Lecture 2 - Clinical Governance and Risk Management

Question 1

Health Round Table is a not-for-profit data sharing organisation.

Where does it get its data from and where else does this data go?

Answer 1

HRT gets its data from the administrative (coded) data set - it includes things like length of stay, which procedures were done, diagnosis, whether there were any adverse events.

This data also goes to the state government and then up to the federal level to the independent hospital pricing authority (IPHA) which makes decisions about efficient price etc.

Question 2

What is a limitation of coded data? Vague question yes i Know

Answer 2

Each coded step has an error rate (e.g. 10%) which multiplies over many steps to give a large error.

e.g. Documentation is 90% accurate, Treatment is 90% accurate, Diagnosis is 90% accurate

This has improved as coders have come closer to the clinical world.

Question 3

What is the data heirarchy of diagnosis groups?

What is the difference between DRG A and DRG B?

Answer 3

1. 25 Major Diagnostic Categories
2. DRG ‘Family’ - 800+
3. DRG A or B
4. Principle Diagnosis/Principle Procedure GROUP
5. Principle/Secondary Diagnoses/Procedures

These groups feed upwards

DRG A is more acute than DRG B

Question 4

ALOS = 
RSI = 
DRG = 
CHADx = 
HACs =

Answer 4

Average length of stay
Relative Stay index
Diagnosis Related Group
Classification of Hospital Acquired Diagnosis
Hospital Acquired Complications - 16 categories

Question 5

How often is administrative coded data received by HRT

Answer 5

Quarterly

Question 6

Formula for RSI:

RSI =

Answer 6

(Actual LOS for patient / Expected LOS for a similar patient ) x 100

Question 7

For HRT’s RSI how many groupings are there for ‘average LOS’ and what features do the groupings take into account.

Answer 7

18,000 groupings

That take into account:

• DRG (800)
• Admission types (elective, emergency I think)
• Arrival source
• Discharge destination
• Co-morbidity levels

Question 8

How does HRT set what is ‘exemplar’ performance out of the hospitals that submit.

Answer 8

Takes the weighted average of top 4.

Question 9

What is the financial benefit of reducing RSI for a particular diagnosis/ward/hospital?

Answer 9

Reduce cost by reducing number of beddays.

You can estimate the amount of saving you would get by comparing your RSI with the RSI of an exemplar.

Question 10

Why are long stay patients a financial burden?

Answer 10

Although they only comprise a small proportion of patients (~ 3% in 2010), they take up significant proportion of beddays (30% in 2010)

3% of patinents –> responsible for 30% of beddays