NHS Information Standards Board

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1 DSC tice: 01/2005 Date of Issue: vember 2005 Subject: NHS Information Standards Board Adult Critical Care (Levels 2 and 3) Healthcare Resource Groups (HRGs) Version 3.6 Implementation Date: 1 st April 2006 DATA SET CHANGE CONTROL PROCEDURE 1 This paper gives notification of changes to be included in the NHS Data Dictionary and the NHS CDS Manual as appropriate. These will be consolidated into the publications in due course. Summary of Changes: This DSCN introduces Adult Critical Care (Levels 2 and 3) Healthcare Resource Groups Version 3.6 The NHS Information Standards Board (ISB) is responsible for approving information standards. The ISB output related to the assurance and sign-off of this standard can be found at The output for the DSCN is located at: 1 Dataset change notices can be found at

2 DATA SET CHANGE NOTICE 01/2005 Reference: DSCN 01/2005 Subject: Introduction of Adult Critical Care (Levels 2 and 3) Healthcare Resource Groups Version 3.6 Type of Change: This DSCN introduces Adult Critical Care (Levels 2 and 3) Healthcare Resource Groups Version 3.6 Effective Date: 1 st April Reason for Change: To extend the use of Healthcare Resource Groups (HRGs) for commissioning and costing of Adult Critical Care (Levels 2 and 3). Background: Adult Critical Care Levels 2 and 3 HRGs have been developed by the Health & Social Care Information Centre (H&SCIC) under the sponsorship of the Department of Heath, Payment by Results team. The purpose of the Adult Critical Care Levels 2 and 3 HRGs is to enable the service to collect resource usage for Adult Critical Care Levels 2 and 3 in a standardised manner. The HRGs are intended to be used to calculate standard reference costs and tariffs from April It is intended that the HRGs will be used as a means of fulfilling the requirement that funding for the majority of work carried out by the NHS is funded at a national tariff as specified in the Department of Health s paper: Financial Flows, Payments by Results. Precisely how the HRGs will be used for tariff setting is not part of the scope of the Standard. However, it is expected that payment will be linked to activity and adjusted for the mix of types of patients or treatment/healthcare episodes. Department of Health, Payment by Results team are expected to establish a set of national tariffs for commissioning of critical care services from 2006/07. Due to the lead-times associated with collecting costs and publishing tariffs, the cost weights for commissioning in 2006/07 are expected to be based on sample data collected from the sites involved in the HRG development process. In subsequent years, critical care HRG tariffs are expected to be based on nationally collected costs. Adult Critical Care Levels 2 and 3 HRGs are new HRGs. Other HRGs are unaffected by their introduction. Adult Critical Care Levels 2 and 3 HRGs are based on the Critical Care Minimum Data Set (CCMDS) and its mandation in Commissioning Data Set (CDS) messages which is subject to a separate DSCN. Dependencies: In order to operate, Adult Critical Care Levels 2 and 3 HRGs require data from the Critical Care Minimum Dataset (CCMDS). DSCN 01/2005 Adult Critical Care HRGs Page 2 of 8

3 CCMDS data items used by Adult Critical Care Levels 2 and 3 HRGs are listed in Appendix A. The CCMDS DSCN can be obtained at: and on the NHSnet at: Human behavioural guidance in the form of a Self-administered training pack with respect to CCMDS is available from: or HRG Grouper Software: A standalone software HRG Grouper is available for free download from the H&SCIC web site: The Grouper is licensed and downloaders will need to complete their contact details prior to download. The software grouper assigns the HRG code based on the data contained within CCMDS. Adult Critical Care Levels 2 and 3 HRGs will be supported by the software grouper from V3.5.1 onwards. Manuals on how to operate the Grouper are also available from the H&SCIC web site as part of the HRG Toolkit download. Grouper software will also be operated within the Secondary Uses Service (SUS). The assignment of HRGs by the SUS Grouper is identical to the standalone grouper provided by the H&SCIC. The Secondary Uses Service plans to support HRG Grouping for Adult Critical Care Levels 2 and 3 HRGs from October Impact on NHS Data Dictionary and Commissioning Data Set Manual Adult Critical Care Levels 2 and 3 HRGs by themselves require no changes to NHS Data Dictionary or the Commissioning Data Set. However, operation of Adult Critical Care Levels 2 and 3 HRGs requires implementation of the Critical Care Minimum Data Set, which will require changes to the NHS Data Dictionary and Commissioning Data Set messages. Changes to the NHS Data Dictionary required to support the Critical Care Minimum Data Set will be effected via a data standards DSCN 13/2005. Details of the changes to the Admitted Patient Care CDS messages will be published by April Trusts will be able to DSCN 01/2005 Adult Critical Care HRGs Page 3 of 8

4 submit the Critical Care MDS to the Secondary Uses Service from October This timetable has been agreed with Payment by Results. This DSCN (01/2005) for Adult Critical Care Levels 2 and 3 HRGs and DSCN 02/2005 for CCMDS have the same implementation date of 1 st April Please address enquiries about this DSCN to:- Helpdesk NHS Health and Social Care Information Centre Aqueous I Waterlinks, Aston Cross Rocky Lane Birmingham. B6 5RQ Tel: [email protected] WWW: NHSnet: nww.icservices.nhs.uk DSCN 01/2005 Adult Critical Care HRGs Page 4 of 8

5 Appendix A Adult Critical Care Level 2 and 3 HRGs The HRGs 7 HRGs have been defined with one additional error category (UY360001) which is used in the event of a data error which prevents assignment of a HRG: Total Organ Groups - during HRG each Completed L2/3 Critical Care period N/a UY YA YA YA YA YA YA YA Critical Care Minimum Data Set (CCMDS) HRGs depend on data collected within the CCMDS. The CCMDS is subject to a separate ISB submission and Data Set Change tice. Fields within the CCMDS used by this Standard are: CCMDS Field Description CRITICAL CARE START DATE CRITICAL CARE UNIT FUNCTION ADVANCED RESPIRATORY SUPPORT DAYS BASIC RESPIRATORY SUPPORT DAYS ADVANCED CARDIOVASCULAR SUPPORT DAYS BASIC CARDIOVASCULAR SUPPORT DAYS RENAL SUPPORT DAYS NEUROLOGICAL SUPPORT DAYS DERMATOLOGICAL SUPPORT DAYS LIVER SUPPORT DAYS CRITICAL CARE LEVEL 2 DAYS CRITICAL CARE LEVEL 3 DAYS CRITICAL CARE DISCHARGE DATE te: Liver support is included in CCMDS but is currently excluded from the Adult Critical Care Levels 2 and 3 HRGs because there was insufficient data available to complete the required analysis. Payment by Results will use other means of reimbursing the cost of liver support initially. Patients Covered By Adult Critical Care Level 2 and 3 HRGs The HRGs YA to YA will be assigned to all patients with a CCMDS record with the exception of: Patients being treated in a specialist paediatric unit or neonatal unit. DSCN 01/2005 Adult Critical Care HRGs Page 5 of 8

6 Appendix A Paediatric patients are identified by the use of the Critical Care Unit Function code within the CCMDS: Description CRITICAL CARE UNIT FUNCTION Value 04 = specialist paediatric unit Any records with a value of 04 will be assigned the UY HRG Code. n Level 2 and 3 patients with zero organs supported. These patients are identified by the use of the Critical Care Level 2 and Critical Care Level 3 days fields within the CCMDS: Description CRITICAL CARE LEVEL 2 DAYS CRITICAL CARE LEVEL 3 DAYS Value Total calendar days during which level two care was provided during the period. Total calendar days during which level three care was provided during the period. Any record calculated as zero total organs supported (see below) which has zero Level 2 or 3 days (i.e. the sum of the two fields) will be assigned the UY HRG Code rather than YA Organ Support Groups Organ groups supported are taken from the proposed Critical Care Minimum Data Set (CCMDS) and are: Organ groups Advanced Respiratory Support (ARS) Basic Respiratory Support (BRS) Advanced Cardiovascular support (AVCS) and Basic Cardiovascular Support (BCVS) Renal Support (RS) Neurological Support (NS) Dermatological Support (DS) tes Basic and Advanced Respiratory Support are treated as separate organ groups for the purposes of the HRG definition. See above Advanced and Basic Cardiovascular Support are treated as one organ group for the purposes of the HRG definition. tes: Gastrointestinal Support is treated as a standard component of care and the cost of providing this care is absorbed into the costs of the other organ support groups so it is not counted as a separate organ support group by the HRG. Liver support was excluded from the HRG because there was insufficient data available to complete the required analysis. Length of Stay is not used in the HRG assignment but is output by the HRG Grouper to facilitate the application of a cost per day type funding tariff. DSCN 01/2005 Adult Critical Care HRGs Page 6 of 8

7 Appendix A Length of Stay is calculated based on the Critical Care Start Date and the Critical Care Discharge Date with parts of a day counted as whole days. Any patient who cannot be assigned a HRG for whatever reason is assigned the UY HRG Code. The error code UY is not assigned in the event of an invalid length of stay. Illustrative Examples The following table illustrates the HRG grouping logic with five fictitious examples: Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Organ Group Advanced Respiratory Support 1 5 Basic Respiratory Support 1 10 Basic Cardiovascular support 4 5 Advanced Cardiovascular support 4 5 Renal Support Neurological Support Dermatological Support L L CC Start date CC Discharge Date Unit Function Length of Stay HRG Assigned YA YA YA UY YA HRG Description 2 Organs 3 Organs 1 Organs Unassigned 0 Organs DSCN 01/2005 Adult Critical Care HRGs Page 7 of 8

8 Appendix A Assignment of HRGs is further illustrated in the flowchart below. ADULT CRITICAL CARE LEVEL 2 AND 3 V3.6: FLOWCHART CCMDS PICU? HRG = UY ARS days > 0 0 L2 + L3 days = 0 BRS days > 0 HRG = YA AVCS + BVCS days > 0 1 HRG = YA RS days > 0 Organs HRG = YA NS days > 0 3 HRG = YA DS days > 0 4 HRG = YA HRG = YA HRG = YA DSCN 01/2005 Adult Critical Care HRGs Page 8 of 8