Transcript Data Quality

Data Quality
HRG4 & Payment by
Results Roadshow
2009
Outline
•
•
•
Introductions and welcome
Data Quality – What is it and why is it important?
Impact of Data Quality
– Impact on HRG4 and grouping process (NHS IC)
– Lessons to be learnt from audits to drive improvement (AC)
– Key Coding/Classification issues – preventing poor coding and
ensuring data is of good quality. (CFH)
•
•
•
Summary & Key messages
Issues to consider
Q&A
Data Quality Workshop HRG4 Roadshow 2009
The dimensions of data quality
Accuracy
Completeness
Validity
Data Quality
Relevance
Reliability
Timeliness
Data Quality Workshop HRG4 Roadshow 2009
The importance of data quality to
the NHS
• Next Stage Review (Darzi)
–
–
–
–
Quality measurement and indicators
Enabling and empowering choice
Greater accountability – Quality Accounts
Payment for Quality – CQUIN, Advancing Quality Programme (NHS NW)
• Hospital funding under PbR
• World Class Commissioning
• PBC
• Regulation
• Can contribute to poor quality of care (which may have
tragic consequences)
Data Quality Workshop HRG4 Roadshow 2009
DQ Quotes: NHS IC DQ Programme
• Somebody, somewhere has already solved this problem – if
only we knew where to look
• We don’t actually turn up every morning planning to create
bad data
• Telling people off doesn’t improve data quality
• It’s no good just telling us we have 5% errors – we need to
know what the errors are so we can fix them
• People don’t realise that bad data is bad for patient care, bad
for income, and bad for reputation
• Most of the problems occur in gaps – between systems,
organisations, programmes, standards, responsibility…
Data Quality Workshop HRG4 Roadshow 2009
Impact of Data Quality
• HRG4 & grouping
• Issues identified from PbR data assurance audits
and impact on payment
• Coding accuracy
Data Quality Workshop HRG4 Roadshow 2009
You and Your U HRG
Identifying and resolving U HRGs
What are the error types and why are they
generated?
UZ01Z – Data invalid for grouping
Error Types
UZ01 - Invalid Diagnosis
UZ02 - Poorly Coded Primary Diagnosis
UZ03 - Age Conflicting with Diagnosis
UZ04 - Diagnosis conflicting with anatomical sites
UZ05 - Invalid Procedures
UZ06 - Poorly Coded Procedures
How to identify the U HRGs
Local Payment HRG Output File
The FCE HRG
The Spell HRG
How to identify the Error Types
Local Payment HRG Data Quality Report
Steps for resolving U HRGs
Ensure the episode contains a valid primary
(ICD-10) diagnosis and/or procedure
(OPCS-4) codes.
If the ICD-10/OPCS-4 codes are valid codes
then examine whether the U HRG being
generated is due to the lack of information
available to the clinical coding teams.
Need for completeness of data
Non trauma primary diagnosis
CASE A
W58.1 Primary resurfacing arthroplasty of joint
HRG: HB99Z Other procedure for non Trauma
*Tariff: £493
CASE B
W58.1 Primary resurfacing arthroplasty of joint
Z84.6 Knee joint
HRG: HB23C Intermediate Knee Procedures for non Trauma without CC
*Tariff: £3077
(*Department of Health, 2009-10 national mandatory tariffs, Elective spell tariff)
Summary
• Correct assignment of HRGs is dependent
on the accuracy and completeness of the
coded clinical data.
• If the grouper encounters an invalid or
poorly coded primary diagnoses or an
invalid or poorly coded procedure, the
grouper will report a U HRG for both the
Consultant Episode and the Spell.
• Details of which error(s) have been
generated can be found in the quality
report.
Further information
• www.ic.nhs.uk/casemix/prepare
– Introduction to HRG4
– HRG4 Concepts
– HRG Coding Validation
– HRG4 Chapter Summaries Definitions
Comparative Analysis
– HRG4 Code to Group [what goes where and
how]
– Guide to Data Field validation
– Top 10 Tips / FAQs
PbR Data
Assurance
Driving improvements
through audit and
benchmarking
Coding errors (Qs 1-3 2008/09)
Percentage of Secondary Procedures Recorded Incorrectly
Percentage of Primary Procedures Recorded Incorrectly
50%
50%
45%
45%
40%
40%
35%
35%
30%
30%
25%
25%
20%
17.0%
27.4%
20%
15%
15%
10%
10%
7.0%
6.0%
5%
5%
0%
0%
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Trust value 2008/2009
Percentage of Primary Diagnoses Recorded Incorrectly
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Percentage of Secondary Diagnoses Recorded Incorrectly
50%
50%
45%
45%
40%
40%
35%
35%
30%
30%
25.5%
25%
21.0%
20%
25%
20%
15%
15%
10%
8.0%
5%
8.4%
10%
5%
0%
0%
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Data Quality Workshop HRG4 Roadshow 2009
Trust Value 2008/2009
National Upper Quartile 2007/2008
National Low er Quartile 2007/2008
Individual trust comparison
40%
30%
20%
10%
0%
HRG errors 2007/08
Data Quality Workshop HRG4 Roadshow 2009
10%
HRG errors 2008/09
20%
30%
40%
Data Quality Workshop HRG4 Roadshow 2009
0%
40%
Issue
CC department
structure
50%
Area not coded by
coding staff or to
national standards
60%
Not following coding
manual or data quality
review
70%
Software affecting
coding
80%
Data definitions
90%
Accredited/experienced
clinical coders
Staffing vacancies and
levels
No or limited clinician
involvement
Coding of comorbidities
Lack of
internal/external audit
Policy and procedure
documents
Training
Poor source
documentation
Percentage of trusts
Issues affecting the quality of
coding data
100%
Areas for improvement
•Quality of documentation
•Coding arrangements
•Clinician involvement
•Coding co-morbidities
30%
20%
10%
Specialty findings
Code
Name
FCEs
0809
% HRG
Error
0809
% HRG
Error
0708
Change
Rank
0809
Rank
0708
410
Rheumatology
118
22.0%
45.9%
-23.9%
1
1
400
Neurology
214
18.2%
1.4%
16.8%
2
36
302
Endocrinology
207
16.9%
1.1%
15.8%
3
-
180
Accident & Emergency
1139
15.6%
12.9%
2.8%
4
11
430
Geriatric Medicine
760
12.5%
20.9%
-8.4%
5
5
340
Respiratory Medicine
583
10.8%
13.4%
-2.6%
6
9
420
Paediatrics
1196
10.3%
11.2%
-0.9%
7
13
300
General Medicine
5984
9.7%
16.7%
-7.0%
8
7
370
Medical Oncology
219
8.7%
38.4%
-29.7%
9
2
424
Well Babies
231
7.8%
37.0%
-29.2%
10
-
Data Quality Workshop HRG4 Roadshow 2009
HRG Chapter findings
% HRG
Error
0809
% HRG
Error
0708
Chap
Chapter Title
FCEs
0809
S
Haematology, Infectious
diseases, Poisoning and
Non-Specific Groupings
2202
13.4%
13.4%
0.0%
1
5
A
Nervous System
1386
9.9%
12.0%
-2.2%
2
8
D
Respiratory System
1867
9.4%
20.1%
-10.7%
3
1
J
Skin, Breast and Burns
1216
9.2%
15.0%
-5.8%
4
3
H
Musculoskeletal System
6424
8.3%
12.3%
-4.0%
5
7
R
Spinal Surgery and Primary
Spinal Conditions
611
7.5%
11.5%
-3.9%
6
10
E
Cardiac Surgery and
Primary Cardiac Condition
2843
7.3%
9.1%
-1.8%
7
14
F
Digestive System
4364
7.3%
11.4%
-4.1%
8
11
K
Endocrine and Metabolic
System
462
7.1%
11.9%
-4.8%
9
9
P
Diseases of Childhood
1432
7.1%
9.2%
-2.1%
10
13
Data Quality Workshop HRG4 Roadshow 2009
Change
Rank
0809
Rank
0708
HRG findings
FCEs
0809
% HRG
Error
0809
% HRG
Error
0708
Change
Rank
0809
Rank
0708
HRG
HRG Label
A24
Cranial Nerve Disorders
39
74.4%
30.8%
43.6%
1
-
S33
Examination, Follow up and
Special Screening
215
46.5%
31.6%
14.9%
2
31
S31
Admission for Unexplained
Symptons
139
36.0%
37.0%
-1.0%
3
19
H28
Non-Inflammatory Bone or Joint
Disorders <70 w/o cc
39
35.9%
32.1%
3.8%
4
29
F18
Stomach or Duodenum Disorders
<70 w/o cc
74
35.1%
19.8%
15.4%
5
95
H27
Non-Inflammatory Bone or Joint
Disorders >69 or w cc
75
30.7%
37.7%
-7.0%
6
17
H85
Intracapsular Neck of Femur
Fracture with Fixation w/o cc
36
30.6%
33.3%
-2.8%
7
24
H89
Other Neck of Femur Fracture w/o
cc
37
29.7%
42.6%
-12.8%
8
9
H63
Head Injury >69 or w cc
34
29.4%
20.7%
8.7%
9
84
H08
Joint Replacements or Revisions,
Site Unspecified
24
29.2%
15.0%
14.2%
10
150
Data Quality Workshop HRG4 Roadshow 2009
Error example 1
Data Quality Workshop HRG4 Roadshow 2009
Error example 2
Data Quality Workshop HRG4 Roadshow 2009
Error example 3
Data Quality Workshop HRG4 Roadshow 2009
Supporting Improvement:
benchmarking case studies
Produced an overall assessment of our coding
accuracy to provide assurance to the board
Director of Finance & Performance (trust)
Identified high level of activity in one HRG –
trust had started recording outpatient test as
day case
Information Development Manager (PCT)
Used regularly to investigate outlying
specialties – identified area where EPR did not
provide enough information for coding
Service Line Reporting Accountant (trust)
Identified sudden increase in activity in
outpatients as trust changed their way of
counting
Deputy Director of Commissioning (PCT)
Data Quality Workshop HRG4 Roadshow 2009
Summary
• Coding accuracy still undermining data quality
• Consistent issues affecting quality of coding
• Variability on Specialty and Chapter
• Direction of travel for HRG errors is positive
• Coding accuracy impacts HRGs price charged by a
trust
Data Quality Workshop HRG4 Roadshow 2009
Supporting Data Quality
Hazel Brear
Principal Cross-mapping Specialist
NHS Classifications Service
NHS Connecting For Health
March 2009
Priorities
Maintenance & Development of the NHS
Information Standards – ICD-10 & OPCS-4
Quality source documentation
Adherence to National Standards
Dimensions of coding accuracy
Training and accreditation.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Documentation and Clinician Involvement
Improve the quality of source documentation
Utilise best practice
Engage clinicians – in partnership with coding
professionals.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Essential Roles in the Provision of Coded
Information
The Clinician provides the information from
which to code the patient’s diagnosis and
treatment
The Clinical Coder translates that information
into the appropriate coded format to reflect the
patient’s hospital stay.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
The Three Dimensions of Accuracy
Individual codes
Sequencing
Totality
Training and Accreditation
Training and development of coders has a
positive impact on limiting coding errors
Invest in and develop your coding departments
Support coder education and training.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Training and Accreditation
NHS Classification Service – Clinical Coding:
Training and accreditation
Training Service
Delivery
(training & materials)
Development
(training & materials
E-learning)
Train-the-trainer programme
Cascade national standard
Training materials
Accreditation
National Clinical Coding
Qualification (UK) Delivery
National Clinical Coding
Qualification (UK)
Development
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Collaborative Working
PbR Data Assurance Framework
Clinical Coding Working Group
Data Definitions Working Group
Stakeholder Groups
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Summary
We all have a responsibility for data quality
National Clinical Coding Standards are crucial to
ensure accurate, consistent and comparable
information
Encourage partnerships between clinical and coding
professionals
Support the training and accreditation of coders.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Figures you can trust: Improving wider
data quality to meet future need
• Leadership
• Clinician engagement
• Board assurance processes
• External monitoring and review
• Support
Data Quality Workshop HRG4 Roadshow 2009
The NHS IC Data Quality
Programme: Vision
Improve the quality of data throughout the NHS
and Social Care by:
• Raising awareness about the impact of data
quality
• Helping data suppliers to improve data quality
• Providing data suppliers and data users with a
data quality grading scheme.
Data Quality Workshop HRG4 Roadshow 2009
Summary & Key messages
• Coding errors impact on HRG assignment and
therefore payment under PbR
• Inaccurate and incomplete data leads to assignment
of u codes in HRG4
• Improving clinician engagement, source
documentation and training will improve coding
accuracy
• Data quality needs to be improved in the wider
context in trusts
Data Quality Workshop HRG4 Roadshow 2009
Key issues
• In tables, identify what your key issues are around
improving the accuracy of coding and wider data
quality
• Feedback your main issues
Data Quality Workshop HRG4 Roadshow 2009
Further information
• www.ic.nhs/casemix/prepare
– Introduction to HRG4
– HRG4 Concepts
– HRG Coding Validation
– HRG4 Chapter Summaries Definitions
Comparative Analysis
– HRG4 Code to Group [what goes where and
how]
– Guide to Data Field validation
– Top 10 Tips / FAQs
Useful Contacts
For clinical coding queries, classification training
products, course bookings and enquiries contact:
www.cfh.nhs.uk/clinicalcoding
[email protected]
For OPCS requests for change
www.cfh.nhs.uk/opcsrequestsportal
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
For more information…
www.audit-commission.gov.uk/pbr