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?UTS HOSPITAL
Analysis of supplied patient data
UTS Hospital: Analysis of supplied patient data
Name of the Student:Name of the University:Author Notes
contents
Executive Summary5
Key Findings and recommendations5
Introduction6
Literature Review7
Methods8
Results9
Discussions and Recommendations10
Conclusions11
References12
DISCLAIMER
This report has been produced as a part of student assessment 92917 Using Health Data for Decision Making at the University of Technology Sydney. As such, the material presented here, any opinions, findings, conclusions or recommendations are those of the student authors and do not necessarily reflect the views of the University of Technology Sydney or its academic staff.

Executive SummaryThe report contains the data analysis strategy, analysis as well as appropriate reference to the entire literature that has been researched for the report. The project aims to address issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’.

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The objectives of the project are as follows:
To evaluate the issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’
To analyse the length of the hospital, stay as well as a cost to women and health service providers

To recommend a solution to the potential problems and issues

It is recommended to the UTS hospital for increasing the amount of contact a pregnant woman has with the health provider and also changing the antenatal care to deliver way. A minimum of eight contacts is recommended for reducing the perinatal mortality and also improving the experience of care for the women. Counselling should also be conducted for healthy eating as well as keeping the patients physically active during pregnancy. The tetanus toxoid vaccination is also recommended for the pregnant women that depend on the tetanus vaccination exposure for preventing the neonatal mortality from tetanus.

IntroductionAs a consultant to the district of local health , the governing Council requires for developing a report based on the data from the Australian public Hospital situated in New South Wales which is the UTS Hospital. The report has addressed the issues which are related to AR-DRGs O65A/B which are ‘Other Antenatal Admissions without or with complicating diagnoses’. The report contains the data analysis strategy, analysis as well as appropriate reference to the entire literature that has been researched for the report.
Antenatal day units have been used widely as an alternative to the inpatient care for women having pregnancy complication that includes moderate and mild hypertension as well as preterm pre-labour rupture of the membranes.
UTS hospital has been a well-established charitable hospital which operates on a non-profit basis. It has around 250 beds within the inner-city location. Local community population from which the majority of the patient are drawn ages 40% over 65 years of age. UTS hospitals also have an excellent reputation for innovative care, new technologies, rapid undertaking capability, research and teaching. It also gets very little support from the government for the running cost. The previous government has been generous in meeting the construction cost of new buildings as well as refurbishing the old ones. The hospital, however, is in financial difficulties. Over 90% of the funding to the hospital for acute inpatients comes from insurers of private health. The remainder is from the department of veterans’ affairs and patients to pay for their admissions, compensable patient from workplace insurance and motor vehicle administration as well as patients whose stay is paid from the research grant.
The rate of reimbursement from private insurers is usually based on the negotiated rate for each of the AR-DG. Every year, the companies for insurances negotiate with the hospital as well as the rate it pays for the AR-DRG that is the type of case-mix or activity-based funding. The fees are usually based on the average length of stay for each AR-DRG using Australian cost weights.
It has been decided that case-mix based funding using AR-DRGs are not the best method for recording the performance as they do not suit the type of patients treated by the UTS Hospital. Majority of the patients are older and more complex and needs to stay longer than the average length of stay for each AR-DRG. Hence, it is suggested that the AR-DRGs are useless for measuring the performance of the hospital when the length of the stay of the patient is different to that of the average hospital. The hospital also should go back to the insurance funds and negotiate the return to the funding operations on a fixed per diam basis.

The project aims to address issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’.

The objectives of the project are as follows:
To evaluate the issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’
To analyse the length of the hospital, stay as well as the cost to women and health service providers

To recommend a solution to the potential problems and issues

The research questions are as follows:
What are the issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’?
What is the length of the hospital, stay as well as the cost to women and health service providers?
What can be recommended for mitigating the potential issues and problems?
The research is significant as it will help in understanding the issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’. It will also help in assessing the length of the hospital, stay as well as the cost to women and health service providers. Finally, the research will recommend a potential solution to mitigate the problems and issues related to it.

Literature ReviewAR-DRG
The Diagnostic related groups which have a long history of development in Australia commence to the release of classification in July 1992, the Australian National DRG (AN-DRG) . The introduction of ICD-10-AM in 1998, the year that AR-DRGs usually replaced the AN-DRGs in December 1998. Using ICD-10-AM/ACHI as a basis, the AR-DRGs were developed for reflecting the clinical practice of Australia as well as the use of hospital resources. The AR-DRGs were used for the Independent Hospital Pricing Authority (IHPA) for development of pricing of admitted acute episodes of care in the public hospitals of Australia as well as private and public hospitals, state and territory health authorities for providing better management, payment and measurement of high quality and efficient healthcare services. Other uses also include researcher’s health funds, epidemiologist, statisticians and health economist (de Jongh et al. 2016).
The AR-DRGs has also classified units of hospital output. The classification groups inpatient stayed into the meaningful categories of the clinic for similar levels of complexity (outputs) which consume similar amounts of resources that are the inputs. Since 1998, a new revision of the AR-DRG has already been made available every two years having the exception of an AR-DRG which had a three-year development period. AR-DRG version 8 is the current version for classification and is used by the IHPA for pricing for July 2016. Their classification is supplied in hard copy format, and grouper software is also available from various vendors. As per Downe et al. (2016), ongoing development of the AR-DRG classification system is also essential for the delivery of national standard for monitoring any major area’s activity of Australian hospital care as well as a determination for public hospitals NEP in Australia.

O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’
Antenatal admissions are the discharge and admission home having no overnight stay. It is a section under AR-DRGs with or without any complicating diagnosis. Few of the data was provided on antenatal admission; however, that comes formation now who is that they were unable to pool data from travels for most of the outcomes. In a study by Downe et al. (2017), there was a significant reduction in the antenatal hospital length stay for the women in the advanced daycare group compared with the women who received routine care of 4 hours a day. The average length of stay was also considered to be shorter for women attending the day care unit. According to Agha and Williams (2016), the overall length of the hospital stay was also reported to be less than the day in the daycare group. There was no maternal mortality issue in the study reporting this outcome.

Antenatal day care units have been widely used as an alternative to the inpatient care for women having complications in pregnancy that includes moderate and mild hypertension; preterm pre-labour membranes rupture as well. Manzi et al. (2018), conducted a study in which the three trials with a total of 504 women were included. For the majority of the outcomes, it was not possible for pulling the results from trials in the meta-analysis as outcomes which were measured in different ways. Compared with women in the ward/routine care group, women who attended daycare units were less likely to be admitted to the hospital for overnight.
The average length of the antenatal admission was shorter for women who attended daycare, although the outpatient attendances were increased for this group. There was also evidence from one study that other women attending daycare was significantly less compared to those who underwent induction of labour but birth mode was similar for women in both groups. For other outcomes, there were no significant differences between the groups. Their evidence regarding the cost of different types is also mixed regarding care. Lund et al. (2014) stated that then the length of the antenatal hospital stays was reduced, they did not necessarily translate into reduced health service costs. Most of the women also tended to be satisfied with whatever care they received, and women prefer daycare compared with hospital admissions.

Methods
The research has been conducted by analysing the UTS Hospital data. A randomised controlled trial has been used for comparing the daycare with inpatient or routine care for the women with the pregnancy complication. The population which has been selected for the proposed research are the patients of UTS Hospital. The hospital data will help in understanding and evaluate the issues related to AR-DRGs O65A/B ‘Other Antenatal Admissions (with or without complicating diagnosis)’. It has also helped in analysing the length of the hospital, stay as well as the cost to women and health service providers issues related (World Health Organization, 2016). Inclusive sampling has been used for including any relevant data. The particular sample has been used for excluding the irrelevant data from the data analysis. The data collection has been done through the automated way which has been recorded in an excel spreadsheet. Simple descriptive statistics have been used for analysing the data and creating tables and charts for a better understanding of the insight and in-depth details of the data. The correlation between different variables has been found out correctly. The research which has been carried out has been adequately following ethicality throughout the study. The confidentiality of the participant was maintained strictly during the research process. The data collected is also free from any personal opinion, tampering and bias by the researcher. Further, it is also not used for commercial purposes and has been strictly collected and used for academic purposes only.
Results
AMO Specialty Count of Patient ID
Anaesthetics 1
Cardiology 1
Cardiothoracic Surgery 1
Casualty 18
General Medicine 3
General Surgery 4
Gynaecology 53
Neurosurgery 3
Obstetrics 1294
Psychiatry 1
Renal Medicine 1
Urology 1
Grand Total 1381
Table 1: AMO Specialty type vs count of patient ID
(Source: Created by the Author)

Chart 1: AMO Specialty type vs count of patient ID
(Source: Created by the Author)
Discharge type Count of Patient ID
Discharge by Hospital 1348
Discharge on leave 1
Left against advice 6
Transfer another hospital 26
Grand Total 1381
Table 2: Discharge type vs count of patient ID
(Source: Created by the Author)

Chart 2: Discharge type vs count of patient ID
(Source: Created by the Author)
Row Labels Sum of LOS Sum of ICU Hours Sum of Episode Seq No
Aboriginal 125 0 41
Australia 125 0 41
Other 2665 29 1340
Australia 2156 20 1111
Bosnia-Herzegovina 1 0 1
Cambodia 1 0 1
Canada 5 0 1
Chile 2 0 2
China (excluding Taiwan) 4 0 1
Cook Islands 4 9 1
Croatia 1 0 1
England 68 0 43
Fiji 54 0 13
Germany (United) 7 0 2
India 24 0 8
Iraq 7 0 2
Ireland 1 0 1
Japan 1 0 1
Jordan 1 0 1
Lebanon 49 0 7
Malaysia 4 0 3
Malta 1 0 1
Netherlands 2 0 1
New Caledonia 2 0 2
New Zealand 75 0 43
Nigeria 1 0 1
Pakistan 10 0 7
Peru 13 0 7
Philippines 51 0 12
Samoa, Western 59 0 27
Scotland 18 0 8
Singapore 6 0 6
Spain 2 0 2
Sri Lanka 13 0 5
Thailand 4 0 4
Turkey 7 0 3
Unknown/Not Known 8 0 8
Viet Nam 2 0 2
Yugoslavia, (not otherwise defined) 1 0 1
Grand Total 2790 29 1381
Table 3: Discharge type vs count of patient ID
(Source: Created by the Author)

Chart 3: Discharge type vs count of patient ID
(Source: Created by the Author)

Discussion and Recommendation
It has been found that out of the patients admitted for antenatal admissions with or without complicating diagnosis, the maximum count of patient ID is for obstetrics, followed by gynaecology and casualty. The least patients are for general surgery, general medicine and neurosurgery followed by neurology, renal medicine, psychiatry, cardiothoracic surgery, cardiology and aesthetics.

The common obstetrics problems are antepartum haemorrhage that is the bleeding from the genital tract after pregnancy’s 24th week, foetal viability which is coming beyond amenorrhoea of 24 weeks, fetal lung maturity of going beyond 34 weeks of amenorrhoea (Thirumurthy et al. 2016).

Majority of the patients are also discharged from the hospital followed by transfer to another hospital, lake strike and state wise discharge and leave. Further, it has also been found that the total sum of ICU ID count by each of the patients of Australia is the highest compared to other nationalities. In fact, the aboriginal Australians are also on the lead compared to other nationalities of the region.

Daycare management in obstetrics, as well as other medical specialities, has now been widespread. Observational studies on antenatal day care units have also supported the findings of the review suggesting that the daycare offers the potential for cost savings. However, savings are only realised if the resources have been redeployed and the daycare does not create the new demands. The clinical staffs should also lower the threshold for referring women to daycare units compared toward admissions. Further, the management of a discrete episode of care in the antenatal period accounts for only a small part of the overall cost. The reduced length of stay on one occasion also results in cost saving if there is an overall reduction in health service utilisation that includes the use of out of hours community-based health service. Interpreting the cost, it has also further complicated by the wide variation in the care cost that is the length of hospital stay in the postnatal and antenatal periods for individual women as well as their babies. A small number of women, as well as babies, might also have high cost and hence the average cost data might not be particularly informative. The result of this review concerning women’s you regarding the care are also supported by findings throughout the study. It has been found that around 57% of the women are prepared for attending antenatal care five times a week for avoiding any admission, and all women were prepared for coming at least once (Watterson, Walsh and Madeka, 2015). However, preferred hospital admission which is essential for opening women’s views about the way that pregnancy complication has been managed. This might also apply primarily to women who have experienced a poor outcome in previous pregnancy admission to the hospitals.

It is recommended to the UTS hospital for increasing the amount of contact a pregnant woman has with the health provider and also changing the antenatal care to deliver way. According to Anastasi et al. (2015), a minimum of eight contacts is recommended for reducing the perinatal mortality and also improving the experience of care for the women. Counselling should also be conducted for healthy eating as well as keeping the patients physically active during pregnancy (Mesfin and Farrow, 2017). Daily oral iron and folic acid supplementation should also be provided with a 30 mg to 60 mg of elemental iron as well as 0.4 mg of the folic acid for the pregnant women to prevent maternal anaemia, puerperal sepsis, preterm birth and low birth weight. The tetanus toxoid vaccination is also recommended for the pregnant women that depend on the tetanus vaccination exposure for preventing the neonatal mortality from tetanus. One ultrasound scan is also recommended before 24 weeks gestation period, and health care providers should ask the pregnant women regarding alcohol use as well as other substances as early as possible in pregnancy and at every visit for antenatal (Joshi et al. 2014).
Conclusions
It can be concluded that most of the patients are older and more complex and needs to stay longer than the average length of stay for each AR-DRG. Hence, it is suggested that the AR-DRGs are useless for measuring the performance of the hospital when the length of the stay of the patient is different to that of the average hospital. Ongoing development of the AR-DRG classification system is also essential for the delivery of national standard for monitoring any major area’s activity of Australian hospital care as well as a determination for public hospitals NEP in Australia. The clinical staffs should also lower the threshold for referring women to daycare units compared toward admissions. Further, the management of a discrete episode of care in the antenatal period accounts for only a small part of the overall cost. However, preferred hospital admission which is essential for opening women’s views about the way that pregnancy complication has been managed. This might also apply primarily to women who have experienced a poor outcome in previous pregnancy admission to the hospitals.

References de Jongh, T.E., Gurol–Urganci, I., Allen, E., Zhu, N.J. and Atun, R., 2016. Integration of antenatal care services with health programmes in low–and middle–income countries: systematic review. Journal of global health, 6(1), pp. 12-35.

Downe, S., Finlayson, K., Tunçalp, ?. and Metin Gülmezoglu, A., 2016. What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women. BJOG: An International Journal of Obstetrics & Gynaecology, 123(4), pp.529-539.

Downe, S., Finlayson, K.W., Tunçalp, Ö. and Gülmezoglu, A.M., 2017. Factors that influence the provision of good-quality routine antenatal services: a qualitative evidence synthesis of the views and experiences of maternity care providers Protocol. Cochrane Database of Systematic Reviews, 8(3), pp.12-45.

Manzi, A., Nyirazinyoye, L., Ntaganira, J., Magge, H., Bigirimana, E., Mukanzabikeshimana, L., Hirschhorn, L.R. and Hedt-Gauthier, B., 2018. Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda. BMC health services research, 18(1), pp.136-154.

Lund, S., Nielsen, B.B., Hemed, M., Boas, I.M., Said, A., Said, K., Makungu, M.H. and Rasch, V., 2014. Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial. BMC pregnancy and childbirth, 14(1), pp.29-45.

World Health Organization, 2016. WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization.

Thirumurthy, H., Masters, S.H., Mavedzenge, S.N., Maman, S., Omanga, E. and Agot, K., 2016. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. The Lancet HIV, 3(6), pp.266-274.

Watterson, J.L., Walsh, J. and Madeka, I., 2015. Using mHealth to improve usage of antenatal care, postnatal care, and immunization: A systematic review of the literature. BioMed research international, 2015, 3(1), pp.56-76.

Anastasi, E., Borchert, M., Campbell, O.M., Sondorp, E., Kaducu, F., Hill, O., Okeng, D., Odong, V.N. and Lange, I.L., 2015. Losing women along the path to safe motherhood: why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC pregnancy and childbirth, 15(1), pp.287-314.

Mesfin, M. and Farrow, J., 2017. Determinants of antenatal care utilization in Arsi Zone, Central Ethiopia. The Ethiopian Journal of Health Development (EJHD), 10(3), pp-18-29.

Joshi, C., Torvaldsen, S., Hodgson, R. and Hayen, A., 2014. Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC pregnancy and childbirth, 14(1), pp.94-105.

Agha, S. and Williams, E., 2016. Quality of antenatal care and household wealth as determinants of institutional delivery in Pakistan: Results of a cross-sectional household survey. Reproductive health, 13(1), pp.84-96.

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