Back in June, we let you know that VAHI was withdrawing the death in low mortality diagnosis-related groups (DRGs) measure from its reports. Following a full methodological review, VAHI will re-introduce the revised measure into its Inspire report for release later this month.
The death in low mortality DRGs measure is intended to capture deaths resulting from episodes of care that are coded to DRGs that have a very low chance of death (i.e. less than 0.5% based on historical data) so that those cases can be reviewed to assess whether quality of care played a role in the outcome.
However, health services and clinicians consistently provided feedback to VAHI that the death in low mortality DRGs measure identified deaths that were not necessarily associated with low mortality conditions. These patients could not have been reasonably considered as ‘unlikely’ deaths.
To review the methods used for this measure, VAHI convened an Expert Advisory Group, comprising clinicians, measurement experts from ACSQHC and the NSW Bureau of Health Information, and representatives from Safer Care Victoria and VAHI. This group worked to review patterns in the false positives identified by selected hospitals and to identify diagnoses classified into low mortality DRGs where death was not an unlikely outcome.
The Expert Advisory Group recommended that the deaths of patients who have a primary diagnosis of palliative care should be excluded from the measure, but only if the admission did not involve a procedure (apart from certain non-invasive allied health procedures). The Expert Advisory Group recommended that deaths of patients who had a primary diagnosis of palliative care and who underwent other procedures should continue to be reported and reviewed.
VAHI has adopted these recommendations and is again reporting the measure, commencing with the February Inspire. The new palliative care exclusion has resulted in a statewide drop of 19% in the number of deaths reported by the measure over the previous year. VAHI will continue to seek feedback on this measure over the next few reporting quarters to see if further refinements to the methodology are required.
We would like to thank the members of the Expert Advisory Group for their contributions to the refinement of this measure.
If you have any queries about this measure, please contact Paula Wilton, Director, Clinical Analytics and Outcomes Research via email@example.com.