Data Quality HRG4 & Payment by Results Roadshow 2009

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

The dimensions of data quality

Completeness

Relevance

Timeliness

Reliability

Validity

Accuracy

Data Quality

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)

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…

Impact of Data Quality

• HRG4 & grouping• Issues identified from PbR data assurance audits and impact on payment

• Coding accuracy

You and Your U HRG Identifying and resolving U HRGs

What are the error types and why are they generated?

Error TypesUZ01 - 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

UZ01Z – Data invalid for grouping

How to identify the U HRGs

The FCE HRG The Spell HRG

Local Payment HRG Output File

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 AW58.1 Primary resurfacing arthroplasty of joint

HRG: HB99Z Other procedure for non Trauma*Tariff: £493

CASE BW58.1 Primary resurfacing arthroplasty of jointZ84.6 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.

• 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

Further information

PbR Data AssuranceDriving improvementsthrough audit and benchmarking

Coding errors (Qs 1-3 2008/09)Percentage of Primary Procedures Recorded Incorrectly

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Trust Value 2008/2009 National Upper Quartile 2007/2008 National Low er Quartile 2007/2008

17.0%

6.0%

Percentage of Secondary Procedures Recorded Incorrectly

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Trust value 2008/2009 National Upper Quartile 2007/2008 National Low er Quartile 2007/2008

27.4%

7.0%

Percentage of Primary Diagnoses Recorded Incorrectly

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


21.0%

8.0%

Percentage of Secondary Diagnoses Recorded Incorrectly

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


25.5%

8.4%

Individual trust comparison

40% 30% 20% 10% 0% 10% 20% 30% 40%

HRG errors 2007/08 HRG errors 2008/09

Issues affecting the quality of coding data

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Accre

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Areas for improvement•Quality of documentation•Coding arrangements•Clinician involvement •Coding co-morbidities

Specialty findings

Code NameFCEs0809

% HRGError0809

% HRGError0708 Change

Rank0809

Rank0708

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 -

HRG Chapter findings

Chap Chapter TitleFCEs 0809

% HRG Error 0809

% HRGError0708 Change

Rank0809

Rank0708

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

RSpinal Surgery and Primary Spinal Conditions 611 7.5% 11.5% -3.9% 6 10

ECardiac 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

KEndocrine 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

HRG findings

HRG HRG LabelFCEs 0809

% HRGError0809

% HRG Error0708 Change

Rank0809

Rank0708

A24 Cranial Nerve Disorders 39 74.4% 30.8% 43.6% 1 -

S33Examination, Follow up and Special Screening 215 46.5% 31.6% 14.9% 2 31

S31Admission for Unexplained Symptons 139 36.0% 37.0% -1.0% 3 19

H28Non-Inflammatory Bone or Joint Disorders <70 w/o cc 39 35.9% 32.1% 3.8% 4 29

F18Stomach or Duodenum Disorders <70 w/o cc 74 35.1% 19.8% 15.4% 5 95

H27Non-Inflammatory Bone or Joint Disorders >69 or w cc 75 30.7% 37.7% -7.0% 6 17

H85Intracapsular Neck of Femur Fracture with Fixation w/o cc 36 30.6% 33.3% -2.8% 7 24

H89Other 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

H08Joint Replacements or Revisions, Site Unspecified 24 29.2% 15.0% 14.2% 10 150

Error example 1

Error example 2

Err

or

exam

ple

3

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)

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

Supporting Data Quality

Hazel BrearPrincipal Cross-mapping SpecialistNHS Classifications ServiceNHS 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.


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 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.


Training and Accreditation


NHS Classification Service – Clinical Coding: Training and accreditation

NHS Classification Service – Clinical Coding: Training and accreditation

Training ServiceTraining Service AccreditationAccreditation

Delivery (training & materials)

Delivery (training & materials)

Development(training & materials

E-learning)

Development(training & materials

E-learning)

National Clinical Coding Qualification (UK) DeliveryNational Clinical Coding

Qualification (UK) Delivery

National Clinical Coding Qualification (UK)

Development

National Clinical Coding Qualification (UK)

DevelopmentTrain-the-trainer programmeCascade national standard

Training materials

Train-the-trainer programmeCascade national standard

Training materials

Collaborative Working

PbR Data Assurance Framework

Clinical Coding Working Group

Data Definitions Working Group

Stakeholder Groups


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.


Figures you can trust: Improving wider data quality to meet future need

• Leadership• Clinician engagement• Board assurance processes• External monitoring and review• Support

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.

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

Key issues

• In tables, identify what your key issues are around improving the accuracy of coding and wider data quality

• Feedback your main issues

• 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

Further information

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


http://www.cfh.nhs.uk/clinicalcoding

mailto:[email protected]

http://www.cfh.nhs.uk/opcsrequestsportal

For more information…

www.audit-commission.gov.uk/pbr

Documents

Data Quality HRG4 & Payment by Results Roadshow 2009