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Journal of Neonatal Nursing (2006) 12, 200e202
www.intl.elsevierhealth.com/journals/jneo
GUEST EDITORIAL
Neonatal Critical Care Minimum Data Set(NCCMDS)
What’s the purpose of the NCCMDS?
The primary purpose of the NCCMDS is to allowoperation of the Payment by Results (PbR)commissioning arrangements within neonatalcritical care. NCCMDS supports PbR by capturingthe data need to assign a Healthcare ResourceGroup (HRG) to each patient.
PbR tariffs will be attached to the HRGs andproviders of neonatal critical care therefore needto record their activity within the NCCMDS in orderto be reimbursed for the cost of providing thecare. If the activity is not recorded, the providerwill not be paid.
Many commissioning arrangements for neonatalcritical care are already very similar to PbR andsome commissioners may choose to adopt theHRGs with locally set tariffs before the introduc-tion of PbR in this area.
As well as being used to drive the reimburse-ment process, data captured as part of NCCMDSwill be added to other data captured by theNHS and is expected to be used for a widerange of statistical analysis related to resourceusage.
What does NCCMDS cover?
The NCCMDS will go live on April 2007 and will bea mandatory data collection for:a) All patients on a Neonatal Intensive Care Unit
regardless of care being delivered.b) Patients on a Maternity Ward or Neonatal
Transitional Care Ward to whom one or moreof the following applies for a period greaterthan 4 h:
1355-1841/$ - see front matter ª 2006 Published by Elsevier Ltd odoi:10.1016/j.jnn.2006.09.010
- Respiratory support via a tracheal tube- Nasal Continuous Positive Airway Pressure
(nCPAP)- Exchange Transfusion- Peritoneal Dialysis- Continuous infusion of inotrope, vasodilator
or prostaglandin- Parentral Nutrition- Convulsions- Oxygen Therapy- Neonatal abstinence syndrome- Care of an intra-arterial catheter or chest
drain- Dilution Exchange Transfusion- Tracheostomy cared for by nursing staff- Tracheostomy cared for by external carer- Recurrent apnoea- Haemofiltration- Continuous monitoring- Intravenous glucose and electrolyte solutions- Tube-fed- Barrier nursed- Phototherapy- Special monitoring- Observations at regular intervals- Intravenous medication
As well as the interventions listed above,NCCMDS also includes:
- Surgery- Carer Resident e Caring for Baby- Gestation length at delivery- Weigh- High cost drugs
You can find a link to the full data set at the endof this article.
n behalf of Neonatal Nurses Association.
Guest Editorial 201
When should NCCMDS be collected?
NCCMDS should be captured daily. A data itemshould be recorded as ‘‘Yes’’ if the criterion wasmet that calendar day. For this reason, datacapture will be most straightforward if it takesplace close to or slightly after midnight each day.
Three examples to illustrate:a) If a patient received nCPAP during part of the
day then this should be recorded as ‘‘yes’’even if the patient is not on nCPAP at midnight,when the data capture takes place.
b) If a patient is put onto nCPAP at 23:50 in theevening then this should also be recorded as‘‘yes’’ even though it has only taken place10 min before midnight.
c) If a patient receives critical care during the daythen any activity should be recorded even ifthe patient is no longer there when the datacapture takes place.
How was NCCMDS developed?
NCCMDS and the related neonatal critical careHRGs nave been developed by the InformationCentre for health and social care under theguidance of an Expert Working Group (EWG) drawnfrom the NHS. The EWG was chaired by GaryHartoll, who is the clinical lead from Chelsea andWestminster Hospital and comprised:
What are the neonatal critical careHRGs?
The neonatal critical care HRGs are:- Intensive Care- High Dependency- Special Care without external carer- Special Care with external carer- Normal Care (only applies to babies in NICU)
The HRGs operate on a daily basis: a HRG isassigned each day depending on the highest levelof care received that calendar day.
These HRGs should be regarded as draft at themoment as they are still to be fully approved andadopted by the Department of Health/PbR.
What is the relationship to BAPM?
The HRGs and NCCMDS are closely related to theBAPM 2001 Levels of Care and the related BAPMdata set.
There are a few differences between BAPM andNCCMDS:
- NCCMDS introduces additional data items todefine Special Care.
- NCCMDS does not include the BAPM item‘‘any other very unstable baby consideredby the nurse-in-charge to need 1:1 nursing’’.The reason for this is simply that an itemsuch as this would be too subjective to base
Gary Hartnoll (Chair) Consultant Neonatologist, Chelsea and Westminster Healthcare NHS TrustIan Hughes (Project Manager) The Information CentreTony Ducker Consultant Neonatologist, Medway NHS TrustKathryn Blake Consultant Neonatologist, University Hospitals Coventry and Warwickshire
NHS TrustProfessor Sunil Sinha Consultant Neonatologist, South Tees University Hospital NHS TrustBen Shaw Consultant Neonatologist, Liverpool Women’s Hospital NHS Foundation TrustChristina Pollard Clinical Services Manager, Cambridge University Hospitals NHS Foundation
Trust and chair of the Neonatal Nurses AssociationAlan Fenton Consultant Neonatologist, Newcastle upon Tyne Hospitals NHS Foundation TrustNoel Durkin Department of Health, Children’s ServicesAndy Gill, Paul Smith Senior Casemix Consultants, The Information CentreSujit Kooner Costing Consultant, The Information CentreLiz Draper Perinatal Epidemiologist, Department of Health Sciences University of Leicester
The data set has been piloted at six trusts andthe experience of the pilot sites has beenincorporated into the user guidance whichaccompanies the data set.
a PbR reimbursement around. It is possiblethat additional data items will be introducedin future maintenance releases of NCCMDS tocapture some of the intensive care which
202 Guest Editorial
might be missed as a result of omitting thisdata item.
- NCCMDS does not include BAPM data itemswhich are not used in deriving HRGs. Thisdoes not mean that units can’t collect them.It just means that they aren’t part of NCCMDSand aren’t used to determine the HRG (Levelof Care).
Further information
The Information Centre’s Casemix service developsgroupings to describe procedures that are clini-cally similar and require similar levels of health-care resource.
Known as Healthcare Resource Groups (HRGs),these provide a way of standardising payments forNHS patient care so that trusts and other providerscan be rewarded transparently, fairly and equita-bly for the work they do.
HRGs support the Department of Health’s (DH)policy of Payment by Results (PbR). This rewardshealthcare providers according to the volume andcomplexity of procedures they carry out ratherthan an annual block payment.
They are developed in consultation with over280 clinical representatives nominated by royalcolleges to ensure they are fit for purpose.
The 2008 national tariff will be based on version4 (V4) HRGs. This will determine the funding thatNHS and other healthcare organisations receive for
treatment they provide, regardless of where it isdelivered. V4 involved large scale revisions ofexisting groupings to take into account routineand complex cases and extended the scope ofgroupings beyond admitted care to new clinicalsettings.
Further information on HRGs and the IC can befound at: http://www.ic.nhs.uk/casemix.
Further information on PbR can be found at:http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSFinancialReforms/fs/en.
DSCNs related to NCCMDS (14/2006 and 15/2006) can be found at: http://www.connectingforhealth.nhs.uk/dscn/dscn2006/.
The Information Standards Board submissiondocuments and the User Guide can be found at:http://www.isb.nhs.uk/docs/neonatal-critical-care-dscn-submission.
Further support in relation to NCCMDS can beobtained from:
The Information Centre Contact CentreTel.: þ44 0 845 300 6016E-mail: [email protected]
Ian HughesProject Manager Critical Care
The Information Centre for health and Social Care,United Kingdom.
Tel.: þ44 0 845 300 6016.E-mail address: [email protected]
Available online 20 October 2006
