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Clinical Data Analysis Tools at Discovery Health
Brian RuffNovember 2013
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
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
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
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
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
Discharge summary form
Introduction of unique patient identifier + coded clinical data
Patient/hospital demographic information
Clinical information
Resource information
Electronic capture screen: Landing screen
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
Clinical summary
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
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
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
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
Health System Regions
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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