HRG4 Design and Clinical Engagement

1
HRG4 Design and Clinical Engagement

• Dr. N.K.Griffin
• Consultant Paediatrician
• Northampton General Hospital
• Part time secondment to HSCIC

2
PbRs requirements of HRGs

• Encourage patient choice
• Provide care in different settings
• Recognise legitimate variations in costs
• Improve performance
• Capable of development in line with PbR expansion

3
How we Developed HRG4

• Requirements from PbR and NHS
• The Design Team
• Design Rules Framework
• The intention
• The expectation
• The implementation

4
Key design rules

• Consistent style and editorial approach across
  chapters
• gt600 cases or gt1.5m per annum
• Limited variance
• Setting independence
• Unbundled elements form separate, additional HRG

5
Steering Group

• Steering Group managed the process
• Ensured compliance with the Design Framework
• 33 Expert working Groups, predominantly
  clinicians, with Casemix support

6
HRG4 Development process

• Overall control by Steering Group
• 33 Expert Working Groups
• 4 Expert Reference Panels
• Cancer
• Children's Services
• Specialised services
• Chronic disabling disease

7
How we Developed HRG4

• The Steering Group task force
• Pilot studies
• Changing datasets
• OPCS 4.3 Effective April 2006
• 25 increase in codes
• Reflecting modern practise
• Non-operative interventions

8
HRG4

• Conform to Design Framework to ensure consistency
  across chapters
• Improved statistical performance
• Extend coverage of HRGs
• Reflect current clinical practice

9
HRG4

• Based on
• Routinely available data
• Spells not FCEs
• Resources not LoS
• OPCS4.3 intervention codes
• Complications/co-morbidities
• Age splits
• Unbundling
• Increase from 19 to 29 Chapters

10
The results

• Better reflection of cost
• Greater clinical relevance
• Unbundling to give better setting-independent
  costing
• Age-specific costing
• Greater complexity
• Untried and untested

11
Childrens Services

• Children are treated in practically every
  specialty
• ICD/OPCS Codes may not reflect very different
  styles or cost of treatment
• Recognise different child/adult costs
• Attempt to separate child from adult HRGs
• Need for a consistent age split
• Similar issues for the elderly

12
Clinical Involvement

• Clinician chaired Design Team and member of
  Steering Group
• 283 clinicians were members of EWGs
• 51 Colleges and Professional Associations
  represented
• Practising doctors, nurses and AHPs released by
  their trusts

13
The Clinicians

• Represented a Royal College or Professional
  Association
• Relevant knowledge and experience
• Understand the process and purpose
• Supported but not paid
• Travel and expenses
• Administrative and secretarial

14
Why every trust needs their clinicians involved

• To ensure accurate coding and optimise HRG
  classification
• To help develop meaningful reference costs
• They need ownership to accept and use the data
• To help you interpret variations from the norm

15
How to get your clinicians involved the simple
answers

• Threats of violence
• Bribery
• Coercion
• Blackmail
• Promises of fame and fortune

16
How to get your clinicians involved the
difficult answers

• Make it interesting
• Make it relevant
• Make it easy
• Make it useful
• Provide the resources
• Make time available

17
How to get your clinicians involved the real
answers

• Respect their opinions
• Recognise their different agenda
• Accept that they have useful knowledge and
  experience
• Identify the champions
• Justify your views
• Use the product honestly and wisely
• Reward involvement with clinical benefits

18

• ANY QUESTIONS?