SIRS) & Sepsis data capture and

reporting in ICD-10-AM in HIPE in

Ireland.”

Best Poster Prize Award at the 32nd

Annual PCSI Conference in Dublin ,

October 2016

Healthcare Pricing Office, Dublin,

Ireland and National Sepsis Programme

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National Stroke Programme

“The Register encourages

communication between stroke

teams and those who code the

main Hospital Inpatient Enquiry

(HIPE) data set.”

Source: Report on the National Stroke

Register 2015. p 4

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National Stroke Programme

Clinical coder education from the National Stroke

Programme

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National COPD and Pneumonia Programme

• Meetings with the national programme on coding of

COPD and Pneumonia

• Clinician Training for coders on:• COPD

• Asthma

• Influenza

• Pneumonia

• Upper Respiratory tract

infections Lower Respiratory

tract infections

• Lung diseases due to exposure

• external agents

• Pulmonary Oedema

• Pulmonary Effusion

• Pneumothorax

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National Critical Care Programme

• Meetings with the national programme

• Collaboration on NOCA ICU audit.

• Clinician Training for coders on:

• Types of Ventilatory

Support

• Invasive Ventilation

• Non-invasive Ventilation

• Ventilatory support

provided with anaesthesia

during surgery

• Weaning

• Abbreviations &

terminology

• Documentation

• Non-invasive Ventilation

versus Oxygen Therapy

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NOCA - NAHM

• HPO on Steering and

Governance committees

• Advise on HIPE data

• Act on Feedback on Data

quality

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NOCA - NAHM

“The strength of NAHM lies in its potential to help

hospitals understand the relationship between;

• the quality of data recorded in the patient

chart,

• the accuracy of its transcription to HIPE and

• how it can be used in conjunction with other

quality indicators to pinpoint potential

areas of concern.”Source: National Audit of Hospital Mortality Report. December 2016

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NOCA – Irish Hip Fracture Database

Source: Irish Hip Fracture Database. September 2016

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NOCA – Irish Hip Fracture Database

• Analysis is based on IHFD records as captured on

Hospital Inpatient Enquiry System (HIPE) Portal

software.

• Diagnosed with either a hip fracture due to injury

diagnosis on HIPE or a specified type of fracture,

other than periprosthetic,

• aged 60 years or older.

Source: Irish Hip Fracture Database. September 2016

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Retroperitoneal Lymph Node Dissection

(RPLND) for testicular cancer

• Working with NCCP

• Concerns over data

• Consultations with surgeons

• HPO responded

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RPLND for testicular cancer • Additional training for coders.

• Publishing a coding article in coder’s newsletter

• Introduction of an Irish Coding Standard (ICS

• Data entry edit where HIPE staff are queried when

a procedure code for RPLND is entered without a

diagnosis code of testicular cancer

• Implementation of a data quality check to

monitor use of these codes and that they are

being applied correctly.

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HPO Clinical Coding team always looking for

collaborations with clinicians!

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