Real-time cost database

1. Real-time cost database Lars Falsted Karlsen National Institute for Health Data and Disease Control

2. 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

3. 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

4. Cost database Activity data • Patient administration system • Registration of individual treatment: • Radiology • Pathology • Clinical lab. • Etc.

5. Cost database Distributedaccounts The hospitals expenditures are distributed to cost centers where patient treatment is performed

6. Linking services to inpatient stay Implantsanddevices Pathology Intensivecare In-patient stay X-rays Anaestezia Laboratory

7. The Cost database table

8. 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

9. 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

10. 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

11. New database model Activity Cost Link to other databases

12. 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

13. DecomposingCost of production X-rays Laboratory Service cost Orthopaedic surgery ward Indirect cost

14. 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

15. 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

16. NoUpdate of the distributedaccountsduring the year Activity Cost

17. Validating data • In the short run: no strong rules of validation • In steadwe show when data is missing orbehavingstrangely • Relyon feedback from the hospitals

18. the Real-time cost database New cost database updated monthly Activity and economy data Updated distri- bution accounts

19. Questions? ?