Subject: Re: DRG WG
From: Kristiina Kahur <[email-masked]>
To: Nino Berdzuli <[email-masked]>
Cc: Zaza Sopromadze <[email-masked]>, Maia Khomeriki <[email-masked]>, "[email-masked]" <[email-masked]>, marina darakhvelidze <[email-masked]>, Ketevan Goginashvili <[email-masked]>, "[email-masked]" <[email-masked]>, Sarah Thomson <[email-masked]>, Marijan Ivanusa <[email-masked]>, "HABICHT, Triin" <[email-masked]>, "[email-masked]" <[email-masked]>
Date: Mon, 02 Oct 2017 18:40:02 +0000

Dear all,

This is to inform you that we had another Skype meeting today.

The aim of the meeting was to present the preliminary results of the grouping.

Main findings were presented and discussed (and also attached to the email).

The whole database with information about DRG grouping results was shared after the meeting (Triin to Maia).

As for next steps, the data with grouping results should be analyzed by SSA staff (by involving other specialists if needed). The main focus should be on error DRGs and the content
of the cases. Error DRGs have grouped to DRG470. My suggestion is to use the results of Finnish grouping for that because there are introduced DRG470 subgroups (470A, 470B, etc) which provide more precise information about the source of error.

It has to be taken into account, that many ICD10 codes in Finnish version (especially in chapter C and I) have 5 characters, while in Georgian version most codes have 4 characters,
and thus, the grouping result with Finnish grouper is DRG470 subgroups. This necessarily does not mean that there are coding issues. Instead, the reason is different ICD10 versions in both countries.

In addition, you may want to conduct some additional controls in the hospitals based on the grouping results. It concerns the DRGs 468, 468O, 477 and 477O where ca 140 cases were
grouped (see separate sheet in attached document). Those cases may have coding problems. But they also can be rear cases where the combination of main diagnosis and procedure is clinically meaningful. The best source to check it is medical record.

I will continue to work on data and submit the analytical report about the grouping results and assessment of SSA invoicing data quality and further use of them by the end of October/beginning
of November.

If you have any urgent questions, we can deal with them asap. Otherwise you can gather your comments/questions/feelings about the grouping results and we will discuss them as agreed
during another Skype call before November mission, preferable on week 47.

Thank you,

Kristiina

From: Kristiina Kahur

Sent: Tuesday, September 19, 2017 5:08 PM

To: Nino Berdzuli

Cc: Zaza Sopromadze; Maia Khomeriki; [email-masked]; marina darakhvelidze; Ketevan Goginashvili; [email-masked]; Sarah Thomson; Marijan Ivanusa; HABICHT, Triin

Subject: Re: DRG WG

Dear all,

We just had the Skype call today with Nino, Maia and colleagues and discussed the first results of the data we were provided last week.

I would like thank you (and Triin joins me) for the work you have done to derive the data from your database and prepare them for first check.

The general picture looks good.
Data includes 108808 unique rows.

Nevertheless, there are some things which need to be fixed before we can proceed with the grouping exercise.

In current stage we focus only for data needed for groping, and only after that we start to deal with different tariffs and cost related data.

Here are the main findings followed by actions to be taken. The findings follow the order of data-fields needed for grouping:

Case ID (column A).

CaseDistplayNumber is used. It’s a unique number and can be used later for linking additional data if needed.

No action needed

Main diagnosis (column AA)

in 248 cases the main diagnosis is missing

Action: to find the main diagnosis for those cases.

in 28 cases instead of diagnosis code “hemotransfusion” is used.

Action: to find correct main diagnosis code for those cases and use NCSP code for hemotransfusion
(if there exist one in GEO version)

Secondary diagnosis (columns AB-AJ)

in some cases instead of diagnosis code “hemotransfusion” and “haemodialysis” is used.

Action: to find correct secondary diagnosis code for those cases (if coded) and use NCSP
codes for those procedures (if there exist one in GEO version)

Procedure codes

There are 16 columns for procedure codes

NCSP_ძირითადი_2-
NCSP_ძირითადი_8
(#7)

NCSP_თანმხლები_1-
NCSP_თანმხლები_9
(#9)

Action: The names of the columns need to be clarified. In addition, it should be checked
whether or not some columns are duplicating each other. If so, the duplicates need to be removed.

Gender (column C)

Information is there but it needs formatting

Action: If male -> use 1, if female -> use 2, if unknown –> use 3

Age (column D)

AgeInDays, the age ranges from 0 to 35272 days (0-99 years) and should be ok

No action needed

Discharge

For this the HospitalizationOutcome (column N) can be used. This information should be mapped to four different characters needed for grouping:

1=any other including normal discharge to home or unknown

2=transferred to another hospital

3=left against medical advice

4=dead

Action:
map every HospitalizationOutcome characteristic (9 different in the table) to one of the above (1-4). Add respective column "Discharge" in the table. Keep column "HospitalizationOutcome".

Length of stay (LOS)

Information is correct (minus one case).

Action:
Check the case 3310497435, were LOS is -5540.

Birthweight (column S)

1170 cases with birthweight information in the data.

Birthweight ranges from 300g to 7000g? Is 300 and 7000g correct?

In 25 cases the birthweight information seems not to be relevant because the age of those cases ranges from 18 to 39 years

Action:
Check the age of those patients. If incorrect, correct the age. If correct, there is no need for birthweight information.

There is one more comment regarding the OrganizationType (column Y). There are 62 cases where the organization type is Family Medicine Center. Most of the cases (#49) are related to cataract issues, some of
them have procedure codes reflecting the cataract surgery. Are those cases relevant to Family Medicine Centre? Can there be the coding issues or do the ophthalmologist work in Family Medicine Centres and provide respective services?

We agreed that the corrected data will be provided by Friday 22nd Sept, if possible. If not, then by Monday 25th
Sept, as latest.

The next steps (given that the data are ok):

Final preparation for grouping
(week 39).

general check

replacing the NCSP+ code with Estonian and Finnish NCSP codes

replacing the birthweight information with respective ICD10 codes which are currently missing in ICD10 version used in Georgia

Grouping the data with NordDRG grouper (EST/FIN)
(week 39).

Providing the preliminary results of the grouping to working group (via Skype, preliminary meeting agreed on 2nd Oct)

Providing
feedback
to SSA for additional check of certain cases with suspicious coding quality (50-100 cases), based on the grouping results
(week 40).

Agree on next steps regarding cost analyses by using current SSA and providers’ tariffs
(tbc).

Thank you once again and looking forward to getting the corrected data so that we can proceed with action our plan.

Regards,

Kristiina

From: Nino Berdzuli

Sent: Friday, September 1, 2017 5:04 PM

To: Triin Gmail

Cc: [email-masked]; Zaza Sopromadze; Maia Khomeriki; [email-masked]; marina darakhvelidze; Ketevan Goginashvili; [email-masked]; Sarah Thomson; Marijan Ivanusa

Subject: Re: DRG WG

Hi Triin,

Thanks for your email and reminder. Just to clarify, have you received data that was supposed to be send by August 31st?

Initial deadline August 20th for data requested was too optimistic given vacation times and amount of work related with data extraction. Let's plan to catch up next week - I will also ask Zaza.

Thanks!

Sent from my iPhone

On Sep 1, 2017, at 5:39 PM, Triin Gmail <[email-masked]> wrote:

Dear Nino and colleagues,

Hope you are all doing fine! Have you had a possibility to discuss the data query related issues and to check initial due date was too optimistic and we have to reconsider our initial action plan?

Just let us know if you have any questions you would like to discuss or if it would be helpful to have a quick call etc.

With all the best,

Triin

On 25 Aug 2017, at 17:14, Nino Berdzuli <[email-masked]> wrote:

Triin, thank you for a response and update. I very much hope that data extraction and requested data set will be available for your review next week.

I am asking Maia to check the progress on data extraction early next week and inform the group if there any challenges in this regard.

Happy weekend everyone!

Nino

Sent from my iPhone

On Aug 25, 2017, at 5:49 PM, Triin Gmail <[email-masked]> wrote:

Dear Nino and all others,

Formation of the working group is very much welcomed and definitely helps to better coordinate activities between ourselves to be timely in agreed activities and to discuss any obstacles that put timeliness into threat. Thank
you for doing that!

Just a quick update of the recent developments. We got feedback from Maia that data preparation takes a bit more time than initially expected and hopefully data becomes available by next Thursday. At this stage we don't need
to revise due dates of next activities but we can come back to that if data extraction is more challenging than was assumed. This can be a case as most probably this data query format is new for you and may need some more efforts. And if there are any questions
related to data then don't hesitate to contact to Kristiina and me.

We could agree also the teleconference time after we have got a data and have had a first look on that.

Let's be in touch!

Best

Triin

On 24 Aug 2017, at 09:10, Nino Berdzuli <[email-masked]> wrote:

Dear Triin and Kristin,

Hope this e-mail finds you very well. Let me thank you both for a very productive mission, practical work/recommendations provided, next steps identified to start and advance DRG-related work. We
are very much looking forward to working with you and make the best use of resources allocated through the UHC-Partnership program.

We have created DRG working group (in the cc) so that communication and exchange of information on DRG related work will be within this group. This will also help to track progress of on-going work.
I am also enclosing in this e-mail translated in Georgian next steps/timelines to remind the group deliverables and deadlines.

Thanks again and look forward to hearing the work progress soon.

მოგესალმებით
DRG-ის სამუშაო ჯგუფის წევრებს,

გთხოვთ ძირითადი კომუნიკაცია
DRG-ისთან დაკავშირებით აწარმოოთ სამუშაო ჯგუფის ყველა წევრის ჩართულობის უზრუნველყოფით.

ასევე, მინდა შეგახსენოთ DRG
-ის პროცესთან დაკავშირებული შემდეგი ნაბიჯები და დედლაინები რომელზეც შევთანხმდით კონსულტანტების ვიზიტის დროს (იხილეთ ბმულში). გთხოვთ, უზრუნველყოთ დედლაინების დაცვა.

გმადლობთ,

ნინო

Nino Berdzuli, MD, MPH

Deputy Minister

Ministry of Labor, Health and Social Affairs

144 Tsereteli Ave

Tbilisi 0119, Georgia

Tel: +995 32 251 00 27 ext 0502

www.moh.gov.ge