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Service delivery planning
Published in Noel Austin, Sue Dopson, The Clinical Directorate, 2018
Perhaps the first point to address is ‘What is meant by a service?’. In the NHS of today, you must define your services in terms of how commissioners or GP fundholders wish to contract for or purchase them. In other words, a service is likely to consist of everything that happens to a patient during a stay in hospital, from admission, clerking by the house officer, all consultant involvement, diagnostic tests, procedures, drugs, therapies, social work involvement, and discharge, perhaps even including follow-up outpatients appointments and any subsequent re-admissions. In other words, codes currently used by doctors to describe patient diagnoses or procedures, such as Read codes, ICD-9, or OPCS-4, are unlikely to be adequate. The most promising candidate appears to be the newly defined Healthcare Resource Groups (HRGs), which are superior to Diagnostic Resource Groups (DRGs) in that an individual HRG covers only one diagnosis. DRGs, which were developed for the US insurance industry, often cover unrelated conditions with similar costs – fine for insurers but useless for service planning.
Practice Accounts and Collection of Fees
Published in Christopher Locke, Private Medical Practice, 2018
Medical health insurance claim forms have to be signed or validated either by the consultant who has carried out the treatment or the patient’s GP, according to the rules of that particular insurance scheme. In completing the account of treatment carried out, specialists should describe the diagnosis and investigative procedures or operations in full. Most insurers use a coding system for operations based on the OPCS 4 classification of operations (with elements of the Korner codings for consultations and diagnostic procedures). With minor differences of interpretation these codes are common to the BUPA and PPP schedules and the BMA Guidelines.
Contracting for change
Published in Rod Smith, Fran Butler, Mike Powell, Chris Ham, Total Purchasing a model for locality commissioning, 2018
HRGs are clinically meaningful groups of treatments that are considered to use approximately the same level of resources. Groups are defined using primary and secondary procedures (OPCS 4 codes) and diagnoses (ICD 9 and 10 codes) and can be further split by age and complications or co-morbidities. There were in 1995 (Version 2) 528 groups divided into 16 chapters based on various body systems. HRGs are important to both purchasers and providers because they can be used to measure casemix within a contract.
Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years
Published in Acta Orthopaedica, 2019
Simon G F Abram, Andrew Judge, Tanvir Khan, David J Beard, Andrew J Price
The primary outcome was the rate of knee arthroplasty following ACL reconstruction. All HES and ONS records (including prior and subsequent hospital admission records) were then extracted for each patient with OPCS-4 codes for either ACL reconstruction or knee arthroplasty. Laterality coding was available to enable matching of procedures both by patient and by knee side (left vs. right). For patients undergoing ACL reconstruction, concurrent chondral or meniscal procedure codes were identified and included for comparison with isolated ACL reconstruction procedures. Per patient, only the first (primary) ACL reconstruction was included. Patients undergoing simultaneous knee arthroplasty and ACL reconstruction in the same hospital episode were excluded as these were not considered to be relevant to this study. Secondary outcomes were the relative odds of knee arthroplasty by a range of patient factors (defined below), and the relative risk of knee arthroplasty versus the control population defined above.
The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients
Published in Acta Orthopaedica, 2019
Gulraj S Matharu, Sofia Mouchti, Sarah Twigg, Antonella Delmestri, David W Murray, Andrew Judge, Hemant G Pandit
Where available, primary care records from CPRD were linked to secondary care admission records from Hospital Episodes Statistics Admitted Patient Care data (HES) and to the Office for National Statistics (ONS) database. HES uses International Classification of Diseases 10th revision (ICD-10) records diagnoses and the Office of Population Censuses and Surveys version 4 (OPCS-4) procedures to record diseases, complications, interventions, and procedures from secondary care. From April 1, 2009, HES provided PROMs data before and 6 months following THA and TKA (see below). The ONS provides data on all-cause mortality.
Comorbid diseases and conditions in people with HIV in the UK
Published in Current Medical Research and Opinion, 2022
Bethan I. Jones, Andrew Freedman, Melissa J. Thomas, Celia Villalba-Mendez, Leena Sathia, Deborah Flanagan, Scott Francis, Craig J. Currie
Read codes are used to record diagnoses, symptoms and procedures in CPRD primary care data, whilst diagnoses and procedures are coded in the HES data as International Classification of Disease (ICD-10), and Office of Population Censuses and Surveys Classification of Interventions and Procedures, version 4 (OPCS-4), respectively23,24.