Hospital-acquired diagnoses and their effect on case complexity and resource use

Australian Commission on Safety and Quality in Health Care, 2013

The Australian Commission on Safety and Quality in Health Care (the Commission), working in collaboration with the Independent Hospital Pricing Authority (IHPA), engaged Health Policy Analysis to analyse hospital-acquired diagnoses and their effect on case complexity and resource use.

The Commission and IHPA are exploring ways in which data routinely collected by hospitals can be used towards improving safety and quality. One of the variables available in these data is a flag against each diagnosis for a patient, identifying which ones were pre-existing at the time of the patient’s admission to hospital, and which ones arose during the hospital stay. This is known as the condition onset flag (COF), and has been collected in a standardised way on a national basis in Australia since 1 July 2008. The COF provides a basis for examining hospital-acquired diagnoses. While it is acknowledged that the COF has limitations as a measure of quality of care, one of the purposes of this project was to explore its potential use.

The specific issues examined in this study included: the completeness and accuracy with which public hospitals record the COF; the impact of excluding hospital-acquired diagnoses in assigning Australian-Refined Diagnosis Related groups (AR-DRGs) and, hence, the impact on the prices payable for certain services; the incremental impact of hospital-acquired diagnoses on costs and bed days that are incurred over and above the cost of uncomplicated care. A final report has been submitted to the Commission and IHPA who are now exploring the feasibility of incorporating pricing signals regarding quality under activity based funding.