By

Nathan Billing, Robin Beaumont, Brett Cornforth, Zina Ayar, Martin Orr.

Background Defining Allied Health Professionals (AHP’s) Diagnosis Related Groups (DRG’s)

Problem Research question

Methodology Results Conclusion Acknowledgement

DRG developed to identify products of hospital group together acute inpatients:

▪ Based on routinely available data on discharge (NMDS)▪ Clinically similar conditions (23 MDC)▪ Similar pattern of resource use (LOS)

Widely adopted to control costs & allocate funds Historical cost data used & data trimming (L3H3)

Health care is labour intensive cost of labour = 60-80% of operating costs1

Allied health staff provide 15-20% of all patient care2.

AHP input not coded alongside clinical information

Little evidence to show how allied health input contributes to the weighting of DRG’s

1. Buchan J, Ball J, O’May F Paper 3. Dept. of Organization of Health Services Delivery. Geneva: World Health Organization . 20002. Boyce R. International Journal of Health Planning and Management 1993; 8(3): 201-217.

There is a growing demand on health services in New Zealand

To meet these needs there is a need for greater efficiency

Hospital administrative data is available and may be a potential tool to help identify and quantify potential cost savings.

(Morgan & Simmons, 2010)

What is the Concordance/ discrepancy between Allied health activity cost and diagnosis related group based reimbursement?

Does allied health cost increase at same rate as actual cost over length of stay?

1. Identify top DRG groups with AHP input

2. To determine AHP contact for each episode

3. Convert AHP time to cost

4. To compare the costs and charges

5. To test the hypothesis that AHP and Actual

cost both vary over length of stay

Total number of inliers seen by Allied Health Professionals = 1360

Demeere N, Stouthuysen K, Roodhooft F. , Health Policy. 2009;92(2):296-304.

Activity Based

Costing

Cost centres

Physiotherapy

Respiratory

Occupational

Therapy

Speech Therapy

Social Work

Dietetics

New Appointment $3.7 $3.4 $3.5 $3.7 $3.4 $1.4

Follow up $4.0 $3.8 $3.8 $3.6 $3.6 $1.6

Dietetic Education - - - -   $1.4

Rehabilitation Therapy

$2.0 - $2.8 $2.3 $3.3 -

New Appointment$3.2 $3.0 $3.1 $2.9 $3.0 -

Follow up $3.6 $3.3 $3.4 $3.1 $3.2 -

Rehabilitation therapy

$2.2 - $2.0 $2.0 $2.9 -

Total$18.6 $13.6 $18.6 $17.6 $19.3 $4.4

Resp + Physio$32.3        

Number of cost centres

10 6 6 6 3

Mean Cost per minute

$3.23 $3.09 $2.94 $3.23 $1.48

Simple model:Cost ~ Allied Health cost +Actual length of stay

Complex Because looking at simultaneous influence of two

variables (allied health cost and Actual cost) on a third (length of stay)

check for an interaction term to check if the influence of two variables on a third is not additive

Cost ~ Allied Health cost +Actual cost+ (Allied Health cost:Actual length of stay)

P value for AHP costOutliers p=0.907 Inliers p= 0.250319

P value for interaction termIn & Outliers p=0.00000

P value for AHP costOutliers =0.00000 Inliers= .00000

P value for interaction termIn & Outliers p=0.00000

Z60A E65B

OutliersInliers

P value for AHP costOutliers p=0.00000Inliers p=0.00014

P value for interaction termIn & Outliers p=0.00000

P value for AHP costOutliers p=0.00033Inliers p= 0.00850

P value for interaction termIn & Outliers p=0.00000

F62B E62B

OutliersInliers

Cost centres and charges can be utilised to identify patient groups with high AHP input.

Allied health staff cost does not increase over length of stay as much as actual cost does.

The interaction term used in our regression model to highlight this had extremely significant results

Secondary data analysis and ? accuracy of data coding

Timeliness of data (2008-2009).

Issues of multiple admissions

DRG funding does not favour prevention

DRG codes not available on admission

Problems of mapping data from separate databases

Time taken to obtain data limited potential for more complex analysis

Further research into potential benefit of this AHP activity data for specific conditions needed

Supervisors R0bin Beaumont Martin Orr

Decision Support team Zina Ayar Brett Cornforth

Management support Phil Barnes Kevin Blair Stuart Bloomfield Tamzin Brott Info about university courses

www.fhi.rcsed.ac.uk