Introduction to HRG4 Reference Cost Grouper Presented by Chris Knee Senior Information Analyst and Peter Broughton Senior Casemix Consultant

Contents of this Session  Presentation on using the HRG4 Reference Cost Grouper  Demonstration of the key features of the HRG4 Reference Cost Grouper

Using the HRG4 Reference Cost Grouper Chris Knee Senior Information Analyst

Presentation Overview  What’s New  Data Preparation Required  Input Data  Output Data  Summary  Grouper Demonstration

What’s 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

What’s New – Part 2 Enhanced Data Validation  Mandatory fields validated before grouping (document –  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

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

Data Preparation – Part 2 Non-Admitted Patients  Sorting  No sorting required  Derived Items  Age at Attendance Date is required

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

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

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

Output Files There are three Output Files 1.Main Output File 2.Error Report 3.Report File (replaces Report Generator)

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

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

Example Error Types  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 Years

Summary  What’s New  Input Data (including data preparation)  Output Data  Questions?

HRG4 Reference Cost Grouper Demonstration Peter Broughton Senior Casemix Consultant

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

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)

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

Emergency and Urgent Care  Uses A&E data  HRGs are based on Investigation and Treatment codes  There are 11 HRGs

HRG4 Reference Cost Grouper Timetable 2007  1 April: HRG4 Grouper NHS UAT ends  20 April: HRG4 Grouper for Ref Costs released  1 March: HRG4 Grouper NHS UAT starts  19 March: HRG4 Grouper documentation: overview, benefits, definitions, coding guidance  1 May: Dedicated Casemix helpdesk & triage commences  8 May: HRG4 trimpoints issued to NHS [FCE & Spells]  16 May: SHA/Nominated RC lead grouper training

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)

Questions