1. Research project on explicit quality adjustments of the volume indicator for hospitals
Aksel Juel Clemmensen
TF price and volume measures October, Luxemburg

2. Content The volume indicator for hospitals The research project so far
Treatment specific quality adjustment
General quality adjustment of patient treatments
General quality adjustment of the volume indicator for hospitals, the results

3. The volume indicator for hospitals
Today, the volume indicator for hospitals is calculated based on the DRGs and DRGs cost weights to measure volumes for both ambulatory (outpatient) and stationary (inpatient) treatments at general hospitals and psychiatric hospitals.
DRG’s are used for budgeting and, particularly, as a tool for developing new methods of premises planning and management in administration and hospitals.
The DRG system includes a large number of categories (about 1,300) where each category denotes a rather homogenous service.
Hereby, unit costs and volume indexes can be constructed at the most detailed level.

4. The research project so far
Reading literature relevant for the project
Meeting with the ministry of health (The Danish Health Data Authority)
Analyzed and selected/used variables from the Danish Health Data Authority’s databanks for quality adjustment
Meetings with The Danish Clinical Registries (RKKP), there constitute the infrastructure of National Clinical Quality Databases, and the directors of several of the databases
Participating in national clinical audits annual conference, to present the project.
Meeting with doctors from several of the quality databases

5. The research project so far - Treatment specific quality adjustment
Data from the Danish Clinical Registries (RKKP)
Quality adjustment, based on the type of disease/DRG
A corporation with the clinicians and health researchers in determine the quality of the DRG treatments
The databases containing information about the patient treatments for the individual patients, used for improvement of quality, research and surveillance purposes.
Construct a quality function based on a weighted index for quality of specific DRG treatments (quality indicator) and control variables for lifestyle and age. The data used to construct is from the RKKP databases.

6. The research project so far - Treatment specific quality adjustment
The Construction of the quality function :
Calculation of control variables for lifestyle and age by OLS Regression
The quality function
The volume indicator with explicit quality adjustment

7. The research project so far - The general quality adjustment
Based on the databank eSundhed, managed by the Ministry of Health, covering all Danish citizens hospital treatments, following has been accomplished:
Studied and chosen the most relevant variables from the databank, in order to calculate general quality adjustment of patient treatments.
Build a production system for calculating the volume indicator for hospitals with explicit quality adjustment.
Calculated the volume indicator for hospitals adjusted for the following:
Patients, who died during patient treatments/hospitalization.
The patient treatment, prior to the re-operation/readmission within 30 days
A quality adjusted volume indicator for hospitals for the years 2015 and 2016 is now ready to be applied in the annual national accounts production system.

8. General quality adjustment of the volume indicator for hospitals, the results
Note: The volume indicator for hospitals includes all in- and out-patient treatments at general hospitals and psychiatric hospitals. In-patient treatments are adjusted for death and re-operations, out-patient treatments are adjusted for death, in the quality adjusted volume indicator. The psychiatric in- and out-patient treatments are not quality adjusted.

9. The volume indicator for inpatient/hospitalized treatments

10. The P.P. effect of quality adjustment of inpatient/hospitalized treatments

11. The volume indicator for outpatient treatments

12. The P.P. effect of quality adjustment