Introduction to HRG4 Reference Cost Grouper

1
Introduction to HRG4 Reference Cost Grouper

• Presented by
• Chris Knee Senior Information Analyst and Peter
  Broughton Senior Casemix Consultant

2
Contents of this Session

• Presentation on using the HRG4 Reference Cost
  Grouper
• Demonstration of the key features of the HRG4
  Reference Cost Grouper

3
Using the HRG4 Reference Cost Grouper

• Chris Knee
• Senior Information Analyst

4
Presentation Overview

• Whats New
• Data Preparation Required
• Input Data
• Output Data
• Summary
• Grouper Demonstration

5
Whats New Part 1

• 3 in 1 - Report Generator and Spell Converter now
  integrated with the Grouper
• The Grouper processes Spells and Episodes
• User selects Trim Point Data
• Unbundling potential for output to contain more
  than one HRG per Episode and Spell
• New code structure e.g. AA01Z not A01
• Additional datasets can be processed
  e.g. Out-patient Attendance

6
Whats New Part 2

• Enhanced Data Validation
• Mandatory fields validated before grouping
  (document www.ic.nhs.uk/casemix/prepare)
• Internal consistency checked during grouping
• Any identified errors are grouped to HRG UZ01Z
  Data Invalid for Grouping
• An error report is produced on run completion
• For APC, if one of the Episode HRGs in a Spell is
  UZ01Z, then the Spell HRG is UZ01Z

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Data Preparation Part 1

• Admitted Patient Care
• Sorting
• The Input File must be sorted by Hospital
  Provider Spell Number and then by Episode Number
• Derived Items
• Age at Episode Start is required
• Episode Duration
• Critical Care days need to be removed from
  Episode Duration (as in previous years)
• Episode Duration should not be negative

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Data Preparation Part 2

• Non-Admitted Patients
• Sorting
• No sorting required
• Derived Items
• Age at Attendance Date is required

9
Input Data Files Part 1

• Six datasets can be processed by the Grouper
• Admitted Patient Care
• Out-patient Attendance
• Accident Emergency
• Adult Critical Care
• Paediatric Critical Care
• Neonatal Critical Care

10
Input Data Files - Part 2

• As with previous Grouper
• Two file formats can be processed
• CSV (Comma separated values)
• Fixed Width
• For APC, input files must be at Episode level not
  Spell level
• There are a number of mandatory fields specified
  in the Record Definition File

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Record Definition File

• As with the previous Grouper
• The RDF tells the HRG Grouper where the mandatory
  fields are located within the Input File
• The Grouper requires one RDF to be defined for
  each input dataset
• The Grouper is supplied with sample RDFs
• Users can define their own RDFs

12
Output Files

• There are three Output Files
• Main Output File
• Error Report
• Report File (replaces Report Generator)

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Main Output File

• Included within the Main File are
• Original input data
• Grouper derived fields
• Spell HRG (repeated for each Episode)
• Spell Dominant Procedure
• Spell Primary Diagnosis
• Episode HRG
• Episode Dominant Procedure
• 0 or more Unbundled HRGs
• Episode Trim Point
• Episode Excess Bed Days
• Programme Budget Code
• Note Episodes assigned to UZ01Z are also
  included

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Error Report File

• Provides additional information for records in
  the Main Output File grouped to UZ01Z Data
  Invalid for Grouping
• Report shows ALL errors for each record grouped
  to UZ01Z
• Each record in the Error Report File will have a
  code and description of the error

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Example Error Types
www.ic.nhs.uk/casemix/prepare

• Invalid Primary Diagnosis
• Diagnosis does not exist / Not valid in primary
  position
• Poorly Coded Primary Diagnosis
• Diagnosis exists and is valid but too unspecific
  to determine resource use and group
• Age Conflicting with Diagnosis
• E.g. Complications of pregnancy in a 5-year old
  child
• Invalid Primary Procedure
• Procedure does not exist / Not valid in primary
  position
• Poorly Coded Primary Procedure
• Procedure exists and is valid but too unspecific
  to determine resource use and group
• Age Outside Range 0 - 130 Years

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Summary

• Whats New
• Input Data (including data preparation)
• Output Data
• Questions?

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HRG4 Reference Cost Grouper Demonstration

• Peter Broughton
• Senior Casemix Consultant

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Contents of Presentation

• Pre-release software issues
• Creating a Record Definition File
• Single spell grouping
• A selection of file grouping scenarios

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Multiple Trauma Review

• Trauma means non-superficial injury (e.g. broken
  limb bone)
• Requirements
• In the first episode of the spell
• Primary diagnosis of trauma
• Another diagnosis of trauma from a different
  trauma site (body is divided into nine areas)

Diag1 (trauma) Diag2 (non-trauma) Diag3 (trauma)
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Non-Admitted Care

• HRG allocation is based on OPCS code
• E.g. Procedure H28.9 (Rigid Sigmoidoscopy)
  produces HRG FB03A Endoscopic or intermediate
  large intestinal procedures 19 years and over
• If no OPCS code, then HRG is WF01Z Non-Admitted
  Attendance
• Multi-professional clinics identified by OPCS
  code X62.2 and X62.3 (HRG is WF02Z)
• Diagnosis is ignored
• Where APC HRG is based on procedure, then the
  Non-Admitted HRG will be the same for the same
  procedure(s) i.e. setting-independent
• Where the APC HRG is influenced by diagnosis, the
  non-admitted HRG will be different

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Emergency and Urgent Care

• Uses AE data
• HRGs are based on Investigation and Treatment
  codes
• There are 11 HRGs

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HRG4 Reference Cost Grouper Timetable 2007

• 1 March HRG4 Grouper NHS UAT starts
• 19 March HRG4 Grouper documentation overview,
  benefits, definitions, coding guidance

• 1 April HRG4 Grouper NHS UAT ends
• 20 April HRG4 Grouper for Ref Costs released

• 1 May Dedicated Casemix helpdesk triage
  commences
• 8 May HRG4 trimpoints issued to NHS FCE
  Spells
• 16 May SHA/Nominated RC lead grouper training

23
Summary

• Covered in this presentation
• Creation of a user-defined Record Definition File
• Grouping a single spell
• Processing of different data sets, requiring the
  use of different Record Definition Files
• A variety of HRG types (APC, Non-Admitted,
  Unbundling, CC, Splits, Multiple Trauma)

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• Questions