Australian Emergency Care Classification and Costing study

In 2015, IHPA commissioned Health Policy Analysis todevelop a new Australian Emergency Care Classification (AECC) to replace the current Urgency Related Groups (URGs) and the Urgency Disposition Groups (UDGs) to price emergency care. 

To develop the new emergency classification, more refined and detailed costing data was required. Therefore, an initial step for HPA was to undertake a nationwide emergency care costing study—the Emergency care costing study--to identify individual variables that contribute to patient complexity and ultimately cost. Then, once this cost data was analysed, HPA were to determine how these could best be used in combination to define end classes and classifying patients that had both clinical meaning and cost homogeneity.

The costing study required immense detail in study design and infrastructure development, as the study needed to account for the vast range of presentations, co-morbidities and social and geographic factors that have the potential to drive cost in emergency care.

HPA lead a consortium that coordinated the national one-month costing study data collection in 10 public hospital emergency departments across Australia. The collectioncaptured 43,175 emergency department presentations, the bulk of which was collected by emergency care physicians themselves. This meant that collection infrastructure and procedure needed to be intuitive and non-intrusive to clinician workflow.  

The costing study data was coupled with that data the hospitals collect routinely for the National Hospital Cost Data Collection (NHCDC), with all variables and interactions analysed individually to estimate how well they predicted costa proxy for patient complexity.

The final AECC was developed using a combination of statistical analysis and clinical input to ensure that the splits in the classification were statistically and clinically valid.The final result, including statistical models that underpin the classification, were reviewed by an independent reviewer, thus providing further assurance of the quality of the resulting classification.

The AECC has 181 end classes (including pre-ECDG—Level 1 classes—and error classes). You can read all of our reports covering the vast pieces of work the went into the AECC development here at the IHPA Website.