Automated computer-assisted evaluation of diagnosis-and-procedure-reports in Austrian hospitals

Abstract

Austria's 320 hospitals with 73,000 beds have to transmit a minimum basic data set for each hospital stay with diagnosis and procedures as well as scores for use in intensive care units (last only in performance-oriented financed hospitals). Based on these data, 160 hospitals or 53,000 beds are financed through performance oriented flat rates per case (LDFs--Leistungsorientierte Diagnosen-Fallpauschalen). Those LDFs are in some principles similar to DRG's (diagnosis related groups), but have been developed by the Federal Ministry of Labor, Health and Social Affairs (BMAGS). 1.94 million data sets of hospital stays, which were reported for financing in the year 1997 had to be analyzed for their correctness and plausibility. For this aim the "Scoringprogramm" of the BMAGS is in use. We describe in detail how many diagnoses and procedures are automatically checked with diagnosis, sex, age, length of stay etc. 1.6% warnings resulted from this checking, and no errors have been reported. The checking routines have to be further developed. At present data seem to be used only with caution for epidemiology or for analyzing medical quality. For financing purposes it might be reliable, especially if data quality commissions are enlarged and if evaluation of data with medical records is improved.