Class Diagram for a Hospital Management System TRUE SUS Payment

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Class Diagram for a Hospital Management System TRUE SUS Payment Powered By Docstoc
					TRUE




       SUS Payment By Results

       Admitted Patient Care File Extract Specifications

       for managed service



                                     Version 1.13
                                     26th August 2005
SUS PbR                                                          Index                                               Managed Service APC
                                                                                                                      Extracts Version 1.2



                      Managed Service APC Extracts Version 1.3


                      Index          Worksheet                         Centre Text
                          1          SheetIndex
                          2          Spell                             Spells
                          3          Episodes                          Episodes
                                                                       Appendix A
                                     SpellErrorCode
                          4                                            Spell Error Codes
                                                                       Appendix B
                                     EmergencyReadmission
                          5                                            Emergency readmission




12/13/2010:12:20 PM                                                2                           279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:SheetIndex
SUS PbR                                                                 Spells                                      Managed Service APC
                                                                                                                     Extracts Version 1.3



                      Group          Seq                       Fields
               System                       1   SUS_VERSION                      System field
               Spell ID                     2   SPELL_ID                         Unique Spell ID following SUS Spell creation
               Future use                   3   PID_IS_PSEUDONYMISED             For later use, to allow records containing
                                            4   POSTCODE_IS_PSEDONYMISED         pseudonymised data to be distinguished.
                                            5   DOB_IS_PSEUDONYMISED
               Patient Identifiers          6   LOCAL_PATIENT_ID                 As NHS data dictionary
                                            7   ORG_CODE_LOCAL_PATIENT_ID
                                            8   ORG_CODE_LPI_ORIG                Value after testing against reference files
                                            9   ORG_CODE_TYPE_LOCAL_PATIENT_ID
                                           10   NHS_NUMBER
               Birth and age               11   BIRTH_DATE                       As NHS data dictionary
                                           12   AGE_ON_ADMISSION
                                           13   AGE_SPELL_START_ORIG             Value after testing against reference files
                                           14   AGE_ON_DISCHARGE
                                           15   AGE_SPELL_END_ORIG
               Other person data           16   CARER_SUPPORT_INDICATOR          As NHS data dictionary
                                           17   LEGAL_STATUS_CODE
                                           18   LEGAL_STATUS_ORIG                Value after testing against reference files
                                           19   ETHNIC_CATEGORY
                                           20   ETHNIC_CATEGORY_ORIG             Value after testing against reference files
                                           21   MARITAL_STATUS
                                           22   NHS_NUMBER_STATUS
                                           23   SEX
                                           24   GENDER_ORIG                      Value after testing against reference files
                                           25   POSTCODE_USUAL_ADDRESS
                                           26   POSTCODE_SECTOR_USUAL ADDR
                                           27   AREACODE_USUAL_ADDR_ORIG         Value after testing against reference files
                                           28   PCT_OF_RESIDENCE
                                           29   PCT_RESIDENCE_CODE_ORIG          Value after testing against reference files
                                           30   ORG_CODE_TYPE_PCT_OF_RESIDENCE




12/13/2010:12:20 PM                                                       3                           279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Spell
SUS PbR                                                                Spells                                          Managed Service APC
                                                                                                                        Extracts Version 1.3



                      Group         Seq                       Fields
               Spell, Admission           31   HOSPITAL_SPELL_NO                    As NHS data dictionary
               & discharge                32   HOSPITAL_SPELL_NO_IS_PSEUDONYMISED
                                          33   ADMINISTRATIVE_CATEGORY
                                          34   PATIENT_CLASSIFICATION
                                          35   PATIENT_CLASSIFICATION_ORIG          Value after testing against reference files
                                          36   ADMISSION_METHOD
                                          37   ADMISSION_METHOD_ORIG                Value after testing against reference files
                                          38   DISCHARGE_DESTINATION
                                          39   DISCHARGE_DESTINATION_ORIG           Value after testing against reference files
                                          40   DISCHARGE_METHOD
                                          41   DISCHARGE_METHOD_ORIG                Value after testing against reference files
                                          42   ADMISSION_SOURCE
                                          43   ADMISSION_SOURCE_ORIG                Value after testing against reference files
                                          44   ADMISSION_DATE
                                          45   DISCHARGE_DATE
               Contract                   46   COMMISSIONER_SERIAL_NO               As NHS data dictionary
               identifiers                47   AGREEMENT_LINE_NO
                                          48   PROVIDER_REFERENCE_NO
                                          49   COMMISSIONER_REFERENCE_NO
               Provider &                 50   PROVIDER_CODE                        As NHS data dictionary
               Commissioner               51   PROVIDER_CODE_ORIG                   Value after testing against reference files
                                          52   PROVIDER_SITE_CODE                   Value after testing against reference files
                                          53   ORG_CODE_TYPE_PROVIDER
                                          54   COMMISSIONER_CODE
                                          55   COMMISSIONER_CODE_ORIG               Value after testing against reference files
                                          56   COMMISSIONER_SITE_CODE               Value after testing against reference files
                                          57   ORG_CODE_TYPE_COMMISSIONER
               Treatment function         58   TREATMENT_FUNCTION_CODE              As NHS data dictionary
                                          59   SPECIALTY_FUNCTION_CODE_ORIG         TFC Value after testing against reference files




12/13/2010:12:20 PM                                                      4                               279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Spell
SUS PbR                                                            Spells                                      Managed Service APC
                                                                                                                Extracts Version 1.3



                      Group     Seq                       Fields
               Future use             60   READY_FOR_DISCHARGE_DATE         Will return data relating to delay discharge
                                      61   DELAY_DISCHARGE_REASON           when available
               GP & referrer          62   REGISTERED_GMP_CODE              As NHS data dictionary
                                      63   GP_CODE_ORIG                     Value after testing against reference files
                                      64   GP_PRACTICE_CODE
                                      65   ORG_CODE_TYPE_GP_PRACTICE
                                      66   REFERRER_CODE
                                      67   REFERRER_CODE_ORIG               Value after testing against reference files
                                      68   ORG_CODE_REFERRER
                                      69   ORG_CODE_TYPE_REFERRER
               Wait & stay            70   ELECTIVE_WAIT_DURATION           As NHS data dictionary
                                      71   INTENDED_MANAGEMENT
                                      72   DECISION_TO_ADMIT_DATE
               PbR dates and          73   PBR_SPELL_START_DATE             Start of first non-excluded episode
               days                   74   PBR_SPELL_END_DATE               End of last non-excluded episode
                                      75   LENGTH_OF_STAY                   Total non-excluded days
                                      76   EXCLUDED_CC_DAYS                 Critical care days within PbR spell
                                      77   INCLUDED_CC_DAYS                 Critical care days outside PbR spell
               In spell PbR           78   NO_COMMISSIONERS                 N of distinct commissioners of PbR Spells
               counts                 79   NO_EXCLUDED_EPISODES             N of excluded episodes in spell
               Trimpoint              80   SPELL_TRIMPOINT_DAYS             Trimpoint of spell HRG
               (from Dominant         81   ADJ_LENGTH_OF_STAY
               episode)               82   DAYS_BEYOND_TRIMPOINT            Spell PbR days beyond spell trimpoint
               Service ID             83   SERVICE_ID                       Service ID for service top-up
                                      84   SERVICE_ORIG                     Value after testing against reference files
                                      85   APPLIED_MFF                      Currently set to 1 in all cases
               Payment                     TARIFF_INITIAL_AMOUNT            Tariff for dominant episode HRG before
               breakdown              86                                    adjustment
                                      87   TARIFF_SS_ADJUSTMENT             Short stay adjustment
                                      88   TARIFF_SERV_ADJUSTMENT           Specialised service adjustment
                                      89   TARIFF_FINAL_AMOUNT              Tariff after adjustment
                                      90   TARIFF_LS_RATE                   Long stay (Beyond trimpoint) rate
                                      91   TARIFF_LS_PAYMENT                Long stay (beyond trimpoint) payment
                                      92   TARIFF_TOTAL_PAYMENT             Total payment for spell




12/13/2010:12:20 PM                                                  5                           279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Spell
SUS PbR                                                                  Spells                                       Managed Service APC
                                                                                                                       Extracts Version 1.3



                      Group          Seq                        Fields
               Extended open               93   EXTENDED_OPEN_SPELL_IND           Later use - to support analysis of spells which
               spell                       94   EXTENDED_OPEN_DATE                have been open fo an extended period at year
                                           95   PREV_EXTEND_SPELL_ID              end
               Freeze & spell                   EFFECTIVE_DATE
               status                      96                                     Date to which freeze applies
                                           97   SPELL_STATUS_IND                  Spell status
                                           98   SPELL_FROZEN_IND                  Indicates whether spell frozen
               Spell Qualification         99   PBR_QUALIFIED_INDICATOR           Indicates whether spell qualifies for PbR
               for payment                                                        0 - qualifying, 2 - excluded, 4 - ended prior 1st
                                                                                  April 2004
                                       100      EXCLUSION_REASON                  Text reason spell not qualified
               14 day readmission      101      READMISSION_IND                   See EmergencyReadmission
               indicator               102      NO_SPELLS_PRIOR_READMIN           for detail
                                       103      NO_SPELLS_FOLL_READMIN
                                       104      SPELL_ID_FIRST_READMIN
                                       105      COSTED_INDICATOR
                                       106      APPLICABLE_COSTING_PERIOD
                                       107      HRG_SUBMITTED                     The HRG submitted by the Provider
                                       108      SUBMITTED_HRG_CODE_ORIG           Value after testing against reference files
                                       109      HRG_VERSION_SUBMITTED             The HRG version submitted by the provider
                                       110      SUBMITTED_HRG_VER_ORIG            Value after testing against reference files
                                       111      HRG_CALCULATED                    The HRG version calculated by SUS
                                       112      CALC_HRG_CODE_ORIG                Value after testing against reference files
                                       113      HRG_VERSION_CALCULATED            The version of HRG calculated by SUS
                                       114      CALC_HRG_VER_ORIG                 Value after testing against reference files
                                       115      SPELL_ERROR_STATUS                As set out in sheet SpellErrorCode




12/13/2010:12:20 PM                                                        6                            279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Spell
SUS PbR                                                             Episodes                                                     Managed Service APC
                                                                                                                                  Extracts Version 1.3


                 Group         Seq                    Fields                                                 Comment
                                  1   SUS_VERSION                              System field
         Record ID                2   NHS_DEFINED_RID                          The NHS provided Unique Record Identifier if provided
         Future use               3   For future use
         Spell ID                 4   SPELL_ID                                 Unique Spell ID following SUS Spell creation
                                  5   CDS_RECORDS_TYPE                         CDS record type as defined in the CDS Manual
         Future use               6   PID_IS_PSEUDONYMISED                     For later use, to allow records containing pseudonymised data to
                                  7   POSTCODE_IS_PSEUDONYMISED                be distinguished.
                                  8   DOB_IS_PSEUDONYMISED
         Patient Identifiers      9   LOCAL_PATIENT_ID                         As NHS data dictionary
                                 10   ORG_CODE_LOCAL_PATIENT_ID
                                 11   ORG_CODE_LPI_ORIG                        Value after testing against reference files
                                 12   NHS_NUMBER
         Birth and age           13   BIRTH_DATE                               Age related items
                                 14   AGE_EPISODE_START
                                 15   AGE_EPISODE_END
         Other person data       16   CARER_SUPPORT_INDICATOR                  As NHS data dictionary
                                 17   LEGAL_STATUS_CLASSIFICATION              Value after testing against reference files
                                 18   LEGAL_STATUS_ORIG
                                 19   ETHNIC_CATEGORY
                                 20   ETHNIC_CATEGORY_ORIG                     Value after testing against reference files
                                 21   MARITAL_STATUS
                                 22   NHS_NUMBER_STATUS
                                 23   SEX
                                 24   GENDER_ORIG                              Value after testing against reference files
                                 25   TOTAL_PREVIOUS_PREGNANCIES
                                 26   POSTCODE_USUAL_ADDRESS
                                 27   AREACODE_USUAL_ADDR_ORIG                 Value after testing against reference files
                                 28   PCT_OF_RESIDENCE
                                 29   PCT_RESIDENCE_CODE_ORIG                  Value after testing against reference files




12/13/2010:12:20 PM                                                    7                                       279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                       Episodes                                                     Managed Service APC
                                                                                                                            Extracts Version 1.3


                 Group      Seq                    Fields                                              Comment
         Spell, Admission     30   HOSPITAL_SPELL_NO                     As NHS data dictionary
         & discharge          31   ADMINISTRATIVE_CATEGORY
                              32   PATIENT_CLASSIFICATION
                              33   PATIENT_CLASSIFICATION_ORIG           Value after testing against reference files
                              34   ADMISSION_METHOD
                              35   ADMISSION_METHOD_ORIG                 Value after testing against reference files
                              36   DISCHARGE_DESTINATION
                              37   DISCHARGE_DESTINATION_ORIG            Value after testing against reference files
                              38   DISCHARGE_METHOD
                              39   DISCHARGE_METHOD_ORIG                 Value after testing against reference files
                              40   ADMISSION_SOURCE
                              41   ADMISSION_SOURCE_ORIG                 Value after testing against reference files
                              42   ADMISSION_DATE
                              43   DISCHARGE_DATE
         Episode in spell     44   EPISODE_NUMBER                        As NHS data dictionary
         no / flags           45   FIRST_REG_DAY_NIGHT_ADMISSION
                              46   LAST_EPISODE_IN_SPELL_IND
         Additional spell     47   NEONATAL_LEVEL_OF_CARE
         data                 48   OPERATION_STATUS
                              49   PSYCHIATRIC_PATIENT_STATUS
                              50   NO_AUGMENTED_CARE_PERIODS
         Episode dates        51   EPISODE_START_DATE
                              52   EPISODE_END_DATE
         Contract             53   COMMISSIONER_SERIAL_NO
         identifiers          54   AGREEMENT_LINE_NO
                              55   PROVIDER_REFERENCE_NO
                              56   COMMISSIONER_REFERENCE_NO
         Provider &           57   PROVIDER_CODE
         Commissioner         58   PROVIDER_CODE_ORIG                    Value after testing against reference files
                              59   PROVIDER_SITE_CODE                    Value after testing against reference files
                              60   COMMISSIONER_CODE
                              61   COMMISSIONER_CODE_ORIG                Value after testing against reference files
                              62   COMMISSIONER_SITE_CODE                Value after testing against reference files




12/13/2010:12:20 PM                                                8                                     279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                   Episodes                                                     Managed Service APC
                                                                                                                        Extracts Version 1.3


                 Group   Seq                    Fields                                             Comment
         Consultant &      63   CONSULTANT_CODE
         specialty         64   MAIN_SPECIALTY_CODE
                           65   TREATMENT_FUNCTION_CODE
                           66   SPECIALTY_FUNCTION_CODE_ORIG         Value after testing against reference files
         GMP &             67   REGISTERED_GMP_CODE
         referrer          68   GP_CODE_ORIG                         Value after testing against reference files
                           69   GP_PRACTICE_CODE
                           70   REFERRER_CODE
                           71   REFERRER_CODE_ORIG                   Value after testing against reference files
                           72   REFERRING_ORG_CODE
         Wait & stay       73   ELECTIVE_WAIT_DURATION               As NHS data dictionary
                           74   INTENDED_MANAGEMENT
                           75   DECISION_TO_ADMIT_DATE
                           76   LENGTH_OF_STAY
                           77   EFFECTIVE_DATE
                           78   APPLICABLE_COSTING_PERIOD
         Episode level     79   HRG_SUBMITTED                        The HRG submitted by the Provider
         HRG data          80   SUBMITTED_HRG_CODE_ORIG              Value after testing against reference files
                           81   HRG_VERSION_SUBMITTED                The HRG version submitted by the provider
                           82   SUBMITTED_HRG_VER_ORIG               Value after testing against reference files
                           83   HRG_CALCULATED                       The HRG version calculated by SUS
                           84   HRG_VERSION_CALCULATED               The version of HRG calculated by SUS
                           85   HRG_DIFFERS_IND                      Set if there is a difference between SUS calculated and locally
                                                                     provdied values of HRG
         PbR Episode       86   SERVICE_ORIG                         The service ID associated with the episode (used to calculate
         level data                                                  specialist top-up)
                           87   DOMINANT_EPISODE_IND                 Indicates that episode is the the "dominant for pruposes of
                                                                     calculating he PbR tariff
                           88   PBR_QUALIFIED_INDICATOR              Indicates whether episode qualifies for PbR
                                                                     0 - qualifying, 1 - excluded
                           89   EXCLUSION_REASON                     Text - reason excluded




12/13/2010:12:20 PM                                            9                                     279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                      Episodes                                               Managed Service APC
                                                                                                                     Extracts Version 1.3


                 Group      Seq                   Fields                                         Comment
         Diagnoses block      90   DIAGNOSIS_SCHEME_IN_USE              As NHS data dictionary
                              91   PRIMARY_DIAGNOSIS _CODE
                              92   SECONDARY_DIAGNOSIS_CODE_1
                              93   SECONDARY_DIAGNOSIS_CODE_2
                              94   SECONDARY_DIAGNOSIS_CODE_3
                              95   SECONDARY_DIAGNOSIS_CODE_4
                              96   SECONDARY_DIAGNOSIS_CODE_5
                              97   SECONDARY_DIAGNOSIS_CODE_6
                              98   SECONDARY_DIAGNOSIS_CODE_7
                              99   SECONDARY_DIAGNOSIS_CODE_8
                             100   SECONDARY_DIAGNOSIS_CODE_9
                             101   SECONDARY_DIAGNOSIS_CODE_10
                             102   SECONDARY_DIAGNOSIS_CODE_11
                             103   SECONDARY_DIAGNOSIS_CODE_12
         Procedures block    104   PROCEDURE_SCHEME_IN_USE              As NHS data dictionary
                             105   PRIMARY_PROCEDURE_CODE
                             106   PRIMARY_PROCEDURE_DATE
                             107   PROCEDURE_CODE_2
                             108   PROCEDURE_DATE_2
                             109   PROCEDURE_CODE_3
                             110   PROCEDURE_DATE_3
                             111   PROCEDURE_CODE_4
                             112   PROCEDURE_DATE_4
                             113   PROCEDURE_CODE_5
                             114   PROCEDURE_DATE_5
                             115   PROCEDURE_CODE_6
                             116   PROCEDURE_DATE_6
                             117   PROCEDURE_CODE_7
                             118   PROCEDURE_DATE_7
                             119   PROCEDURE_CODE_8
                             120   PROCEDURE_DATE_8
                             121   PROCEDURE_CODE_9
                             122   PROCEDURE_DATE_9
                             123   PROCEDURE_CODE_10
                             124   PROCEDURE_DATE_10
                             125   PROCEDURE_CODE_11
                             126   PROCEDURE_DATE_11
                             127   PROCEDURE_CODE_12
                             128   PROCEDURE_DATE_12



12/13/2010:12:20 PM                                              10                               279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                   Episodes                                                  Managed Service APC
                                                                                                                     Extracts Version 1.3


                 Group    Seq                  Fields                                           Comment
         Augmented care    129   ACP_NUMBER_1                        Repeating blocks - As NHS data dictionary
                           130   ACP_START_DATE_1
                           131   ACP_SOURCE_1
                           132   ACP_INTENSIVE_CARE_DAYS_1
                           133   ACP_HIGH_DEPENDENCY_DAYS_1
                           134   ACP_ORGAN_SYSTEMS_SUPPORTED_1
                           135   ACP_PLANNED_INDICATOR_1
                           136   ACP_OUTCOME_INDICATOR_1
                           137   ACP_DISPOSAL_1
                           138   ACP_END_DATE_1
                           139   ACP_MAIN_SPECIALTY_CODE_1
                           140   ACP_LOCATION_CLASS_1
                           141   ACP_LOCATION_1
                           142   ACP_NUMBER_2
                           143   ACP_START_DATE_2
                           144   ACP_SOURCE_2
                           145   ACP_INTENSIVE_CARE_DAYS_2
                           146   ACP_HIGH_DEPENDENCY_DAYS_2
                           147   ACP_ORGAN_SYSTEMS_SUPPORTED_2
                           148   ACP_PLANNED_INDICATOR_2
                           149   ACP_OUTCOME_INDICATOR_2
                           150   ACP_DISPOSAL_2
                           151   ACP_END_DATE_2
                           152   ACP_MAIN_SPECIALTY_CODE_2
                           153   ACP_LOCATION_CLASS_2
                           154   ACP_LOCATION_2




12/13/2010:12:20 PM                                          11                                   279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                  Episodes                      Managed Service APC
                                                                                        Extracts Version 1.3


                 Group   Seq                  Fields                Comment
                          155   ACP_NUMBER_3
                          156   ACP_START_DATE_3
                          157   ACP_SOURCE_3
                          158   ACP_INTENSIVE_CARE_DAYS_3
                          159   ACP_HIGH_DEPENDENCY_DAYS_3
                          160   ACP_ORGAN_SYSTEMS_SUPPORTED_3
                          161   ACP_PLANNED_INDICATOR_3
                          162   ACP_OUTCOME_INDICATOR_3
                          163   ACP_DISPOSAL_3
                          164   ACP_END_DATE_3
                          165   ACP_MAIN_SPECIALTY_CODE_3
                          166   ACP_LOCATION_CLASS_3
                          167   ACP_LOCATION_3
                          168   ACP_NUMBER_4
                          169   ACP_START_DATE_4
                          170   ACP_SOURCE_4
                          171   ACP_INTENSIVE_CARE_DAYS_4
                          172   ACP_HIGH_DEPENDENCY_DAYS_4
                          173   ACP_ORGAN_SYSTEMS_SUPPORTED_4
                          174   ACP_PLANNED_INDICATOR_4
                          175   ACP_OUTCOME_INDICATOR_4
                          176   ACP_DISPOSAL_4
                          177   ACP_END_DATE_4
                          178   ACP_MAIN_SPECIALTY_CODE_4
                          179   ACP_LOCATION_CLASS_4
                          180   ACP_LOCATION_4
                          181   ACP_NUMBER_5
                          182   ACP_START_DATE_5
                          183   ACP_SOURCE_5
                          184   ACP_INTENSIVE_CARE_DAYS_5
                          185   ACP_HIGH_DEPENDENCY_DAYS_5
                          186   ACP_ORGAN_SYSTEMS_SUPPORTED_5
                          187   ACP_PLANNED_INDICATOR_5
                          188   ACP_OUTCOME_INDICATOR_5
                          189   ACP_DISPOSAL_5
                          190   ACP_END_DATE_5
                          191   ACP_MAIN_SPECIALTY_CODE_5
                          192   ACP_LOCATION_CLASS_5
                          193   ACP_LOCATION_5



12/13/2010:12:20 PM                                         12       279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                  Episodes                      Managed Service APC
                                                                                        Extracts Version 1.3


                 Group   Seq                  Fields                Comment
                          194   ACP_NUMBER_6
                          195   ACP_START_DATE_6
                          196   ACP_SOURCE_6
                          197   ACP_INTENSIVE_CARE_DAYS_6
                          198   ACP_HIGH_DEPENDENCY_DAYS_6
                          199   ACP_ORGAN_SYSTEMS_SUPPORTED_6
                          200   ACP_PLANNED_INDICATOR_6
                          201   ACP_OUTCOME_INDICATOR_6
                          202   ACP_DISPOSAL_6
                          203   ACP_END_DATE_6
                          204   ACP_MAIN_SPECIALTY_CODE_6
                          205   ACP_LOCATION_CLASS_6
                          206   ACP_LOCATION_6
                          207   ACP_NUMBER_7
                          208   ACP_START_DATE_7
                          209   ACP_SOURCE_7
                          210   ACP_INTENSIVE_CARE_DAYS_7
                          211   ACP_HIGH_DEPENDENCY_DAYS_7
                          212   ACP_ORGAN_SYSTEMS_SUPPORTED_7
                          213   ACP_PLANNED_INDICATOR_7
                          214   ACP_OUTCOME_INDICATOR_7
                          215   ACP_DISPOSAL_7
                          216   ACP_END_DATE_7
                          217   ACP_MAIN_SPECIALTY_CODE_7
                          218   ACP_LOCATION_CLASS_7
                          219   ACP_LOCATION_7
                          220   ACP_NUMBER_8
                          221   ACP_START_DATE_8
                          222   ACP_SOURCE_8
                          223   ACP_INTENSIVE_CARE_DAYS_8
                          224   ACP_HIGH_DEPENDENCY_DAYS_8
                          225   ACP_ORGAN_SYSTEMS_SUPPORTED_8
                          226   ACP_PLANNED_INDICATOR_8
                          227   ACP_OUTCOME_INDICATOR_8
                          228   ACP_DISPOSAL_8
                          229   ACP_END_DATE_8
                          230   ACP_MAIN_SPECIALTY_CODE_8
                          231   ACP_LOCATION_CLASS_8
                          232   ACP_LOCATION_8



12/13/2010:12:20 PM                                         13       279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                  Episodes                      Managed Service APC
                                                                                        Extracts Version 1.3


                 Group   Seq                  Fields                Comment
                          233   ACP_NUMBER_9
                          234   ACP_START_DATE_9
                          235   ACP_SOURCE_9
                          236   ACP_INTENSIVE_CARE_DAYS_9
                          237   ACP_HIGH_DEPENDENCY_DAYS_9
                          238   ACP_ORGAN_SYSTEMS_SUPPORTED_9
                          239   ACP_PLANNED_INDICATOR_9
                          240   ACP_OUTCOME_INDICATOR_9
                          241   ACP_DISPOSAL_9
                          242   ACP_END_DATE_9
                          243   ACP_MAIN_SPECIALTY_CODE_9
                          244   ACP_LOCATION_CLASS_9
                          245   ACP_LOCATION_9




12/13/2010:12:20 PM                                         14       279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:Episodes
SUS PbR                                                           Appendix A                                                              Managed Service APC
                                                                Spell Error Codes                                                          Extracts Version 1.3




                      APPENDIX A – Treatment of Errors in Spell Construction
                                              Error               Action        Error           Notes              ErrorCode    PbR Pay
                                                                                Level
                                                                                V3.5
                      A. EPISODE START DATE/EPISODE END DATE errors
                           1    Non-contiguous EPISODE START   Build Spell      Low     Where gaps are                 1            Y
                                DATE/EPISODE END DATE                                   present within a spell
                                                                                        according to episodes
                                                                                        start and end dates.

                          2     Missing EPISODE START DATE       Build Spell    Low                                    2            Y

                          3     Missing EPISODE END DATE         Build Spell    Low                                    3            Y

                          4     Overlapping EPISODE START        Build Spell    Low                                    4            Y
                                DATE/EPISODE END DATE values
                                within a spell
                      B. EPISODE ORDER errors
                           1    Non-consecutive EPISODE ORDER    Build Spell    Low     Example; EPISODE               5            Y
                                                                                        ORDER 1, 2, 4
                          2     EPISODE ORDER and EPISODE        Build Spell    Low     Where the ordering of          6            Y
                                START DATE mismatch                                     EPISODE START
                                                                                        DATE contradicts
                                                                                        EPISODE ORDER
                          3     Duplicate EPISODE ORDER          Build Spell    Low                                    7            Y

                          4     Missing EPISODE ORDER            Build Spell    Low                                    8            Y




12/13/2010:12:20 PM                                                        15                                    279c3bb3-da13-4636-ba05-e2a6722b5d5d.xls:SpellErrorCode
SUS PbR                                                                   Appendix A                                                               Managed Service APC
                                                                        Spell Error Codes                                                           Extracts Version 1.3



                      APPENDIX A – Treatment of Errors in Spell Construction
                                                  Error                   Action        Error             Notes             ErrorCode    PbR Pay
                                                                                        Level
                                                                                        V3.5
                      A. EPISODE START DATE/EPISODE END errors errors
                      C. ADMISSION DATE/DISCHARGE DATE DATE
                           1    EPISODE END DATE later than      Build Spell            Medium                                  9            Y
                                DISCHARGE DATE
                           2      Single episode spell mismatch between Build Spell     Medium   Implies that other            10            Y
                                  EPISODE START DATE/ADMISSION                                   episodes exist outside
                                  DATE or EPISODE END                                            submission.
                                  DATE/DISCHARGE DATE

                           3      DISCHARGE DATE missing on any          Build Spell    Medium                                 11            Y
                                  later episodes within the spell
                           4      Duplicate ADMISSION DATE with           Build         Medium   First spell                   12            Y
                                  different DISCHARGE DATE, first         Single
                                  ADMISSION DATE different from first     Spells
                          5       DISCHARGE DATE DATE
                                  Missing ADMISSION                      Fail Spell      High                                  14            N
                      D. UNIQUE IDENTIFIER errors
                          1      Missing Unique Identifier               Fail Spell      High                                  15            N




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SUS PbR                                                                                   Appendix B                                                                        Managed Service APC
                                                                                     Emergency readmission                                                                   Extracts Version 1.3



Appendix B - Emergency readmissions

            PbR Emergency re-Admission
            There is a requirement to identify PbR Spells which involve the emergency re-admission of a patient within 14
            days of discharge from the same provider to support local flexible funding arrangements.

            In the diagram below, each HOSPITAL PROVIDER SPELL involving emergency admissions 1 to n for a given
            patient will need

                      Initial HOSPITAL                       HPS 2- Emergency                       HPS 3 - Emergency                       HPS n- Emergency
                      PROVIDER SPELL                         Admission 1                            Admission 2                             Admission n



                                         Less than readmit                      Less than readmit                       Less than readmit
                                         interval                               interval                                interval

                        HPS = Hospital Provider Spell                  Readmit interval = 14 days

            to be identified as an emergency re-admission and linked back to the initial HOSPITAL PROVIDER SPELL.


            The approach is to derive and maintain on each spell affected:
                              A unique identifier for the initial spell
                         ·       The number of prior Readmission spells (including the initial spell)[1]
                              The number of subsequent re-admission spells
                     This allows a query to be run which identifies a “parent” initial HOSPITAL PROVIDER SPELL together with
                     the chain of related emergency re-admissions.
            Further derivation and analysis would be subject to local analysis. Allowing different local definitions to be
            applied to readmissions
            The following definitions apply:
                              The re-admission interval relates to the period between
                         DISCHARGE DATE(HOSPITAL PROVIDER SPELL) and the START DATE(HOSPITAL PROVIDER SPELL)
                         of the immediately following (HOSPITAL PROVIDER SPELL)
                              An Emergency Spell is defined as one with ADMISSION METHOD (HOSPITAL PROVIDER SPELL)
                         between 20 and 30.
            The re-admission interval will is 14 days, but should maintained as a parameter. The re-admission interval will
            be nationally mandated and not subject to change by individual commissioners or providers.




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