Revision of DRGs regarding Multiple significant trauma (484, 485, - PowerPoint PPT Presentation

Revision of DRGs regarding Multiple significant trauma (484, 485, 486, 486O and 487) – MDC 21 Nils Oddvar Skaga, MD PhD Oslo University Hospital Trauma Registry Oslo University Hospital, Ullevål Oslo - Norway

Objectives • Oslo University Hospital (OUH) trauma service – brief introduction • The trauma registry at OUH (TR-OUH) • Scoring of anatomic injury in trauma • What is the DRG-problem in trauma? • Our suggestions nosk_2015 2

OUH Trauma Service • Major trauma centre, Oslo (600,000) • Trauma referral centre, health regions East and South of Norway (2.7 million) • 1,800 trauma admissions each year • Severe injury (ISS >15) 600 patients/yr (40%) ISS = Injury Severity Score nosk_2015 3

Trauma service activity Trauma team activations 2000 - 2014 OUH-TR, Ullevål 2000 1800 1600 1400 1200 1000 800 600 400 200 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 nosk_2015 4

Oslo University Hospital Trauma Registry • Operative since August 2000 • Nearly 17.000 patients included • Document trauma service activity and quality • Research • DRG revision – potential financial gain for the hospital nosk_2015 5

What is the DRG-problem in trauma? nosk_2015 6

Formal request MDC21

Formal request for MDC21 • principal diagnosis from the group Fresh trauma or fresh trauma related diagnosis (principal diagnosis property 00P21) (1011 diagnoses) • two or more diagnoses indicating significant trauma in more than one body region (24X10 – 24X81) OR • a diagnosis indicating injuries in multiple areas of the body (diagnosis property 24X90)

Present DRG • a good description of the field • necessary to do a revision of the diagnosis properties – in order to make the system more consistent and more logical • “Significant injury” • “Not significant injury” nosk_2015 9

International classification of traumatic injury 1350 codes Severity score 1 to 6: • AIS code 1 Minor • AIS code 2 Moderate • AIS code 3 Serious • AIS code 4 Severe • AIS code 5 Critical • AIS code 6 Maximum nosk_2015 10

Suggestion Focus on 5 categories 1) Columna injuries 2) Large blood vessels 3) Open wounds 4) Nerve damage in arms and legs 5) Other diagnosis nosk_2015 11

Suggestions • Marked “IN” – should be reclassified as significant • Marked “OUT” – should be reclassified as not significant nosk_2015 12

Columna nosk_2015 13

Inconsistency? • Diagnosis included (significant) today: • Must be included: nosk_2015 14

Injuries on large blood vessels nosk_2015 15

Open wounds nosk_2015 16

Nerve damage in arms and legs nosk_2015 17

Other injuries nosk_2015 18

Other injuries, continued nosk_2015 19

Severe Injury TR-OUS 2009 – 2013 DRG-groups Injury Severity Score > 15 • 483 476 patients (17,0%) • 484 116 patients (4.1%) • 485 13 patients (0.5%) • 486 454 patients (16.2%) • 487 279 patients (10.0%) Number of patients with ISS > 15: 2803 Number of patients in actual DRG groups: 1338 (47,7%)

Severe injury – international convention • Injury Severity Score (ISS) > 15 – Range 1 (small) to 75 (lethal) • ISS = AIS 2 + AIS 2 + AIS 2 • ISS = 4 2 + 3 2 + 3 2 = 34 nosk_2015 21

Conclusion • A trauma rigistry is a unique tool for quality assurance • The present DRG groups give a good description of the field • demanding to do a revision of the diagnosis properties – to make the system more consistent and more logical nosk_2015 22