NordDRG - Developing grouping logic for psychiatric care
Lotta Sokka a
Introduction
Psychiatry, as a field of medicine, is very complex, and psychiatric illnesses, their symptoms as well as diagnostic and treatment options are often multidimensional. So far, the NordDRG grouper has not been able to produce information on the level the field of psychiatry would need. This is due to the fact, that grouping variables used by the grouper in psychiatry field have been limited mainly to diagnoses information and some patient and care characteristics, which have not been sufficient to create clinically and economically meaningful groups. The mental health and addiction related intervention classification, which was introduced into national classification of interventions in 2018, created a good opportunity to revise the current grouping logic in this area.
Methods
The aim of the project is to update the grouping logic for psychiatric diseases and disorders in such way, that it will fulfill both clinical and economical needs of the psychiatric field. The organization responsible for the project is Finnish Consulting Group, and it is implemented in cooperation with Nordic Casemix Centre (NCC), Finnish institute of national health and welfare and several national hospital districts. The data used in analyses is from five Finnish university hospitals. No additional data was collected for the development work.
NordDRG grouping starts with the patient's main diagnosis, on basis of which a certain MDC (Major Diagnostic Category) is assigned for each case. The MDC for psychiatry is 19 (Mental diseases and disorders). Within MDC, the cases are assigned into more specific diagnosis categories. A diagnosis category is a group of clinically similar diagnoses. In the updated grouping logic not only the main diagnosis, but also possible complicating secondary diagnoses and procedures, both psychiatric and others, performed are taken into account. In some cases, patient's age may affect the care of a certain illness and the costs involved. This is also being considered while updating the logic. The development work is an iterative process including continuous testing and iteration of the grouping rules.
Results and Conclusions
In 2022, the development work is still ongoing. The new psychiatric grouper should be ready and tested by the end of the year 2022, and available for use in 2024 national grouper version.
a FCG Finnish Consulting Group Oy, Finland
Original Version in PDF