Clinical Data Analysis Tools at Discovery Health
Transcript of Clinical Data Analysis Tools at Discovery Health
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Clinical Data Analysis Tools at Discovery Health
Brian RuffNovember 2013
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Care of the population
Care of the individual patient
Facility management
Key Message
Clinical encounters must generate coded, patient-level data to facilitate:
PROCESS IMPROVEMENT
PROCESS IMPROVEMENT
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Burden of Illness
Population demographics
Burden of illness
Episodes of care
Case Mix of hospital admits
including mortality
throughput / outcomes
bed & theatre & procedures & drug
usage/costs
case mix
- hospital in patients
episode mix of patients
burden of disease
population
supply side
demandside
outcoumes
Demand side measures
Measuring the
Burden of Illness: tools
Diagnosis Related Grouper (DRGs)
Discovery Episode Grouper
Age, gender, chronic dx
ACGs
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Diagnosis code
Major Disease Category
No Procedure Procedure
Medical Base DRG Surgical Base DRG
Co-morbidity and Complication code
Full DRG with Severity level
04 - Respiratory
0438 - Asthma
04382 – Asthma with CCs
MDC
Base DRG
Full DRG
The Discovery Health DRG Grouper groups data into DRGs using diagnosis and
procedure codes and age
04381 – Asthma without CCs
04383 – Asthma with MCCs
or
or
DRG algorithm
ICD 10
diagnosis
codes
ICD 10
diagnosis
codes
CPT 4 or
ICD 9 CM
procedure
codes
e.g. Diabetes;
Epilepsy
e.g. Cardiac
/Resp. failure
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0
50
100
150
200
250
300
350
No
. o
f C
as
es
1 3 5 7 9 11 13 15
R’000 Amount
< 17 yrs without C.C. with C.C.
Detailed Breakdown Distribution of Admission Costs per condition
0
50
100
150
200
250
300
350
No
. o
f C
as
es
1 3 5 7 9 11 13 15
R’000 Amount
< 17 yrs without C.C. with C.C.
Detailed Breakdown Distribution of Admission Costs per condition
0
50
100
150
200
250
300
350
No
. o
f C
as
es
1 3 5 7 9 11 13 15
R’000 Amount
Total Distribution
0
50
100
150
200
250
300
350
No
. o
f C
as
es
1 3 5 7 9 11 13 15
R’000 Amount
Total Distribution
0
10
20
30
40
50
60
70
No.
of
Cases
1 3 5 7 9 11 13 15
R Amounts
Condition X - < 17 yrs
Condition <17 yrs
0
10
20
30
40
50
60
70
No.
of
Cases
1 3 5 7 9 11 13 15
R Amounts
Condition X - < 17 yrs
Condition <17 yrsWithout C.C.*
0
50
100
150
200
250
300
350
No
. o
f C
as
es
1 3 5 7 9 11 13 15
R’000 Amount
Without C.C.
0
50
100
150
200
250
300
350
No
. o
f C
as
es
1 3 5 7 9 11 13 15
R’000 Amount
Without C.C.With minor C.C.*
0
10
20
30
40
50
60
70
80
90
Condition X - with C.C.
1 3 5 7 9 11 13 15
With C.C.
0
10
20
30
40
50
60
70
80
90
Condition X - with C.C.
1 3 5 7 9 11 13 15
With C.C.With major C.C.*
*Co-morbidities or complications
Condition x
Diagnosis Related Groups (DRG) logic: basic diagnosis with splits by co-morbidities and complications
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District Hospital A: Volumes; resources and case mix-adjusted relative efficiency
Hospital A
Base Drg
Casemix
Index Admits
Average
LOS
Hospital
Cost Per
Event
Case Mix
Expected
Cost Efficiency
646 - OESOPHAGITIS, GASTROENTERITIS & MISCELLANEOUS DIGESTIVE DISORDERS0.41 53 1.73 3,938 4,783 1.21
441 - RESPIRATORY SYSTEM SIGNS, SYMPTOMS & OTHER DIAGNOSES0.58 32 2.95 9,044 6,819 0.75
436 - SIMPLE PNEUMONIA & WHOOPING COUGH 0.93 31 3.00 7,170 10,817 1.51
1931 - PSYCHOSES 0.60 26 6.23 9,178 7,033 0.77
1460 - CESAREAN DELIVERY 1.25 26 3.54 17,788 14,606 0.82
333 - EPIGLOTTITIS,OTITIS MEDIA,URI & LARYNGOTRACHEITIS0.36 19 1.82 4,537 4,248 0.94
1463 - VAGINAL DELIVERY 0.75 15 2.27 9,688 8,771 0.91
1030 - DIABETES & NUTRITIONAL & MISC METABOLIC DISORDERS0.71 12 1.63 3,455 8,297 2.40
1633 - RED BLOOD CELL DISORDERS EXCEPT SICKLE CELL ANEMIA CRISIS0.39 12 2.67 5,369 4,514 0.84
438 - ASTHMA & BRONCHIOLITIS 0.60 12 1.96 5,528 7,047 1.27
1132 - KIDNEY & URINARY TRACT INFECTIONS 0.45 11 2.64 5,755 5,226 0.91
1833 - VIRAL ILLNESS 0.55 9 2.94 7,515 6,363 0.85
144 - HEAD TRAUMA 0.37 2 1.50 2,673 4,298 1.61
437 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1.09 2 2.50 5,224 12,745 2.44
536 - DEEP VEIN THROMBOPHLEBITIS 0.50 2 2.25 4,657 5,843 1.25
1470 - THREATENED ABORTION 0.29 2 1.25 3,100 3,365 1.09
0.83
1.33
0.66
1.30
1.22
1.06
1.10
0.42
1.19
0.79
1.10
1.18
0.62
0.41
0.80
0.92
Hospital A
Base Drg
Casemix
Index Admits
Average
LOS
Hospital
Cost Per
Event
Case Mix
Expected
Cost Efficiency
646 - OESOPHAGITIS, GASTROENTERITIS & MISCELLANEOUS DIGESTIVE DISORDERS0.41 53 1.73 3,938 4,783 1.21
441 - RESPIRATORY SYSTEM SIGNS, SYMPTOMS & OTHER DIAGNOSES0.58 32 2.95 9,044 6,819 0.75
436 - SIMPLE PNEUMONIA & WHOOPING COUGH 0.93 31 3.00 7,170 10,817 1.51
1931 - PSYCHOSES 0.60 26 6.23 9,178 7,033 0.77
1460 - CESAREAN DELIVERY 1.25 26 3.54 17,788 14,606 0.82
333 - EPIGLOTTITIS,OTITIS MEDIA,URI & LARYNGOTRACHEITIS0.36 19 1.82 4,537 4,248 0.94
1463 - VAGINAL DELIVERY 0.75 15 2.27 9,688 8,771 0.91
1030 - DIABETES & NUTRITIONAL & MISC METABOLIC DISORDERS0.71 12 1.63 3,455 8,297 2.40
1633 - RED BLOOD CELL DISORDERS EXCEPT SICKLE CELL ANEMIA CRISIS0.39 12 2.67 5,369 4,514 0.84
438 - ASTHMA & BRONCHIOLITIS 0.60 12 1.96 5,528 7,047 1.27
1132 - KIDNEY & URINARY TRACT INFECTIONS 0.45 11 2.64 5,755 5,226 0.91
1833 - VIRAL ILLNESS 0.55 9 2.94 7,515 6,363 0.85
144 - HEAD TRAUMA 0.37 2 1.50 2,673 4,298 1.61
437 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1.09 2 2.50 5,224 12,745 2.44
536 - DEEP VEIN THROMBOPHLEBITIS 0.50 2 2.25 4,657 5,843 1.25
1470 - THREATENED ABORTION 0.29 2 1.25 3,100 3,365 1.09
Volume
Actual vs. expected
1.06
0.92
Clinical categories
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Discharge summary form
Introduction of unique patient identifier + coded clinical data
Patient/hospital demographic information
Clinical information
Resource information
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Electronic capture screen: Landing screen
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08 Jan’08 12 Feb’08 14 Feb’08 13 Mrch’08 14 Mrch’08 10 Apr’08 07 May’08 12 May ’08 29 May ’08 04 Jun’08 10 Jun’08
Delivery Cesarean Section
16 Aug’08 16 Sept’08 21 Dec’08
Ante- and Post Partum Complications
Phar: NasonexAqueous
GP: Consult
ation
Radio: Glucose
Quantitative
Hospital Event: Ward
TheatreRadioPath
Specialists
GynecologistConsultation
GynecologistConsultation
GynecologistConsultation
GynecologistConsultation
GynecologistConsultation
GynecologistConsultation
Phar: Novomix
30Flexpen
NovolineNeedle
Phar: Novomix
30Flexpen
NovolineNeedle
Phar: Novomix
30Flexpen
NovolineNeedle
Phar: Novomix
30Flexpen
NovolineNeedle
Diabetes Mellitus Type 1
CLAIMS
EPISODES OF CARE AFTER APPYING THE DEG Inflammation and Infection of Skin
18 Oct’05
Episode grouper
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Clinical summary
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Johns Hopkins ACG Algorithm
Chronic Medical: Stable
Likely to Recur: Discrete
Chronic Medical: Unstable
Prevention/Administrative
Signs/Symptoms: Uncertain
Likely to Recur: Discrete-Infections
N
N
Y
N
N
N
Population Case Mix SystemDiagnosis-based
Statistically valid
Single risk score, based on:
Age
Gender
Commonly occurring combinations of Aggregated Diagnosis Groups (ADGs)
10%
17%
23%
41%
7%
2%0%
2%
8%
42%
27%
22%
-
2,000
4,000
6,000
8,000
10,000
12,000
0%
10%
20%
30%
40%
50%
0 - No or Only Invalid Dx 1 - Healthy Users 2 - Low 3 - Moderate 4 - High 5 - Very High
% Members % Money PLPM
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13
Strategic approach to team work: Member segmentation by clinical severity
2%Complex
Condition
8%Significant chronic
condition
20%Well but at risk
70%Healthy
Care coordination
Disease management
Preventative care
21%
27%
52%
% Spend
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All Medical Aids
1 - Discovery Health
Medical Scheme
Year-Quarter-Month 2008
Plan Series-Plan Type-Plan All
Age Band-5yr bands-Age (Multiple Items) 0 - 5yrs
Hierarchy 5
Values
Row Labels Amount Paid PLPM
Claimants Distinct
Count
Cost Per
Claimant
461-Hyaline Membrane Disease/Respiratory Distress Syndrome 5,019 1,113 108,261
457-Prematurity: Low Birthweight 878 238 88,559
455-Prematurity: Extremely Low Birthweight 601 45 320,514
152-Anomaly: Other Congenital Heart Disease 567 98 138,801
471-Other Neonatal Conditions 546 295 44,436
243-Pneumonia: Bacterial 482 512 22,593
531-Anomaly: Other Digestive or Hepatobiliary System 246 48 123,109
151-Anomaly: Patent Ductus Arteriosus 223 37 144,992
456-Prematurity: Very Low Birthweight 218 79 66,389
144-Anomaly: Tetralogy of Fallot 169 7 578,219
258-Other Respiratory Infections 163 637 6,136
285-Gastroenteritis 133 542 5,877
Grand Total 12,092 2,890 100,459 14
Sickest Under 5’s
Using the Episode Grouper
+ age+ ACG
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All Medical Aids
1 - Discovery Health
Medical Scheme
Year-Quarter-Month 2008
Plan Series-Plan Type-Plan All
Age Band-5yr bands-Age (Multiple Items) > 75 yrs
Hierarchy 5
Values
Row Labels Amount Paid PLPM Claimants Distinct Count Cost Per Claimant
142-Coronary Artery Disease 758 1,694 26,349
203-Cerebrovascular Disease 417 979 25,109
243-Pneumonia: Bacterial 400 821 28,711
168-Congestive Heart Failure 346 1,156 17,616
103-Fracture: Femur, Head or Neck 270 187 84,918
338-Osteoarthritis 257 718 21,057
160-Arrhythmias 229 1,061 12,707
UNLC-Unallocated CTG code 191 4,586 2,451
164-Essential Hypertension 189 3,575 3,115
101-Fracture: Femur, Except Head or Neck 188 126 87,845
373-Chronic Renal Failure 186 162 67,680
29-Neoplasm, Malignant: Colon and Rectum 179 134 78,598
260-Other Disorders of Respiratory System 177 183 56,840
302-Other Gastrointestinal Disorders 163 281 34,247
10-Neoplasm, Malignant: Prostate 140 344 23,975
268-Cholecystitis and Cholelithiasis 140 157 52,506
325-Herniated Intervertebral Disc 137 329 24,577
514-Other Bacterial Infections 137 139 57,863
326-Other Spinal and Back Disorders 131 1,034 7,476
424-Cataract 131 559 13,765
565-Complications of Surgical and Medical Care 120 269 26,347
229-Chronic Obstructive Pulmonary Disease 120 483 14,575
390-Bladder Disorders 95 673 8,342
18-Neoplasm, Malignant: Lungs, Bronchi, or Mediastinum 94 100 55,397
Grand Total 8,754 5,549 92,914
15
Sickest Over 75’s
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Health System Regions
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Regional variation
Proportion of DHMS lives Paid PLPM
Disease Burden Index adjusting for access to benefits
Paid PLPM Disease Burden Adjusted
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