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Real-time cost database. Lars Falsted Karlsen National Institute for Health Data and Disease Control. Real time cost database. Overview How we constructed the cost database today Limitations and challenges of the present setup Real time cost database - the new setup.

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real time cost database

Real-time cost database

Lars Falsted Karlsen

National Institute for Health Data and Disease Control

real time cost database1
Real time cost database

Overview

  • How we constructed the cost database today
  • Limitations and challenges of the present setup
  • Real time cost database - the new setup
the cost database today
the cost database today
  • Made by the National Institute for Health Data and Disease Control using input from regions and hospitals
  • Valuing (allmost) all ward-discharges and out-patient contacts in public Danish hospitals
  • Use:
  • CalculateDRG-tariffs in Denmark
  • Costanalysis
cost database
Cost database

Activity data

  • Patient administration system
  • Registration of individual treatment:
    • Radiology
    • Pathology
    • Clinical lab.
    • Etc.
cost database1
Cost database

Distributedaccounts

The hospitals expenditures are distributed to cost centers where patient treatment is performed

linking services to inpatient stay
Linking services to inpatient stay

Implantsanddevices

Pathology

Intensivecare

In-patient stay

X-rays

Anaestezia

Laboratory

the year of the cost database today
the year of the cost database today

Cost database covering the previous year

Activity and economy

data

Updated distri-

bution accounts

The DRG-tariffs become effective

challenges with the current setup
challenges with the current setup

Quality

  • Distributed accounts
  • Procedure weights
  • Data deliveries
  • Old data – 6 to 18 monthold
  • Relevant information is disposed, eg. cost of specific services
  • Not possible to decompose the cost in all dimensions
  • Lack of data model
real time cost database2
real-time cost database

Therefore we want to make a new database with:

  • monthlyupdates
  • a new efficient datamodel, thatcontains all information in the inputdata
  • Monthlyupdatesare not real-time!
  • But the datamodel will support real-time updates
new database model
New database model

Activity

Cost

Link to other databases

decomposing cost in the new setup
Decomposing COST in the new setup

Patient

Patient

Service

Cost of care

Cost of operating room

Cost of radiology

Accountcategory

Wages, doctors

Wages, nurses

Wages, other

Services

Cost center (direct/indirect)

Wages, administration

Wagescleaning

Wagespharmacy

decomposing cost of production
DecomposingCost of production

X-rays

Laboratory

Service cost

Orthopaedic surgery ward

Indirect cost

updating activity data
UpdatingActivity data
  • Today activity data is collected from hundreds of system
  • We receive data weekly/monthly/annualy

Challenges updating activity data:

  • Correction of “old” data
  • Late registration of discharges or services
  • Reliability of data deliveries
  • In the short run: stockoverwrite from year to date.
  • Delta update
updating the distributed accounts
Updating the Distributedaccounts
  • The distributed accounts are made annually by personel at the contributing hospitals
  • Wereceive data from the account database of the hospitals but areunable to construct the distributions
  • Using the account data wecanupdate the distributedaccountsmonthlykeeping the distributions constant
validating data
Validating data
  • In the short run: no strong rules of validation
  • In steadwe show when data is missing orbehavingstrangely
  • Relyon feedback from the hospitals
the real time cost database
the Real-time cost database

New cost database updated monthly

Activity and economy

data

Updated distri-

bution accounts