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ABF Data Quality
What a Change in 2 years! – Clinical Coding11th May 2017
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ABF DRG Complexity Level 2014 v 2016 (excl Z DRGs)
2
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
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Hosp A - DRG Complexity Level 2014 v 2016 (excl Z DRGs)
3
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
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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
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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
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DRG Complexity Level 2014 v 2016 –E75 Other Respiratory System Diagnosis
6
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
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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.
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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
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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
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Hospital Use of Checker Tool
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Data Quality Strategy
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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!
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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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