- Email: [email protected]
Neonatal Critical Care Minimum Data Set (NCCMDS)
Journal of Neonatal Nursing (2006) 12, 200e202
www.intl.elsevierhealth.com/journals/jneo
GUEST EDITORIAL
Neonatal Critical Care Minimum Data Set (NCCMDS) What’s the purpose of the NCCMDS?
-
The primary purpose of the NCCMDS is to allow operation of the Payment by Results (PbR) commissioning arrangements within neonatal critical care. NCCMDS supports PbR by capturing the data need to assign a Healthcare Resource Group (HRG) to each patient. PbR tariffs will be attached to the HRGs and providers of neonatal critical care therefore need to record their activity within the NCCMDS in order to be reimbursed for the cost of providing the care. If the activity is not recorded, the provider will not be paid. Many commissioning arrangements for neonatal critical care are already very similar to PbR and some commissioners may choose to adopt the HRGs with locally set tariffs before the introduction of PbR in this area. As well as being used to drive the reimbursement process, data captured as part of NCCMDS will be added to other data captured by the NHS and is expected to be used for a wide range of statistical analysis related to resource usage.
-
-
-
What does NCCMDS cover? The NCCMDS will go live on April 2007 and will be a mandatory data collection for: a) All patients on a Neonatal Intensive Care Unit regardless of care being delivered. b) Patients on a Maternity Ward or Neonatal Transitional Care Ward to whom one or more of the following applies for a period greater than 4 h:
Respiratory support via a tracheal tube Nasal Continuous Positive Airway Pressure (nCPAP) Exchange Transfusion Peritoneal Dialysis Continuous infusion of inotrope, vasodilator or prostaglandin Parentral Nutrition Convulsions Oxygen Therapy Neonatal abstinence syndrome Care of an intra-arterial catheter or chest drain Dilution Exchange Transfusion Tracheostomy cared for by nursing staff Tracheostomy cared for by external carer Recurrent apnoea Haemofiltration Continuous monitoring Intravenous glucose and electrolyte solutions Tube-fed Barrier nursed Phototherapy Special monitoring Observations at regular intervals Intravenous medication
As well as the interventions listed above, NCCMDS also includes: -
Surgery Carer Resident e Caring for Baby Gestation length at delivery Weigh High cost drugs
You can find a link to the full data set at the end of this article.
1355-1841/$ - see front matter ª 2006 Published by Elsevier Ltd on behalf of Neonatal Nurses Association. doi:10.1016/j.jnn.2006.09.010
Guest Editorial
201
When should NCCMDS be collected? NCCMDS should be captured daily. A data item should be recorded as ‘‘Yes’’ if the criterion was met that calendar day. For this reason, data capture will be most straightforward if it takes place close to or slightly after midnight each day. Three examples to illustrate: a) If a patient received nCPAP during part of the day then this should be recorded as ‘‘yes’’ even if the patient is not on nCPAP at midnight, when the data capture takes place. b) If a patient is put onto nCPAP at 23:50 in the evening then this should also be recorded as ‘‘yes’’ even though it has only taken place 10 min before midnight. c) If a patient receives critical care during the day then any activity should be recorded even if the patient is no longer there when the data capture takes place.
How was NCCMDS developed? NCCMDS and the related neonatal critical care HRGs nave been developed by the Information Centre for health and social care under the guidance of an Expert Working Group (EWG) drawn from the NHS. The EWG was chaired by Gary Hartoll, who is the clinical lead from Chelsea and Westminster Hospital and comprised:
Gary Hartnoll (Chair) Ian Hughes (Project Manager) Tony Ducker Kathryn Blake Professor Sunil Sinha Ben Shaw Christina Pollard Alan Fenton Noel Durkin Andy Gill, Paul Smith Sujit Kooner Liz Draper
What are the neonatal critical care HRGs? The neonatal critical care HRGs are: - Intensive Care - High Dependency - Special Care without external carer - Special Care with external carer - Normal Care (only applies to babies in NICU) The HRGs operate on a daily basis: a HRG is assigned each day depending on the highest level of care received that calendar day. These HRGs should be regarded as draft at the moment as they are still to be fully approved and adopted by the Department of Health/PbR.
What is the relationship to BAPM? The HRGs and NCCMDS are closely related to the BAPM 2001 Levels of Care and the related BAPM data set. There are a few differences between BAPM and NCCMDS: - NCCMDS introduces additional data items to define Special Care. - NCCMDS does not include the BAPM item ‘‘any other very unstable baby considered by the nurse-in-charge to need 1:1 nursing’’. The reason for this is simply that an item such as this would be too subjective to base
Consultant Neonatologist, Chelsea and Westminster Healthcare NHS Trust The Information Centre Consultant Neonatologist, Medway NHS Trust Consultant Neonatologist, University Hospitals Coventry and Warwickshire NHS Trust Consultant Neonatologist, South Tees University Hospital NHS Trust Consultant Neonatologist, Liverpool Women’s Hospital NHS Foundation Trust Clinical Services Manager, Cambridge University Hospitals NHS Foundation Trust and chair of the Neonatal Nurses Association Consultant Neonatologist, Newcastle upon Tyne Hospitals NHS Foundation Trust Department of Health, Children’s Services Senior Casemix Consultants, The Information Centre Costing Consultant, The Information Centre Perinatal Epidemiologist, Department of Health Sciences University of Leicester
The data set has been piloted at six trusts and the experience of the pilot sites has been incorporated into the user guidance which accompanies the data set.
a PbR reimbursement around. It is possible that additional data items will be introduced in future maintenance releases of NCCMDS to capture some of the intensive care which
202 might be missed as a result of omitting this data item. - NCCMDS does not include BAPM data items which are not used in deriving HRGs. This does not mean that units can’t collect them. It just means that they aren’t part of NCCMDS and aren’t used to determine the HRG (Level of Care).
Further information The Information Centre’s Casemix service develops groupings to describe procedures that are clinically similar and require similar levels of healthcare resource. Known as Healthcare Resource Groups (HRGs), these provide a way of standardising payments for NHS patient care so that trusts and other providers can be rewarded transparently, fairly and equitably for the work they do. HRGs support the Department of Health’s (DH) policy of Payment by Results (PbR). This rewards healthcare providers according to the volume and complexity of procedures they carry out rather than an annual block payment. They are developed in consultation with over 280 clinical representatives nominated by royal colleges to ensure they are fit for purpose. The 2008 national tariff will be based on version 4 (V4) HRGs. This will determine the funding that NHS and other healthcare organisations receive for
Guest Editorial treatment they provide, regardless of where it is delivered. V4 involved large scale revisions of existing groupings to take into account routine and complex cases and extended the scope of groupings beyond admitted care to new clinical settings. Further information on HRGs and the IC can be found at: http://www.ic.nhs.uk/casemix. Further information on PbR can be found at: http://www.dh.gov.uk/PolicyAndGuidance/ OrganisationPolicy/FinanceAndPlanning/ NHSFinancialReforms/fs/en. DSCNs related to NCCMDS (14/2006 and 15/ 2006) can be found at: http://www.connecting forhealth.nhs.uk/dscn/dscn2006/. The Information Standards Board submission documents and the User Guide can be found at: http://www.isb.nhs.uk/docs/neonatal-critical-caredscn-submission. Further support in relation to NCCMDS can be obtained from: The Information Centre Contact Centre Tel.: þ44 0 845 300 6016 E-mail: [email protected] Ian Hughes Project Manager Critical Care The Information Centre for health and Social Care, United Kingdom. Tel.: þ44 0 845 300 6016. E-mail address: [email protected] Available online 20 October 2006
www.intl.elsevierhealth.com/journals/jneo
GUEST EDITORIAL
Neonatal Critical Care Minimum Data Set (NCCMDS) What’s the purpose of the NCCMDS?
-
The primary purpose of the NCCMDS is to allow operation of the Payment by Results (PbR) commissioning arrangements within neonatal critical care. NCCMDS supports PbR by capturing the data need to assign a Healthcare Resource Group (HRG) to each patient. PbR tariffs will be attached to the HRGs and providers of neonatal critical care therefore need to record their activity within the NCCMDS in order to be reimbursed for the cost of providing the care. If the activity is not recorded, the provider will not be paid. Many commissioning arrangements for neonatal critical care are already very similar to PbR and some commissioners may choose to adopt the HRGs with locally set tariffs before the introduction of PbR in this area. As well as being used to drive the reimbursement process, data captured as part of NCCMDS will be added to other data captured by the NHS and is expected to be used for a wide range of statistical analysis related to resource usage.
-
-
-
What does NCCMDS cover? The NCCMDS will go live on April 2007 and will be a mandatory data collection for: a) All patients on a Neonatal Intensive Care Unit regardless of care being delivered. b) Patients on a Maternity Ward or Neonatal Transitional Care Ward to whom one or more of the following applies for a period greater than 4 h:
Respiratory support via a tracheal tube Nasal Continuous Positive Airway Pressure (nCPAP) Exchange Transfusion Peritoneal Dialysis Continuous infusion of inotrope, vasodilator or prostaglandin Parentral Nutrition Convulsions Oxygen Therapy Neonatal abstinence syndrome Care of an intra-arterial catheter or chest drain Dilution Exchange Transfusion Tracheostomy cared for by nursing staff Tracheostomy cared for by external carer Recurrent apnoea Haemofiltration Continuous monitoring Intravenous glucose and electrolyte solutions Tube-fed Barrier nursed Phototherapy Special monitoring Observations at regular intervals Intravenous medication
As well as the interventions listed above, NCCMDS also includes: -
Surgery Carer Resident e Caring for Baby Gestation length at delivery Weigh High cost drugs
You can find a link to the full data set at the end of this article.
1355-1841/$ - see front matter ª 2006 Published by Elsevier Ltd on behalf of Neonatal Nurses Association. doi:10.1016/j.jnn.2006.09.010
Guest Editorial
201
When should NCCMDS be collected? NCCMDS should be captured daily. A data item should be recorded as ‘‘Yes’’ if the criterion was met that calendar day. For this reason, data capture will be most straightforward if it takes place close to or slightly after midnight each day. Three examples to illustrate: a) If a patient received nCPAP during part of the day then this should be recorded as ‘‘yes’’ even if the patient is not on nCPAP at midnight, when the data capture takes place. b) If a patient is put onto nCPAP at 23:50 in the evening then this should also be recorded as ‘‘yes’’ even though it has only taken place 10 min before midnight. c) If a patient receives critical care during the day then any activity should be recorded even if the patient is no longer there when the data capture takes place.
How was NCCMDS developed? NCCMDS and the related neonatal critical care HRGs nave been developed by the Information Centre for health and social care under the guidance of an Expert Working Group (EWG) drawn from the NHS. The EWG was chaired by Gary Hartoll, who is the clinical lead from Chelsea and Westminster Hospital and comprised:
Gary Hartnoll (Chair) Ian Hughes (Project Manager) Tony Ducker Kathryn Blake Professor Sunil Sinha Ben Shaw Christina Pollard Alan Fenton Noel Durkin Andy Gill, Paul Smith Sujit Kooner Liz Draper
What are the neonatal critical care HRGs? The neonatal critical care HRGs are: - Intensive Care - High Dependency - Special Care without external carer - Special Care with external carer - Normal Care (only applies to babies in NICU) The HRGs operate on a daily basis: a HRG is assigned each day depending on the highest level of care received that calendar day. These HRGs should be regarded as draft at the moment as they are still to be fully approved and adopted by the Department of Health/PbR.
What is the relationship to BAPM? The HRGs and NCCMDS are closely related to the BAPM 2001 Levels of Care and the related BAPM data set. There are a few differences between BAPM and NCCMDS: - NCCMDS introduces additional data items to define Special Care. - NCCMDS does not include the BAPM item ‘‘any other very unstable baby considered by the nurse-in-charge to need 1:1 nursing’’. The reason for this is simply that an item such as this would be too subjective to base
Consultant Neonatologist, Chelsea and Westminster Healthcare NHS Trust The Information Centre Consultant Neonatologist, Medway NHS Trust Consultant Neonatologist, University Hospitals Coventry and Warwickshire NHS Trust Consultant Neonatologist, South Tees University Hospital NHS Trust Consultant Neonatologist, Liverpool Women’s Hospital NHS Foundation Trust Clinical Services Manager, Cambridge University Hospitals NHS Foundation Trust and chair of the Neonatal Nurses Association Consultant Neonatologist, Newcastle upon Tyne Hospitals NHS Foundation Trust Department of Health, Children’s Services Senior Casemix Consultants, The Information Centre Costing Consultant, The Information Centre Perinatal Epidemiologist, Department of Health Sciences University of Leicester
The data set has been piloted at six trusts and the experience of the pilot sites has been incorporated into the user guidance which accompanies the data set.
a PbR reimbursement around. It is possible that additional data items will be introduced in future maintenance releases of NCCMDS to capture some of the intensive care which
202 might be missed as a result of omitting this data item. - NCCMDS does not include BAPM data items which are not used in deriving HRGs. This does not mean that units can’t collect them. It just means that they aren’t part of NCCMDS and aren’t used to determine the HRG (Level of Care).
Further information The Information Centre’s Casemix service develops groupings to describe procedures that are clinically similar and require similar levels of healthcare resource. Known as Healthcare Resource Groups (HRGs), these provide a way of standardising payments for NHS patient care so that trusts and other providers can be rewarded transparently, fairly and equitably for the work they do. HRGs support the Department of Health’s (DH) policy of Payment by Results (PbR). This rewards healthcare providers according to the volume and complexity of procedures they carry out rather than an annual block payment. They are developed in consultation with over 280 clinical representatives nominated by royal colleges to ensure they are fit for purpose. The 2008 national tariff will be based on version 4 (V4) HRGs. This will determine the funding that NHS and other healthcare organisations receive for
Guest Editorial treatment they provide, regardless of where it is delivered. V4 involved large scale revisions of existing groupings to take into account routine and complex cases and extended the scope of groupings beyond admitted care to new clinical settings. Further information on HRGs and the IC can be found at: http://www.ic.nhs.uk/casemix. Further information on PbR can be found at: http://www.dh.gov.uk/PolicyAndGuidance/ OrganisationPolicy/FinanceAndPlanning/ NHSFinancialReforms/fs/en. DSCNs related to NCCMDS (14/2006 and 15/ 2006) can be found at: http://www.connecting forhealth.nhs.uk/dscn/dscn2006/. The Information Standards Board submission documents and the User Guide can be found at: http://www.isb.nhs.uk/docs/neonatal-critical-caredscn-submission. Further support in relation to NCCMDS can be obtained from: The Information Centre Contact Centre Tel.: þ44 0 845 300 6016 E-mail: [email protected] Ian Hughes Project Manager Critical Care The Information Centre for health and Social Care, United Kingdom. Tel.: þ44 0 845 300 6016. E-mail address: [email protected] Available online 20 October 2006