Patient and customer classification systems are processed to yield routine information on service provision. After classification, the information is available to support the design, organisation and management of services.
The casemix systems of patient classification have been developed and maintained in cooperation with social and health care organisations. The systems used for the classification are
- EPR patient classification for the entire treatment path of the patient
- Comprehensive episode-based pDRG® classification of basic outpatient health care
- Episode-based dDRG® classification of oral health care
- NordDRG® patient classification system for specialised health care
Classified patient and customer data create a knowledge base for improving health care, quality of care and cost-effectiveness. The data also forms the basis for measuring the effectiveness of treatment and its development.
Well-classified patient information that is easy to understand is essential in the planning and monitoring of the service network.
We have long and extensive experience in calculating the patient-specific cost of different health care services. The costs per patient model of cost calculation is widely used in specialised medical care and is also used in outpatient care, home care and other primary care services where there is a need for customer-specific cost calculation. The bottom-up, function-based, time-based, and interim-based cost calculation model is the basis for the cost calculation of different patient groups in patient and customer classification systems. The model makes it possible to calculate patient-specific or customer-specific costs in different social and health care services and their service packages.
The EPR classification connects the patient’s treatment and its costs throughout the service chain
All health services received by the patient may be combined into care episodes, irrespective of the care organisation or occupation of the caregiver. It may also include information on social services close to health care, such as home care, housing services and long-term institutional care. EPR episodes consist of patient-specific treatment of either one problem or related care procedures for illnesses. The classification uses the same grouping logic as the primary health care pDRG patient classification, and these two classifications can therefore be carried out simultaneously, depending on the scope of the baseline data to be used. The classification is structured in social and health care routine information, such as diagnoses (ICD10), causes of visits (ICPC2) and other information according to national classifications. The recording of separate statistics is unnecessary.
Treatment episodes serve as a basis for health care productisation
The intermediate performance-based cost per patient method is widely used for the calculation of the patient-specific cost of treatment in specialised medical care. It is the most accurate method of targeting costs according to health problems. The same method can be used to calculate costs, for example, in primary or home care as an EPR patient classification service.
The EPR system produces a diverse range of detailed information on the services provided to patients and their costs.
The assessment can be carried out by region or service provider and organisation, and reports can describe extensive treatment packages or the individual patient level.
Based on regional information, it is possible to compare the implementation and cost of treatment in different areas, identify a large number of patient groups, and monitor the impact of changes in the organisation of services and the cost of services. The organisation providing services will receive information from the EPR on its own patient populations and the costs of their treatment, the division of labour between the departments and the various professions, including the comprehensiveness of the diagnosis and the causes of the visit.
pDRG® combines primary care with outpatient activity and finances
pDRG® (primary care diagnosis-related groups) is an episode-based primary care patient classification and productisation system developed in Finland. It combines patient care data with organisational cost and personnel data. The results provide information on patient-specific actual costs and use of services. The system enables the planning of future activities and evaluation of the necessary resources in a customer-oriented manner.
The treatment episode is formed when patient visits and tests are grouped into health care groupings. Patient-specific costs are calculated using the organisation’s financial statements and personnel information. The result is the care groupings formed from the various health problems and the cost of producing them.
The easy-to-use system is based on data on the reason for visits and diagnostic data routinely collected in the patient information system. It does not require any additional statistics from the care professionals.
- Examples of data use
- Guidance of operations and knowledge-based management
- Assessment of population service needs
- Development of the organisation’s operating processes
- Internal and mutual cost comparison of locations
- Assessment of the division of labour between human resources and professional groups
- Benchmarking between organisations
- Basis for invoicing and budgeting, as well as a pricing aid
- Assessment of quality and health benefits achieved.
The pDRG system is owned by the Association of Finnish Local and Regional Authorities, which also directs and monitors its development. Further information is also available on the web pages of the patient grouping and productisation systems of the Association of Finnish Local and Regional Authorities.
dDRG produces a unified service production description for oral health care
The dental care diagnosis-related group (dDRG) is an episode-based patient classification and branding system developed for oral health care. The system provides information on the health service needs of the population, the reasons for the use of services and the resources used in providing the services.
The system combines the patient’s oral health information with the cost and personnel data of the organisation to obtain episodes of oral health problems. The costs are calculated with the cost per patient model, which is also used in other patient and customer classification systems. The system is based on routine patient, diagnostic and procedure data entered in the patient information system.
Based on the information, the organisation can review patient-specific or episode-specific costs, use of resources from different professions, and plan activities. The information can be used to guide and plan oral health operations and finances. In addition, the information is used to support the measurement of quality and health benefits.