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Guide to File Preparation Document

1. Table 1 Field Name Grouper Description Format Validation Notes Derivation T Local provider code possibly PROCODET Organisation Code text Not Null the NACS code an 5 PROVSPNO Noe te Not Null Local Spell Identifier 1 87 Distinct File must be ordered by EPIORDER Episode Number number within Provider PROCODE PROVSPNO and Spell EPIORDER 180 10019558 Stark Date Episode Person between episodes 5 STARTAGE StartAge number relative to Birth Date integer whole episode duration years 0 1 2 or 9 Identical value for SEX Sex text all episodes Must be a valid national code within Provider Spell CLASSPAT Patient Classification number Not Null Must be a valid national code Not Null Identical Source Of Admission value for all ADMISORC Hospital Provider Spell text episodes within Must be a valid national code Provider Spell Not Null Identical Admission Method value for all ADMIMETH Hospital Provider Spell text episodes within Must be a valid national code Provider Spell Not Null Identical Discharge Destination value for all DISDEST Hospital Provider Spell text episodes within Must be a valid national code Provider Spell Not Null Identical Discharge Method for all episodes DISMETH Hospital Provider Spell text within Provider Must be a valid national code Spell EPIDUR Episode Duration number 0 99999 Whole days MAINSPEF Main Specialty Code text Not Null Must b
2. Term Expansion explanation CART Classification and Regression Trees Casemix Classification of people or treatment episodes into groups using classification characteristics associated with the condition treatment or outcome that can be used to predict need resource use or outcome CC Complications and Comorbidities CDS Commissioning Data Set CV Coefficient of variation a measure of the amount of variation within a group of values DH Department of Health ERP Expert Reference Panel EWG Expert Working Group HRG Healthcare Resource Group groupings of treatment episodes which are similar in resource use and clinical response ICD 10 International Classification of Disease and Related Health Problems Internationally defined classification of disease managed by the World Health Organisation 10 Revision Iso resource Similar in resource use LOS Length Of Stay Duration of the hospital stay from admission to discharge IC Information Centre for Health and Social Care OPCS The system of codes used to record interventions and procedures This was originally developed by the Office of Population Censuses and Surveys superseded by the UK Statistics Authority PbR Payment by Results The financial system providing a transparent rules based system for paying trusts where payment is linked to activity and adjusted for casemix PCT Primary Care Trust
3. RIV Reduction in Variance This is a measure of how much variation is explained by the HRGs The aim with HRGs is to maximise the RIV Page 3 of 18 The Information Centre for health and social care 1 Introduction This document assists users of the HRG4 Reference Cost Grouper the grouper in preparing data for processing within the application Activity data from existing healthcare systems will be prepared and processed as part of the Reference Costs submission to the DH for the year 2007 08 This document identifies the data items required and provides information about the data preparation necessary for successful processing This document is not intended as a user guide for the grouper A help file which gives full instructions is incorporated into the grouper software package this can be downloaded from the Casemix website 1 1 Why is the Reference Cost Grouper Required The Reference Cost Grouper has been developed to e Underpin Payment by Results and support the introduction of HRG4 e Prepare data for Reference Costs submission for 2007 08 e Provide HRG4 assignment to activity reflecting changes in a clinical practice and costs b introduction of HRGs to new clinical areas c introduction of setting independence e Incorporate the introduction of a unbundling b improved complication and comorbidity splits c improved identification and classification of procedures usi
4. Derivation CCUF Critical Care Unit Function Code text Not null valid code for adult must be supplied ARSD Respiratory Support number 0 99999 BRSD Basic Respiratory Support Days number 0 99999 ACSD Advanced Cardiovascular Support number 0 99999 Days BCSD Basic Cardiovascular Support Days number 0 99999 RSD Renal Support Days number 0 99999 NSD Neurological Support Days number 0 99999 DSD Dermatological Support Days number 0 99999 CCL2D Critical Care Level 2 Days number 0 99999 CCL3D Critical Care Level 3 Days number 0 99999 N B Critical Care Start Date and Critical Care Discharge Date fields are no longer used in assigning activity to an HRG The inclusion of additional fields that help relate records to other systems may be valuable e g to link the critical care record back to the appropriate admitted care episode The following fields where available may be considered for inclusion Field Name Description Format Validation Notes Derivation PROCODET Organisation Code text n a ee poe ae INE NACH PROVSPNO Hospital Provider Spal text n a Local Spell Identifier Number EPIORDER Episode Number number n a 5 2 Record Preparation A full description of how Adult Critical Care records should be prepared for Reference Costs submission is beyond the scope of this document Further information is avai
5. Page 5 of 18 The Information Centre for health and social care 2 2 Data Preparation The data items required differ for each activity type and extracts from each proprietary PAS may also differ It is therefore difficult to fully automate the data input process without some user intervention in the form of data preparation This is covered in more detail for each activity data type in the chapters below In general the user must provide the Reference Cost Grouper with information regarding which data item in their own input file maps to the required data field for the relevant activity type definition file The software achieves this by using a Record Definition File RDF to interpret the input data file This cross references each of the required activity data fields to the mapped field position within the user s data file 2 3 Data Validation In order to accurately assign an HRG to activity data the software will ensure that the data are complete valid and within expected value ranges The software will apply three stages of validation to the data during a processing run The three stages are e Field content within record e Cross validation of episodes within spell e Grouping Logic assignment of flag values Where the Reference Cost Grouper has not been able to resolve the assignment of an HRG definition to the data contained in an input record a code of UZ01Z is returned the output record signifying that the d
6. character NACS code Hospital Provider Spell Number and Episode Number The Reference Cost Grouper provides data output based on HRGs assigned at both an Episode and Spell level It is not necessary to sort the data before processing the grouper sorts the data automatically during processing All records are treated as Finished Consultant Episodes FCEs It is the user s responsibility to ensure that the data file contains only those records required for the purpose of Reference Costs submission Where the source data does not include data items which are directly equivalent to Hospital Provider Spell Number and Episode Number or they cannot be extracted from the source systems then some form of proxy must be included in these fields within the submitted file For Episode Number a simple incremental count may be used There are several ways to create a proxy to spell number examples are 1 Concatenate local patient identifier Admission Date and Admission Time to create a proxy spell number Important When concatenating data do not include any spaces Page 9 of 18 The Information Centre for health and social care between data items Admission Time is suggested in order to identify separate spells starting on the same date 2 Where unique episode identifiers are assigned then use the first episode identifier within the spell as the spell number StartAge This is the patient s age at the start of the consultan
7. 393 In the above record sequence it should be noted that in episode 2 the site recorded as 2393 Portal vein is taken to refer only to the J104 angioplasty procedure and is not applied to the J106 thrombolysis procedure If both procedures are performed on the portal vein then the record must be recorded as shown in episode no 3 2 5 Data Output Given a correctly configured RDF and user data file then the software package can process the data against the chosen HRG4 definitions The assigned core HRG and any additional information is appended to each record and this is output as a flat file in CSV format with quoted alphanumeric fields This will allow ease of import into MS Excel Access or other applications The filename and location can be chosen using the Process File dialog box The output file will have the following features e single output row for each row from the input file e Each column of the input file will be output in the same location in the output file e The relevant grouping and activity analysis data will be appended to the end of each record The data to be appended is specific to each activity type and is covered in the relevant chapters below FOR HEALTH AND 5 Page 7 of 18 3 Admitted Patient Care 3 1 Overview The Information Centre for health and social care Table 1 below shows the data items required by the Reference Cost Grouper
8. NHS The Information Centre for health Ith and social care Casemix Service HRG4 The Casemix Service HRG4 Reference Cost Grouper Guide to File Preparation Issue Date 28 April 2008 Page 1 of 18 The Information Centre for health and social care CONTENTS DICTIONARY AND GLOSSARY ssvcisscsssscsacsssccscssavecescsoveasesudecesescaynsnceasscsndetbnnaessioteonccsenanesutesenascivesusccinns 3 1 INTRODUCTION oe ee 4 2 OVERVIEW FILE PROCESSING eeeeseeseseeseseeseoreseoseoresessoseoreseoseoreseeroreoreseoseeeesessoreoeeseeseeeese 5 ADMITTED PATIENT GARE sisccssacccosssssccenssseressdstsciscesesecsasutscatesrevecousvaneaseatabinsesrtvedbacevancenaeteacsencenes 8 4 INONSADMITTED PATIENT Sissccsicssscascssssccscosssecssssssccsccssooesosstinssuedesacscsersacssssisassadessasdeastienssssstssseess 14 5 EMERGENCY MEDICINE scssiscssccssciesscoscsassssachessessssesastsesensouastasesissseiostsesesesanctassessisescauscveasssasoaseaie 16 G ADULT CRITICAL CARE sisccscessscesscsesccisasscccecaseskcssesstiessasesus naysisanssseatonsapseaes vopenaacasnteteapithacnessices 17 Page 2 of 18 The Information Centre for health and social care Dictionary and Glossary The following definitions and abbreviations are provided to assist users to understand some key terms and acronyms Where definitions are provided they have been stated in a context relating to the use of HRGs Healthcare Resource Groups
9. ata is invalid for grouping If there are errors the input data these will be reported in the Data Quality Report but processing will not be halted There can be more than one reason why the assignment was not resolved and so this report may contain several records all of which need to be reviewed to identify the underlying problems In order to relate invalid records to source systems it may be valuable to add a unique key field to each record 2 4 Approaches and Sites Within the HRG4 definitions there are instances where the assignment of an HRG toa procedure code is dependent on the presence of other codes indicating either the approach that was taken or the site of treatment Such codes should always be subsequent to the procedure to which they refer this should be taken to mean after and adjacent to unless otherwise specifically stated Page 6 of 18 The Information Centre for health and social care Care should be taken that coding practice reflects this the software will not apply a single site code to a group of procedures and neither will it apply an approach code at the end of a record to all of the procedures in that record Site codes and approach codes are only applied to the procedure that directly precedes them in the input record An example is given below Episode No Primary Procedure 2 Procedure 3 Procedure 4 Procedure 1 J104 Z393 J118 2 J106 J104 Z393 3 J106 Z393 J104 Z
10. ated with the number of Adult Critical Care days that are to be removed from that FCE If Adult Critical Care days have already been removed from the data or there are no Adult Critical Care days to be removed the input field CRITICALCAREDAYS should either be left blank or populated with zeroes Treatment of Rehabilitation and or Specialist Palliative Care Activity To avoid double counting activity episode and spell duration should be adjusted for Rehabilitation and Specialist Palliative Care following grouping This is because Rehabilitation and Specialist Palliative Care admitted patient activity will generate unbundled per diem HRGs assuming accurate recording of classification codes Care should be taken to ensure that the HRGs for the core care do not change in line with the adjusted episode and spell duration Main Specialty Code This is the main specialty in which the consultant is contracted or recognised it should be a valid code from the Main Specialty Codes table Treatment Function Code This is the treatment function under which the patient is treated It may be the same as the main specialty code or it may be a valid code from the Treatment Function Codes table Neonatal Level of Care Neonatal Level of Care is used by the HRG4 Reference Cost Grouper to allocate the HRG for Neonatal Critical Care Retrieval XA06Z When a patient is not neonatal a value of 0 should be supplied even for adults Primary Procedure The g
11. ce CDS allows first and second investigations and first and second treatments to be recorded and so the application requires that all 4 fields are present and populated with either a valid national code or null Within the A amp E Attendance CDS the investigation fields can contain up to six alpha numeric characters However only the two leading characters are the national code the last four positions being taken up by locally assigned values These fields must be truncated to the two leftmost characters prior to submitting the data input file Within the A amp E Attendance CDS the treatment fields can contain up to six alpha numeric characters Only the three leading characters are the national code the last three positions being taken up by locally assigned values These fields must be truncated to the three leftmost characters prior to submitting the data input file 4 3 File Preparation The Reference Cost Grouper processes the data items shown above and if a meaningful HRG cannot be assigned a code of UZ01Z is returned signifying that the data is invalid for grouping In order to relate invalid records to source systems it may be valuable to add a unique key field to each record Page 16 of 18 The Information Centre for health and social care 5 Adult Critical Care 5 1 Overview Table 4 below shows the data items required by the Reference Cost Grouper Table 4 Description Format Validation Notes
12. de to be assigned as the core HRG Admission Method Hospital Provider Spell This is the national code for the method of admission for the Hospital Provider Spell The Reference Cost Grouper will check all of the episodes within a spell in order from the earliest FCE forward It will take the first available value from this field and validate it against the FOR HEALTH AND SOCIAL CARE NHS Page 10 of 18 The Information Centre for health and social care national codes The software will ignore null values but users should be aware that a value outside of the national codes will cause a UZ01Z code to be assigned as the core HRG Discharge Destination Hospital Provider Spell For finished spells only this is the national code for the discharge destination The Reference Cost Grouper will obtain the value of this field from the last episode in the spell and validate it against the national codes A value outside of the national codes will cause a UZ01Z code to be assigned as the HRG Discharge Method Hospital Provider Spell For finished spells only this is the national code for the discharge method of the patient The Reference Cost Grouper will obtain the value of this field from the last episode in the spell and validate it against the national codes A value outside of the national codes will cause a UZ01Z code to be assigned as the core HRG Episode Duration This is a derived data item which the user must ca
13. e Organisation Code and Hospital Provider Spell Number as belonging to the same Spell and will perform spell based processes on the total content Page 13 of 18 The Information Centre for health and social care Non Admitted Patients 3 4 Overview Table 2 below shows the data items required by the Reference Cost Grouper for Non admitted Patients i e outpatient attendances or attendances by patients for nursing care on a ward ward attenders Since April 1 2005 the data source for both of these has been the Outpatient Attendance CDS Table 2 Field Name Description Format Validation Notes Derivation _ Appointment Date Person Birth AGE Age mer Date integer whole years SEX Sex text 0 1 20 9 Must be a valid national code MAINSPEF Specialty text Not Null Must be a valid national code Treatment TRETSPEF Function Code text Not Null Must be a valid national code FIRSTATT First Attendance text Not Null Must be a valid national code Primary Dots are not accepted For OPER_01 Procedure text example use F343 rather than OPCS F34 3 Additional Null or valid OPCS OPER_02 12 procedures text Code See above 3 5 Record Preparation Age This is the patient s age at the time of the attendance It is therefore Attendance Date Birth Date The user must therefore extract the patient s Birth Date from their source data calculate the age value and p
14. e a valid national code TRETSPEF a text Not Null Must be a valid national code Must be a valid national code NEOCARE Neonatal Level of Care text Not Null 0 if not relevant Null or valid Dots are not accepted For OPER 01 Primary Procedure texi OPCS Code example use F343 rather OPCS without decimal than F34 3 See note at foot point of table FOR HEALTH AND SOCIAL CARE NHS Page 8 of 18 The Information Centre for health and social care OPER_02 12 Additional procedures text As above Not Null Valid ICD code Dots are not accepted and excluding decimal any dagger asterisk codes DIAG_01 Primary Diagnosis ICD text point character must be removed For and any example use A170 rather dagger asterisk than A17 0f or A17 0D characters DIAG_02 14 Additional diagnoses text See above Number of Critical Care days Blank or 0 99999 Blank or zero where the user Non numeric has already removed Critical CRITICALCAREDAYS CRITICALCAREDAYS Number characters treated Care days from the data or as zero where there are no Critical Care days Note the Record Definition File extract facility can be used to remove decimal points from clinical codes during file processing See the grouper user manual for details 3 2 Record Preparation Organisation Code This data item can be any code used locally to identify the organisation We recommend using the three or five
15. lable in the Critical Care Minimum Dataset Training Pack available from http www icservices nhs uk casemix pages downloads FOR HEALTH AND SOCIAL CARE NHS Page 17 of 18 The Information Centre for health and social care 5 3 File Preparation The Reference Cost Grouper processes the data items shown above and if a meaningful HRG cannot be assigned a code of UZ01Z is returned signifying that the data is invalid for grouping In order to relate invalid records to source systems it may be valuable to add a unique key field to each record FOR HEALTH AND SOCIAL CARE NHS Page 18 of 18
16. lace it in each record of the data input file The age should be an integer value of whole years rounded down Age is required as a determinant for several HRG assignments The validation procedures will therefore return a UZ01Z code if age is not present or is not a value between 0 and 130 Sex Sex can be a value 0 1 2 9 as per ISO 5218 However where sex is a determinant of the HRG then sex must be a value either 1 or 2 indicating male or female for the correct HRG to be assigned Page 14 of 18 The Information Centre for health and social care Main Specialty Code This is the main specialty in which the consultant is contracted or recognised it should be a valid code from the Main Specialty Codes table Treatment Function Code This is the treatment function under which the patient is treated It may be the same as the main specialty code or it may be a valid code from the Treatment Function Codes table First Attendance An indicator for whether the patient was making a first or follow up attendance and whether this was a face to face contact or telephone telemedicine consultation Primary Procedure The grouper application requires any interventions and procedures to be recorded as OPCS codes Where no OPCS codes are recorded the grouper logic will assign an HRG based on the value in the first attendance Additional Procedures Some of the grouper processing uses predefined combinations of codes to simplify
17. lculate prior to the record being submitted to the Reference Cost Grouper The basic calculation is End Date Episode Start Date Episode To avoid double counting for reference costs submission purposes both critical care and rehabilitation activity should be subtracted from the Episode and Spell Duration To Exclude Adult Critical Care Activity For the purpose of Reference Costs subtract from the Episode Duration the number of days within the FCE that the patient has spent in Adult Critical Care It is possible for either the Critical Care Start Date or the Critical Care Discharge Date to be different from the Episode Start Date or the Episode End Date so care must be taken in calculating how many days within the FCE have been spent in critical care The calculation for the number of critical care days is The earlier of CC Discharge Date or End Date Episode the later of CC Start Date or Start Date Episode N B Episode Duration should be returned as the number of whole days rounded down However where this would give zero or a negative figure then Episode Duration should be recorded as 1 one day Page 11 of 18 The Information Centre for health and social care Automatic Exclusion of Adult Critical Care Days The grouper application provides a facility to remove critical care days as part of the grouping process To use this facility the input field CRITICALCAREDAYS for each FCE record should be popul
18. ng updated OPCS codes e Enable more accurate analysis of healthcare activity within the service Further information on Payment by Results can be found at _ http www dh gov uk PolicyAndGuidance OrganisationPolicy FinanceAndPlanning NHSFinancia IReforms fs en Although this document contains references to adjustments to be made to data for reference costing a full description of which records to include in and exclude from the DH PbR Reference Costs submission is beyond the scope of this document Further information on Reference Cost data collection can be found at http www dh gov uk PolicyAndGuidance OrganisationPolicy FinanceAndPlanning NHSReferen ceCostsDataCollection fs en Page 4 of 18 The Information Centre for health and social care 2 Overview of File Processing 2 1 Data Input The HRG4 Reference Cost Grouper allows activity data to be processed into standard groupings of clinically similar treatments which use comparable levels of healthcare resource To achieve this it uses the HRG4 definitions for the following activity types e Admitted Patient Care e Non Admitted Patients e Emergency Medicine e Adult Critical Care Because of differences in the way HRG4 definitions are applied to the above activity types and differences in the data required to correctly assign the HRG the Reference Cost Grouper only processes a data file for a single activity type at one time The activity type must be specified by
19. rouper application relies on interventions and procedures being recorded as OPCS codes Page 12 of 18 The Information Centre for health and social care Additional Procedures Some of the grouper processing uses predefined combinations of codes to simplify the processing logic These may be combinations of procedure codes referring to approaches used or the site to which the procedure was applied These should be recorded as OPCS codes The grouper application will take all of the procedure codes into account when assigning HRGs Primary Diagnosis This is the clinical classification of the patient s diagnosis the Reference Cost Grouper only recognises the ICD 10 coding system Additional Diagnoses Where the Reference Cost Grouper cannot assign an HRG based on the procedures within an FCE record it will attempt to assign an HRG based on diagnosis In doing so it only takes the primary diagnosis and the secondary diagnosis in the most significant position into account However some HRG assignments based on procedure codes are dependent on the diagnosis recorded and in some instances the position of the diagnosis within the record is irrelevant The Reference Cost Grouper therefore accepts all of the diagnoses codes recorded in the CDS record 3 3 File Preparation The Reference Cost Grouper will process all records in the data input file and treat them as FCE records It will treat all records with identical values for th
20. t episode The calculation is Start Date Episode patient s date of birth The age should be an integer value of whole years rounded down Age is required as a determinant for several HRG assignments the validation procedures will return a UZ01Z code where age is not present or where it is not a value between 0 and 130 The user must therefore extract the correct data from their source data files and calculate the age value for each record of the data input file N B the validation process will check each FCE record and will not accept the AGE field appearing only within the initial FCE of a Spell Sex Sex can be a value 0 1 2 9 as per ISO 5218 However where sex is a determinant of the HRG then sex must be a value either 1 or 2 indicating male or female for the correct HRG to be assigned Patient Classification Patient Classification must be a value 1 2 3 4 or 5 as per the national codes It must be the same value for all episodes within a Hospital Provider Spell Source of Admission Hospital Provider Spell This is the national code for the source of admission for the Hospital Provider Spell The Reference Cost Grouper will check all of the episodes within a spell in order from the earliest FCE forward It will take the first available value from this field and validate it against the national codes The software will ignore null values but users should be aware that a value outside of the national codes will cause a UZ01Z co
21. the processing logic These may be combinations of procedure codes referring to approaches used or the site to which the procedure was applied These should be recorded as OPCS codes The grouper application will take all of the procedure codes into account when assigning HRGs 3 6 File Preparation The Reference Cost Grouper processes the data items shown above and if a meaningful HRG cannot be assigned a code of UZ01Z is returned signifying that the data is invalid for grouping In order to relate invalid records to source systems it may be valuable to add a unique key field to each record Page 15 of 18 The Information Centre for health and social care 4 Emergency Medicine 4 1 Overview Table 3 below shows the data items required by the Reference Cost Grouper Table 3 a Grouper Desc Format Validation Desc Derivation INV_01 Accident And Emergency Investigation an 2 Null or valid Validinati nal code First code INV_02 Accident And Emergency Investigation an 2 Null or valid Vali national code Second code TREAT 01 a And Emergency Treatment an 3 ae valid Valid national code TREAT 02 Accident And Emergency Treatment an 3 Null or valid Valid national code Second code Please note that validation permits records where all fields are null such records should be avoided as default codes will be assumed by the grouper 4 2 Record Preparation The A amp E Attendan
22. the user within the grouper prior to the input data file being processed This is done by choosing the required definition database file from the drop down list on the main screen at start up See the grouper help for further details The software accepts data as a comma separated text file using the standard ASCII character set The data items required for the purpose of Reference Costs submission are largely a sub set of the data items used for recording Hospital Episode Statistics HES These in turn are either derived or taken directly from the CDS data file definitions This should ensure that the data are readily available from sources that are routinely collected The principal data sources from which data for HRG4 groupings are derived are e Admitted Patient Care Commissioning data set CDS e Outpatient Attendance CDS e Accident and Emergency CDS for Emergency and Urgent Care HRGs e Adult Critical Care Minimum Data Set MDS These data are already recorded in many existing Patient Administration Systems PAS however it is likely that data required to support the derivation of HRGs for Chemotherapy and Radiotherapy treatments are not currently being captured in a local PAS Where these data are only collected in specialist departmental systems local arrangements will be needed to ensure that the data can be incorporated into admitted care or outpatient datasets for HRG grouping following the guidance in the relevant chapter below

Guide to File Preparation Document

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