Even though the episode was considered as high complexity for the adjustment for HAC02 was greater and therefore selected for the adjustment. This assessment is performed on an episode level for all HAC episodes. As the adjustments have been designed and calculated at an episode allowing for aggregation to a jurisdiction, LHN or hospital level to determine the aggregate impact. The issues and other considerations of developing a funding adjustment for safety and quality are discussed further in Section 8.1. Vignettes The following clinical examples demonstrate the application of the risk adjustment model and funding adjustments to individual episodes. Case one: falls resulting in fracture or intracranial injury low risk – A 27 year old female patient was a booked admission to day surgery for a cholecystectomy. She had no comorbid conditions. Following the surgery, she slipped and fell in the ward, hitting her head on the floor. A computed tomography (CT) scan showed a subdural haematoma. The patient was transferred to the tertiary hospital for further treatment and surgery. Table 15 breaks down the complexity and adjustment calculations for case one. Table 15: Case one breakdown: HAC02 Falls resulting in fracture or intracranial injury Complexity score calculations Risk factor breakdown Complexity Score Baseline 45.8 Age Group :025 to 029 +0 Charlson Score =0 +0 DRG Type: Surgical +2.6 Gender: Female +0.7 MDC: Diseases & Disorders of the Hepatobiliary System & -3.8 Pancreas Emergency admission: No +0 ICU Hours: No +0 Admission transfer status: No +0 Total 45.3 Adjustment calculations Complexity group Low Incremental cost 6.7%
Even though the episode was considered as high complexity for the adjustment for HAC02 was greater and therefore selected for the adjustment. This assessment is performed on an episode level for all HAC episodes. As the adjustments have been designed and calculated at an episode allowing for aggregation to a jurisdiction, LHN or hospital level to determine the aggregate impact. The issues and other considerations of developing a funding adjustment for safety and quality are discussed further in Section 8.1. Vignettes The following clinical examples demonstrate the application of the risk adjustment model and funding adjustments to individual episodes. Case one: falls resulting in fracture or intracranial injury – low risk A 27 year old female patient was a booked admission to day surgery for a cholecystectomy. She had no comorbid conditions. Following the surgery, she slipped and fell in the ward, hitting her head on the floor. A computed tomography (CT) scan showed a subdural haematoma. The patient was transferred to the tertiary hospital for further treatment and surgery. Table 15 breaks down the complexity and adjustment calculations for case one. Table 15: Case one breakdown: HAC02 Falls resulting in fracture or intracranial injury Complexity score calculations Risk factor breakdown Complexity Score Baseline 45.8 Age Group :025 to 029 +0 Charlson Score =0 +0 DRG Type: Surgical +2.6 Gender: Female +0.7 MDC: Diseases & Disorders of the Hepatobiliary System & Pancreas -3.8 Emergency admission: No +0 ICU Hours: No +0 Admission transfer status: No +0 Total 45.3 Adjustment calculations Complexity group Low Incremental cost 6.7%
risk_adjustment_model_for_hospital_acquired_complications_-_technical_specifications_v1.0_july_2017.docx