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Презентация на тему The Audit Process

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2. Health Research & Information Division, ESRI, Dublin,
3. Health Research & Information Division, ESRI, Dublin,
4. Health Research & Information Division, ESRI, Dublin,
5. Health Research & Information Division, ESRI, Dublin, July 2008Audit ProcessAuditProcess
6. Health Research & Information Division, ESRI, Dublin,
7. Health Research & Information Division, ESRI, Dublin,
8. Health Research & Information Division, ESRI, Dublin,
9. Health Research & Information Division, ESRI, Dublin,
10. Health Research & Information Division, ESRI, Dublin,
11. Health Research & Information Division, ESRI, Dublin,
12. Health Research & Information Division, ESRI, Dublin,
13. Health Research & Information Division, ESRI, Dublin,
14. Health Research & Information Division, ESRI, Dublin,
15. Health Research & Information Division, ESRI, Dublin,
16. Health Research & Information Division, ESRI, Dublin, July 2008Audit Process Phase 2Phase 2:ReabstractionGroupingComparing codes
17. Health Research & Information Division, ESRI, Dublin,
18. Health Research & Information Division, ESRI, Dublin,
19. Health Research & Information Division, ESRI, Dublin,
20. Health Research & Information Division, ESRI, Dublin,
21. Health Research & Information Division, ESRI, Dublin,
22. Health Research & Information Division, ESRI, Dublin,
23. Health Research & Information Division, ESRI, Dublin,
24. Health Research & Information Division, ESRI, Dublin,
25. Health Research & Information Division, ESRI, Dublin,
26. Health Research & Information Division, ESRI, Dublin,
27. Health Research & Information Division, ESRI, Dublin,
28. Health Research & Information Division, ESRI, Dublin,
29. Health Research & Information Division, ESRI, Dublin,
30. Health Research & Information Division, ESRI, Dublin,
31. Health Research & Information Division, ESRI, Dublin, July 2008The Audit ReportSuggested Format IntroductionMethodologyAudit Findings e.g.DiagnosesAdministrativeDRG ConclusionsRecommendationsAppendices
32. Health Research & Information Division, ESRI, Dublin,
33. Health Research & Information Division, ESRI, Dublin,
34. Health Research & Information Division, ESRI, Dublin,
35. Health Research & Information Division, ESRI, Dublin,
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Health Research & Information Division, ESRI, Dublin, July 2008The Audit ProcessPhase 1: Audit PreparationPhase 2: Conduct audit and analyse resultsPhase 3: Findings and RecommendationsThe Audit reportComputerised audit

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Слайды презентации

Слайд 2 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008The Audit ProcessPhase

2008
The Audit Process
Phase 1: Audit Preparation
Phase 2: Conduct audit and

analyse results
Phase 3: Findings and Recommendations

The Audit report
Computerised audit

Слайд 3 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008Audit ProcessAlways consider

2008
Audit Process
Always consider the resources required to conduct all

phases of an audit
Time
Coding skills
Analysis
Administrative support
Availability of charts
Preparation of report

Слайд 4 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008Audit ProcessPhase 1-

2008
Audit Process
Phase 1- Audit Preparation
Decide on subject of Audit
Identify

Population
Identify Sample Size
Contact Hospitals
Chart availability
Office requirements
Arrange to meet with coding staff/supervisor

Слайд 5 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process
Audit
Process

Слайд 6 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008Audit Process Phase

2008
Audit Process Phase 1
Phase 1- Decide on subject of

Audit
Resources may determine focus and size of audit
One hospital or many hospitals
Examples of audits
High cost areas
High frequency areas
High complexity areas

Слайд 7 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1- Decide on subject of

Audit Examples
Particular DRG
Cases with a long length of stay
Cases with a particular procedure
E.g. Hip replacements
Complex neonate cases
Cases with a stay in intensive care
Areas where there is a data quality query

Слайд 8 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase1
Phase 1: Identify population and sample size

Population=

The entire number of cases that meet the chosen criteria
for the subject of the audit

When the population is known the sample size can be determined

Слайд 9 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1: Identify population and sample

size

Sample size: The number of cases to be
audited

Note: Resources may influence the sample
size

Слайд 10 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1: Identify population and sample

size

Sample Size: Must be practical

5% of one months discharges is a statistically acceptable sample size for a chart based audit (Source Australian Coding Benchmark Audit, 2nd Edition, NCCH, Sydney)

Слайд 11 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1: Identify population and sample

size

Suggested Sample Size:

General Audit = Minimum of 40 charts
Targeted audits = Audits on specific topics can have a smaller sample size

Слайд 12 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1:Types of Samples

Random Sample =

each record in the population has an equal chance of being selected for inclusion in the sample

e.g. Population = 200 hip replacements
10% random sample= any 20 cases in the population

Слайд 13 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1: Types of Samples

Stratified Random

Sample = Identifying a subset of the population and randomly sampling that subset.

e.g. Patients aged over 65 with a hip replacement
Population = 200 hip replacements
10% random stratified sample= any 20 cases in the population where the patient is aged over 65 years

Слайд 14 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1: Types of Samples

Targeted Sample

= Sample includes only a particular section of the population

e.g. Patients aged over 65 with a hip replacement
Population = 200 hip replacements
Targeted sample= All cases in the population where the patient is aged over 65 years

Слайд 15 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 1
Phase 1: Contact hospitals
Arrange dates
Provide list

of charts in the sample to be retrieved
Note that not all charts requested will be available
List of sample charts to be in same order as medical records are stored
Request suitable space and facilities
Make arrangements to meet coding supervisor
Pre-audit and post audit meetings

Слайд 16 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2:
Reabstraction
Grouping
Comparing codes

Слайд 17 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Reabstraction

Will original codes be

visible to auditor?
Will there be a audit data collection sheet?
Will additional information be collected?
e.g.
Presence of discharge summary
Documentation issues

Слайд 18 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Reabstraction

Adherence to guidelines
Assessment

of completeness of chart
Meet with coding staff –
Opportunity for discussion of code differences
Preliminary findiongs and outline of next stage in process
Identify local issues that may affect coding

Слайд 19 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Grouping

If DRG analysis is

required then recoded cases must be grouped into DRGs

Access to grouper and sytem for regrouping to allow for comparison at DRG and MDC level

Слайд 20 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Comparing Codes
Compare original codes

to re abstracted codes
Compare original administrative data to re-abstracted data
Compare DRG assignment between original codes and re-abstracted codes.

Слайд 21 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Comparing Codes
Diagnoses: Identify Differences

e.g.
Differences in Principal Dx
Differences in Additional Dx
Compare Average number of Dx
Differences in Sequencing of codes
Diagnoses frequency
Procedures

Слайд 22 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Comparing Codes

Identify differences in

administrative data
Date of birth
Admission & Discharge dates
Admission code
Discharge code

Слайд 23 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Comparing Codes

Facility to record

why codes are different.
Helps to identify factors affecting coding quality

e.g. Original coding PDx= Abdominal Pain
Re abstracted PDx= Appendicitis

Reason for difference: Original coder recorded symptom as Principal diagnosis and appendicitis as additional code

Слайд 24 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Comparing Codes

Factors affecting coding

quality can include:
Documentation
Discharge summaries
Information on ventilation
Information on ICU stay
Coder training levels
Knowledge of coding guidelines
Correct use of Classification
Support for coding function

How will these factors be recorded?

Слайд 25 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Comparing Codes

Identify how many

differences in each data field

And the reason for the difference

Слайд 26 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 2
Phase 2: Compare DRG assignment

Identify differences

in DRG assignment
DRG frequency
Change in severity of DRG

Identify differences in MDC assignment

Слайд 27 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 3
Phase 3: Findings & Recommendations

Having compared

data make findings and recommendations based on evidence found by the audit process

E.g. 70% of cases record a different Principal diagnoses due to poor documentation.

Слайд 28 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 3
Phase 3: Findings & Recommendations

Highlight any

areas with major differences
Highlight system problems found to affect data quality
Draw conclusions based on findings

Слайд 29 Health Research & Information Division, ESRI, Dublin, July

2008
Audit Process Phase 3
Phase 3: Findings & Recommendations

Make recommendations

that address the problems identified
Recommendations may involve areas other then the coding department

Слайд 30 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008The Audit ReportConsider

2008
The Audit Report
Consider a standard format/house style for reports
Will

the same format be used for in-house reports?
How will data be presented
Consider confidentiality- use of a reference number instead of medical record number
Use appendices for listing detailed information – e.g. details of all cases in the sample

Слайд 31 Health Research & Information Division, ESRI, Dublin, July

2008
The Audit Report
Suggested Format
Introduction
Methodology
Audit Findings e.g.
Diagnoses
Administrative
DRG
Conclusions
Recommendations
Appendices

Слайд 32 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008The Audit ReportIssue

2008
The Audit Report
Issue the report
Keep a record of

all audit documents and work to allow for queries by the hospital
Enclose a covering letter arranging for follow up discussions
Arrange any follow up promised by the report e.g. training

Слайд 33 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008National AuditMaintain a

2008
National Audit
Maintain a library of audits
Similar issues can arise

in different hospitals
Where inappropriate coding is identified – how will cases be rectified.
Number of national audits
Type of national audits
Maintain audit skills – hospital and national

Слайд 34 Health Research & Information Division, ESRI, Dublin, July

Health Research & Information Division, ESRI, Dublin, July 2008Computerised AuditSpeeds up

2008
Computerised Audit
Speeds up processes such as
Identifying Population
Creation of sample
Data

entry and re-grouping
Collection of reasons for code differences
Error categories
Analysis of results

Helps to maintain records of audits and outcomes to build a body of knowledge