Report Template

Activity Based Funding / Management Performance Management Report

Performance Indicator Definitions Manual (Outcome Measures) 2014-2015

Version 1.2 22 October 2014

improving care | managing resources | delivering quality

© Department of Health, State of Western Australia (2014). Copyright to this material produced by the Western Australian Department of Health belongs to the State of Western Australia, under the provisions of the Copyright Act 1968 (C’wth Australia). Apart from any fair dealing for personal, academic, research or non-commercial use, no part may be reproduced without written permission of the Performance Activity and Quality Division, Western Australian Department of Health. The Department of Health is under no obligation to grant this permission. Please acknowledge the WA Department of Health when reproducing or quoting material from this source.

Important Disclaimer: All information and content in this Material is provided in good faith by the WA Department of Health, and is based on sources believed to be reliable and accurate at the time of development. The State of Western Australia, the WA Department of Health and their respective officers, employees and agents, do not accept legal liability or responsibility for the Material, or any consequences arising from its use.

Table of Contents

ACKNOWLEDGMENTS ...... I ACRONYMS ...... II 1. INTRODUCTION ...... 1 2. DATA DEFINITIONS ...... 9 2.1 EFFECTIVENESS ACCESS (EA) PIS ...... 9 EA1A-E: PROPORTION OF EMERGENCY DEPARTMENT PATIENTS SEEN WITHIN RECOMMENDED TIMES A) % TRIAGE CAT 1 – 2 MINS; B) % TRIAGE CAT 2- 10MIN; C) % TRIAGE CAT 3- 30 MIN; D) % TRIAGE CAT 4- 60 MIN; E) % TRIAGE CAT 5- 2 HOURS ...... 10 EA2: NEAT PERCENTAGE OF ED ATTENDANCES WITH LOE LESS THAN OR EQUAL TO 4 HOURS ...... 13 EA3: AVERAGE OVERDUE WAIT TIME OF ELECTIVE SURGERY CASES WAITING BEYOND THE CLINICALLY RECOMMENDED TIME, BY URGENCY CATEGORY ...... 16 EA4.A: ELECTIVE SURGERY PATIENTS TREATED WITHIN BOUNDARY TIMES: A) % CAT 1 < 30DAYS ...... 21 EA4.B: ELECTIVE SURGERY PATIENTS TREATED WITHIN BOUNDARY TIMES: B) % CAT 2 < 90DAYS ...... 25 EA4.C: ELECTIVE SURGERY PATIENTS TREATED WITHIN BOUNDARY TIMES C) % CAT 3 <365 DAYS ...... 29 EA5: PERCENTAGE OF SELECTED ELECTIVE CANCER SURGERY CASES (FOR BLADDER CANCER, BOWEL CANCER AND BREAST CANCER) TREATED WITHIN BOUNDARY TIME ...... 33 2.2 EFFECTIVENESS APPROPRIATENESS (EAP) PIS ...... 36 EAP1: RATE OF SELECTED POTENTIALLY PREVENTABLE CHRONIC CONDITION HOSPITALISATIONS (FOR SPECIFIED CHRONIC CONDITIONS) ...... 37 2.3 EFFECTIVENESS QUALITY (EQ) PIS ...... 41 EQ1: AGE-ADJUSTED RATE (AAR) OF AVOIDABLE DEATHS ...... 42 EQ3: STAPHYLOCOCCUS AUREUS BACTERAEMIA (SAB) INFECTIONS PER 10,000 PATIENT DAYS ...... 46 EQ5: HOSPITAL STANDARDISED MORTALITY RATIO ...... 50 EQ7: DEATH IN LOW-MORTALITY DRGS ...... 53 EQ8.A: IN HOSPITAL MORTALITY RATES FOR AMI ...... 87 EQ8.B: IN HOSPITAL MORTALITY RATES FOR STROKE ...... 92 EQ8.C: IN HOSPITAL MORTALITY RATES FOR FRACTURED NECK OF FEMUR ...... 95 EQ8.D: IN HOSPITAL MORTALITY RATES FOR PNEUMONIA ...... 99 EQ10: RATE OF TOTAL HOSPITAL READMISSIONS WITHIN 28 DAYS TO AN ACUTE DESIGNATED MENTAL HEALTH INPATIENT UNIT ...... 103 2.4 EFFICIENCY INPUTS PER OUTPUT UNIT (EI) KPIS ...... 107 EI1.A: VOLUME OF ACTIVITY WEIGHTED YEAR TO DATE: INPATIENTS (VARIANCE FROM TARGET) ...... 108 EI1.B: VOLUME OF ACTIVITY WEIGHTED YEAR TO DATE ED ATTENDANCES (VARIANCE FROM TARGET) ...... 120 EI1.C: VOLUME OF ACTIVITY WEIGHTED YEAR TO DATE: OUTPATIENTS (VARIANCE FROM TARGET) ...... 127 EI3: AVERAGE COST PER TEST PANEL FOR PATHWEST ...... 138 EI6: YTD DISTANCE OF NET COST OF SERVICE TO BUDGET ...... 139 EI8: RATIO OF ACTUAL COST OF SPECIFIED PUBLIC HOSPITAL SERVICES COMPARED WITH THE STATE EFFICIENT PRICE . 142 2.5 EQUITY ACCESS (EQA) KPIS ...... 155 EQA1: STANDARDISED MORTALITY RATIO (SMR) OF DEATHS AMONG ABORIGINAL CHILDREN (0-4 YEARS) AND NON- ABORIGINAL CHILDREN (0-4 YEARS) ...... 156

EQA4: PROPORTION OF ELIGIBLE POPULATION RECEIVING DENTAL SERVICES FROM SUBSIDISED DENTAL PROGRAMS BY GROUP (AGED 16 YEARS AND OVER, AGED 65 YEARS AND OVER, AND TOTAL ABORIGINAL POPULATION) ...... 159 2.6 SUSTAINABILITY WORKFORCE (SW) KPIS ...... 163 SW3: STAFF TURNOVER ...... 164 2.7 PROCESSES CODING (PC) KPIS ...... 167 PC2A&B: PERCENTAGE OF CASES CODED AND AVAILABLE FOR REPORTING WITHIN:(A) 2 WEEKS AND (B) 4 WEEKS ...... 168 2.8 PROCESSES FINANCE (PF) KPIS ...... 176 PF2: MANUALLY CORRECTED PAYROLL ERRORS (UNDERPAYMENTS) ...... 177 PF3: AVAILABILITY OF INFORMATION COMMUNICATION TECHNOLOGY (ICT) SERVICES: PERCENTAGE OF SERVICE CALLS RESOLVED AT FIRST POINT OF CONTACT ...... 179

Acknowledgments

The production of the report would not have been possible without the support of the key stakeholders and data providers from the Department of Health. Their advice and provision of information is greatly appreciated.

Acknowledgement is also extended to key staff within the Performance Reporting Branch and Information Development and Management Branch, Performance Activity and Quality Division.

Acronyms AAR Age Adjusted Rate ABF Activity Based Funding ABF/M Activity Based Funding/Management ABM Activity Based Management ABS Australian Bureau of Statistics ACEM Australasian College of Emergency Medicine ACHS Australian Council on Health Standards ACIR Australian Childhood Immunisation Register AIHW Australian Institute of Health and Welfare ATSI Aboriginal Torres Strait Islander BMI Body Mass Index CAHS Child and Adolescent Health Service CEO Chief Executive Officer COAG Council of Australian Governments DOH Department of Health DOHA Department of Health and Ageing DOSA Day of Surgery Admission ED Emergency Department EDDC Emergency Department Data Collection EDIS Emergency Department Information System ESWL Elective Surgery Waiting List eWAU emergency department Weighted Activity Unit FTE Full Time Equivalent GL General Ledger HIN Health Information Network HMDC Hospital Morbidity Data Collections HMDS Hospital Morbidity Data System HR Human Resources HS Health Service HSMR Hospital Standardised Mortality Ratio HWSS Health and Wellbeing Surveillance ICD International Classification of Diseases IDM Information Development and Management Branch iWAU inpatient Weighted Activity Schedule JHC Joondalup Health Campus KPIs Key Performance Indicators MRSA Methicillin Resistant Staphylococcus Aureus NHDD National Health Data Dictionary NMHS North Metropolitan Health Service OP Operational Plan OSH Occupational Safety and Health OSQH Office of Safety and Quality in Health Care OSR Own Sourced Revenue PHC Peel Health Campus PMF Performance Management Framework PRB Performance Reporting Branch SA2 Statistical Area 2 SMHS South Metropolitan Health Service SMR Standardised Mortality Ratio TOOCS Type of Occurrence Classification System WACHS WA Country Health Service WLDC Wait List Data Collections YTD Year to Date

1. Introduction

The purpose of this manual is to provide consistent and clear definitions for the Performance Indicators (PIs) detailed in the Activity Based Funding and Management Performance Management Framework 2014-15 (PMF) to enable users to report and interpret on the results of the reporting entities. Any changes to the definitions will be in accordance with the “Guidelines for Creating and Changing State-wide Reporting Definitions” document (Information Circular 0087/11).

The PIs cover all domains of performance and include Outcome Measures (KPIs) and Health Service Measures. This document contains Outcome Measures only and should be read in conjunction with the Performance Indicators Definitions Manual (Health Service Measures) document. The selected PIs are aligned to all 4 pillars noted in the WA Health Strategic Intent 2010-2015. An extract of the PIs schedule from 2014-15 PMF is provided in Table 1.

Table 1: Schedule of KPIs and Reporting Frequency 2014-15

Key: * Proposed PAF indicator developed as the same indicator title or a WA Health equivalent measure ^ National core hospital-level outcome indicators recommended by the ACSQHC developed as the same indicator or a WA Health equivalent measure new! Indicator is new to PMF 2014-15 changed! Indicator title, reporting level and/or reporting frequency changed from PMF 2013-14 to PMF 2014-15 deferred! Indicator deferred until 2015-16

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY OUTCOME MEASURE EA1 * Proportion of emergency department patients seen within Facility Monthly recommended times a) % Triage Category 1 - 2 minutes b) % Triage Category 2 - 10 minutes c) % Triage Category 3 - 30 minutes d) % Triage Category 4 - 60 minutes e) % Triage Category 5 - 2 hours

EA2 * NEAT % of ED Attendances with LOE <=4 hours Facility Monthly EA3 Average overdue wait time of elective surgery cases waiting beyond Facility Monthly the clinically recommended time, by urgency category EFFECTIVENESS Access a) beyond 30 days for urgency category 1 b) beyond 90 days for urgency category 2 c) beyond 365 days for urgency category 3

EA4 * Elective surgery patients treated within boundary times: Facility Monthly a) % Category 1 within 30 days b) % Category 2 within 90 days c) % Category 3 within 365 days

EA5 * Percentage of selected elective cancer surgery cases treated within Facility Quarterly boundary time: a) Bladder Cancer b) Bowel Cancer c) Breast cancer

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY HEALTH SERVICE MEASURE EA7 Percentage of ED Mental Health patients admitted within 8 hrs Facility Monthly EA8 Theatre activity Facility Monthly EA10 Access Block Facility Monthly EA11 Admissions from ED Facility Monthly EA12 Percentage of SJAA patients with Off Stretcher time within 20 minutes Facility Monthly new! OUTCOME MEASURE EAP1 Rate of selected potentially preventable chronic condition Whole of Annually hospitalisations (for specified chronic conditions) population (reported at Health Service level) HEALTH SERVICE MEASURE EAP2 Adult immunisation: percentage of people aged 65 years and over Whole of Annually immunised against Influenza population (reported at Health Service Appropriateness level) EAP3 Obesity: percentage of population who are overweight or obese: Whole of Annually a) Adults population b) Children (reported at Statewide level) EAP4 Tobacco: percentage of adults who are current smokers Whole of Annually population (reported at Statewide level)

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY OUTCOME MEASURE EQ1 Age-adjusted rate (AAR) of avoidable deaths Whole of Annually population (reported at Health Service level) EQ3 *^ Staphylococcus aureus bacteraemia infections per 10,000 patient Facility Annually days EQ5 *^ Hospital standardised mortality ratio Facility Annually

EQ7 *^ Death in low-mortality DRGs Facility Annually

EQ8 *^ In hospital mortality rates (for acute myocardial infarction, stroke, Facility Annually fractured neck of femur & pneumonia)

Quality EQ10 Rate of total hospital readmissions within 28 days to an acute Facility Quarterly designated mental health inpatient unit changed!

HEALTH SERVICE MEASURE EQ2 Percentage of Emergency Department Attendances which are Facility Monthly unplanned re-attendances in less than or equal to 48 hours of previous attendance.

EQ4 Rate of Severity Assessment Code (SAC) 1 clinical incident Health Service Quarterly investigation reports received by Patient Safety Surveillance Unit within 45 working days of the event notification date

EQ6 Hospital accreditation Facility Annually EQ9 *^ Unplanned hospital readmissions of patients discharged following Facility Quarterly management of (knee replacement, hip replacement, tonsillectomy & adenoidectomy, hysterectomy, prostatectomy, cataract surgery and appendicectomy)

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY EQ12 * Rate of community follow up within first 7 days of discharge from Facility Quarterly psychiatric admission

EQ13 * Measures of patient experience (including satisfaction) with hospital Facility Annually services

EQ14 Hand Hygiene Compliance Facility Tri-annually

OUTCOME MEASURE EI1 Volume of weighted activity year-to-date: Facility Monthly a) Inpatients (variance from target) b) ED attendances (variance from target) c) Outpatients (variance from target) EI3 Average cost per test panel for PathWest Statewide Monthly EI6 * YTD distance of net cost of service to budget Health Service Monthly EI8 * Ratio of actual cost of specified public hospital services compared Health Service Annual with the ‘state efficient price’ deferred! HEALTH SERVICE MEASURE Inputs per output EFFICIENCY EI2 * Elective surgery day of surgery admission rates Facility Monthly unit EI4 YTD Distance of Expenditure to Budget Health Service Monthly EI5 YTD Distance of Own Sourced Revenue to Budget Health Service Monthly EI7 School Dental Service ratio of examinations to enrolments Whole of Annually population (reported at Health Service level) EI9 Number of separations (unweighted) Facility Monthly EI10 * Coded acute multiday average length of stay Facility Quarterly EI11 YTD Distance of Salaries Expenditure to Budget deferred! Health Service Monthly

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY OUTCOME MEASURE EQA1 Standardised Mortality Ratio (SMR) of deaths among Aboriginal Whole of Annually children (0-4 years) and non-Aboriginal children (0-4 years) population (reported at Health Service level)

EQA4 Proportion of eligible population receiving dental services from Whole of Quarterly subsidised dental programs by group: population a) Aged 16 years and over (reported at b) Aged 65 years and over Health Service c) Total Aboriginal population level)

HEALTH SERVICE MEASURE EQUITY Access EQA2 Standardised Rate Ratio of Hospitalisations of : Whole of Annually a) Aboriginal People compared to non-Aboriginal People. population b) Aboriginal children (0-4 years) compared to non-Aboriginal (reported at children (0-4 years) Health Service level)

EQA3 Childhood immunisation: percentage of children fully immunised at 12- Whole of Quarterly 15 months: population a) Aboriginal (reported at b) Total Health Service level)

EQA5 WA Health Aboriginal employment headcount Health Monthly Service

OUTCOME MEASURE SW3 Staff turnover Facility Monthly SUSTAINABILITY Workforce

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY HEALTH SERVICE MEASURE SW1 Proportion of medical graduates (and other categories of medical Facility Quarterly staff) to total medical staff a) Interns (graduate) b) Resident Medical Officers c) Registrars d) Consultants e) Other

SW2 Proportion of nursing graduates (and other categories of nursing staff) Facility Quarterly to total nursing staff changed! a) Graduate b) Junior c) Experienced d) Senior e) SRN and above f) Other

SW4 Injury management: Health Service Bi-annually a) Lost time injury severity rate b) Percentage of managers and supervisors trained in occupational safety and health (OSH) and injury management responsibilities

SW5 Leave Liability Facility Monthly SW6 Actual and Budget FTE Health Service Monthly

Facilities &

Equipment

OUTCOME MEASURE changed! PROCESSES Coding PC2 Percentage of cases coded and available for reporting within: Facility Monthly a) 2 weeks b) 4 weeks

ABF/ABM Framework Domain DOH PERFORMANCE MANAGEMENT MEASURES REPORTING REPORTING Domain Dimension Code LEVEL FREQUENCY HEALTH SERVICE MEASURE PC1 Percentage of cases coded by end of month closing date Facility Monthly

PC3 Clinical Information Audit Program measure of DRG accuracy new! Facility Quarterly

OUTCOME MEASURE PF2 Manually corrected payroll errors (underpayments) HCN Service Monthly

PF3 Availability of Information Communication Technology (ICT) services: HIN Service Monthly percentage of Service calls resolved at first point of contact

Finance HEALTH SERVICE MEASURE PF1 Patient fee debtors Health Service Monthly PF4 NurseWest shifts filled Statewide Monthly PF5 Accounts payable – payment within terms HCN Service Monthly

2. Data Definitions 2.1 Effectiveness Access (EA) PIs

There are 10 EA PIs proposed in the 2014-15 PMF, including 5 outcome measures.

EA1a-e: Proportion of emergency department patients seen within recommended times a) % Triage Cat 1 – 2 mins; b) % Triage Cat 2- 10min; c) % Triage Cat 3- 30 min; d) % Triage Cat 4- 60 min; e) % Triage Cat 5- 2 hours Reported Data Description Items Identifier MDG-04-003

Name Triage 1, 2, 3, 4 & 5 Patients seen within recommended time

Aliases . Triage 1, 2, 3, 4 & 5 within wait time . Triage 1, 2, 3, 4 & 5 patients seen on time Definition The percentage of all Emergency Department/Service Triage 1, 2, 3, 4 & 5 patients seen within the benchmarked time

Related metadata MDG-04-001 Total ED Attendances

Guide for Use Triage 1, 2, 3, 4 & 5 attendances are counted from event records in EDDC using [Presentation Date] and [Presentation Time], [Triage category], [Seen by doctor], [Seen by nurse], [Time Seen] and [Episode end status]. Only episodes with a [Triage category] value of 1, 2, 3, 4 & 5 are included. [Presentation Date] and [Presentation Time] and [Service commencement date] and [Service commencement time] are used to calculate Wait time to be seen. For WACHS sites (excluding Bunbury and Kalgoorlie), the service commences when the medical officer (or, if no medical officer is on duty in the Emergency Department/ Service, a treating nurse) provides treatment or diagnostic service. The [Service commencement date] and [Service commencement time] is the [Time Seen] field which is populated by the earlier of [Seen by doctor] or [Seen by nurse]. For Metro sites and Bunbury and Kalgoorlie, where there is 24 hour medical officer coverage in the ED, the service commences when the medical officer provides treatment or diagnostic service. The [Service commencement date] and [Service commencement time] is the [Seen by doctor] field. From the commencement of the 2009/10 year, WACHS has advised that Kalgoorlie Hospital has 24 hour medical officer coverage in the ED. Therefore, the rules for Kalgoorlie Hospital are as per all WACHS up until 1 July 2009. From this date, the rules are as stated above.

The Australasian College of Emergency Medicine specifies that:- 100% of all Triage 1 patients should be seen immediately (within seconds) (a time interval of less than or equal to 2 minutes is used to identify those Triage 1 patients seen within time);

80% of all Triage 2 patients should be seen within 10 minutes; 75% of all Triage 3 patients should be seen within 30 minutes; 70% of all Triage 4 patients should be seen within 60 minutes; and 70% of all Triage 5 patients should be seen within 120 minutes. These times are used by DOHA and AIHW to calculate wait times nationally.

Limitations Due to continuous quality improvement processes historical figures may be subject to change.

Reported Data Validation Items

Format Percentage 7 NNN.NN% Data Values Inclusions Triage category = 1 (Resuscitation) Triage category = 2 (Emergency) Triage category = 3 (Urgent) Triage category = 4 (Semi-urgent) Triage Category = 5 (Non-urgent)

Exclusions [Presentation Date] and [Presentation Time] values are invalid or null. [Service commencement date] and [Service commencement time] values are invalid or null.

Scope . Public Hospitals with an Emergency Department and publicly funded activity at Joondalup and Peel Health Campuses . Excludes nursing posts and other non-hospital establishments . The rules for Kalgoorlie Hospital are as per all WACHS up until 1 July 2009. From this date, the rules are as stated above.

Formula [Service commencement date] and [Service commencement time] for WACHS sites (excluding Bunbury and Kalgoorlie) is the [Time Seen] field which is populated by the earlier of [Seen by doctor] or [Seen by nurse]. For Metro sites and Bunbury and Kalgoorlie, this is the [Seen by

doctor] field.

Wait time to be seen = [Service commencement date] and [Service commencement time] minus [Presentation Date] and [Presentation Time]

Numerator Total Triage 1, 2, 3, 4 or 5 patients seen within time is a count of the number of records where:- [Triage category] = 1 and Wait time to be seen is ≦ 2 minutes; or where [Triage category] = 2 and Wait time to be seen is ≦ 10 minutes; or where [Triage category] = 3 and Wait time to be seen is ≦ 30 minutes or where [Triage category] = 4 and Wait time to be seen is ≦ 60 minutes; or where [Triage category] = 5 and Wait time to be seen is ≦ 120 minutes. Denominator Total Triage 1, 2, 3, 4 or 5 patients is a count of the number of records for each [Triage category] of 1, 2, 3, 4 and 5

Calculation Numerator for each [Triage category] of 1, 2, 3, 4 and 5 divided by Denominator for each same [Triage category] of 1, 2, 3, 4 or 5, expressed as a percentage by each [Triage category], with all exclusions applied to both Numerator and Denominator.

Verification Rules Value is between zero and one hundred (100) percent inclusive. Data Collection Identification Items Source Emergency Department Data Collection (EDDC) extract provided by IMR is updated every day at 2 am, for EDIS, every Monday for HCARe and Peel, and 3rd working day of the month for TOPAS and Peel.

Governance Items Purpose of the data Used to measure performance against the Australasian College of Emergency Medicine (ACEM) recommendation that all patients are seen within the benchmarked time for Triage 1, 2, 3, 4 & 5.

Source of the . Health Services, Performance, Activity and Quality Division definition Local definition Version number V 2.0 Approval date 20091019

EA2: NEAT Percentage of ED Attendances with LOE less than or equal to 4 hours

Reported Data Description Items Identifier MDG-04-080

Name National Emergency Access Target (NEAT) Percentage of Emergency Department (ED) Attendances with LOE less than or equal to 4 hours Aliases . National Emergency Access Target (NEAT) Performance Definition The percentage of all ED attendance records whose total time as a patient in the ED is less than or equal to 4 hours. Related Metadata . MDG-04-080 NEAT Attendances LOE less than or equal to 4 hours . MDG-04-086 NEAT ED Attendances LOE greater than 12 hours . MDG-04-097 NEAT Total ED Attendances Guide for Use All NEAT Performance Indicators (PIs) have the following General inclusions/exclusions: Records must have a valid [Presentation Date] and [Presentation Time] Records must have a valid [Discharge Date] and [Discharge Time] Records must have a [Presentation Date] and [Presentation Time] within the Reference Period i.e. for Date fields to be considered valid, the day, month and year components must be accurate, as per Meteor Data Element 294429 Date—accuracy indicator, code AAA.

{NEAT attendances} are counted from event records in the Emergency Department Data Collection (EDDC) using [Presentation Date], [Presentation Time], [Discharge Date] and [Discharge Time]. [Presentation Date] and [Presentation Time] is the earlier of [Arrival Date] and [Arrival Time] and [Triage Date] and [Triage Time]. [Presentation Date] and [Presentation Time] is used rather than [Arrival Date] and [Arrival Time] and [Triage Date] and [Triage Time] to ensure that the attendance is within the desired reference period. Some patients may arrive before midnight and be triaged after midnight. Recording the earlier of the two fields ensures the correct date and time is referenced.

An attendance at the emergency department is recorded when a patient is registered in any manner in one of the electronic data collection systems, i.e. includes those cases that may not have been completely clerically registered or triaged.

The NEAT requires length of episode to be measured from the point of first contact to physical departure from the emergency department (ED), where first contact is with any staff member e.g. clerk or triage nurse. All {NEAT attendances} have their {Length of Episode} determined by [Discharge Date] and [Discharge Time] minus [Presentation Date] and [Presentation Time].

For patients to be a bona-fide admission to Short Stay Unit (SSU), where the [Discharge Date] and [Discharge Time] is the time they were admitted to the SSU, the following definition must be used. Short Stay Unit (SSU) may also be known as Clinical Decision Unit (CDU)/ Emergency Medical (Observation) Units (EMU). These units must have the following characteristics: • Designated and designed for the short term treatment, observation, assessment and reassessment of patients initially triaged and assessed in the Emergency Department; • Have specific admission and discharge criteria and policies; • Designed for short term stays <24 hours; • Physically separate from the Emergency Department acute assessment area; • Have a static number of beds with oxygen, suction and patient ablution facilities; and • Not a temporary ED overflows area nor used to keep patients solely awaiting an inpatient bed nor awaiting treatment in the emergency department.

For sites that do not have a SSU as defined above, patients admitted for observation within the main ED area are not considered to have left the ED. Limitations Due to continuous quality improvement processes, historical figures may be subject to change.

Reported Data Validation Items Format Numeric 6 NNN.N% Data Values Inclusions [Presentation Date] and [Presentation Time] are not missing and are valid. [Discharge Date] and [Discharge Time] are not missing and are valid. {Length of Episode} is valid i.e. >= 0.

Exclusions [Presentation Date] or [Presentation Time] are missing or invalid. [Discharge Date] or [Discharge Time] are missing or invalid. {Length of Episode} is invalid i.e. < 0. Formulae For records with [Presentation Date] and [Presentation Time] within the reference period, calculate the {Length of Episode} (in minutes). Numerator: The count of {NEAT attendances} determined above, where [Presentation Date] and [Presentation Time] are within the reference period and are not missing and are valid and [Discharge Date] and [Discharge Time] are not missing and are valid and {Length of Episode} is greater than or equal to zero AND less than or equal to 240 minutes.

Denominator: The count of {NEAT attendances} determined above, where [Presentation Date] and [Presentation Time] are within the reference period and are not missing and

are valid and [Discharge Date] and [Discharge Time] are not missing and are valid and {Length of Episode} is greater than or equal to zero.

Verification Rules Calculation: Numerator divided by Denominator.

Value is >/= to zero

Reported Data Structure Items

Scope Public Hospitals with an Emergency Department, publicly funded activity at Joondalup and Peel Health Campuses; and the following rural hospitals:  Albany Regional Hospital  Bunbury Hospital  Broome District Hospital  Geraldton Regional Hospital  Kalgoorlie Regional Hospital  Nickol Bay Hospital  Hedland Health Campus

Data Collection Identification Items Source Emergency Department Data Collection (EDDC) Provider Performance, Activity and Quality Division Governance Items Purpose of To measure compliance with the National Emergency Access Target the data (NEAT): ED attendance records whose total time as a patient in the ED is less than or equal to 4 hours. Source of the National Partnership Agreement, Health System Improvement Unit, definition Performance Activity and Quality Division, Health Services. Version 1.0 number Approval 20120926 date

EA3: Average overdue wait time of elective surgery cases waiting beyond the clinically recommended time, by urgency category

Reported Data Description Items Identifier Name Average overdue wait time of elective surgery cases waiting beyond the clinically recommended time, by urgency category

Aliases . On List Wait Time Over Boundary Definition The average overdue wait time (in days) for reportable elective surgery wait list cases that have waited beyond the clinically recommended time, reported by urgency category. Related Metadata

Guide for Use Elective Surgery Wait List (ESWL) ‘reportable cases’ are those that are surgical in nature and not included in the excluded procedures list (Excluded procedures MDG-03-012). The excluded procedures list is consistent with that of the Australian Institute of Health and Welfare (AIHW) although includes additional procedure codes in an attempt to provide a fully comprehensive list of non-surgical procedures. Permissible values for 'Client listing status' are 1 - Ready for Care, 2 - Staged or 3 - Deferred. HCARe assigns a client listing status of ‘4’ for a small number of cases that are missing a 'Date returned ready for care' value. Patients with a client listing status of '4' are deemed 'ready for care', as a patient on the wait list should be ready for care unless otherwise notified. The average overdue wait time (in days) is calculated for all eligible cases that have waited beyond the recommended time for their urgency category, as at the last day of the reporting period. The average waiting time over boundary is reported separately for each of the following clinical urgency categories: Category 1, boundary = 30 days Category 2, boundary = 90 days Category 3, boundary = 365 days If the patient is on the waitlist at a TOPAS or webPAS site and is in the same urgency category at census date as when they were added to the wait list (i.e. if [Urgency Reassignment Date] = [Listing Date]), or if they are on the waitlist at a HCARe site then the number of {days on list} is calculated by subtracting the listing date for care from the census date, minus any days when the patient was 'not ready for care'. Days when the patient was not ready for care is obtained from the [Time not ready] field. This field is calculated by subtracting the date(s) the person was

recorded as 'not ready for care' from the date(s) the person was subsequently recorded as again being 'ready for care'. If the patient is on the waitlist at a TOPAS or webPAS site and is in a different urgency category at census date from the date they were added to the wait list, then the number of {days on list} is calculated by summing the wait days for the urgency category the patient is in at census date, plus any days where the patient was in a higher urgency category (e.g. see the below table).

Urgency Category Urgency Days calculation 1 Urgency 1 days 2 Urgency 1 days + Urgency 2 days 3 Urgency 1 days + Urgency 2 days + Urgency 3 days

For Joondalup and Peel Health Campuses (JHC and PHC), the {days on list} is equal to the [List Days] field, which is the number of days the patient has been on the wait list, minus any days that they were not ready for care. The number of days over boundary (overdue days) is calculated by subtracting the number of within boundary days from the total number of {days on list}.

Limitations Non-ICD-10 coded cases may include non-reportable procedures.

Reported Data Validation Items Format Numeric 7 NNNNNNN

Data Values Inclusions Event Type = ONL Clinical Urgency Code = 1, 2 or 3 ICD-10 Coded Cases

. Client Listing Status = 1, 4 = Ready for Care

. Wait List Type = 2 = Surgical

. Wait List Category = 1 = Elective

Exclusions Cases with Clinical Urgency Code = 4 (HCARe) Cases from the DOH “Excluded Procedures” List (Excluded procedures MDG-03-012) ref. National Health Data Dictionary (NHDD) Data Element “Elective care waiting list episode – elective care type, code N”. Ward Type = ‘R’ (Ambulatory Surgery Initiative for TOPAS) Financial class = ‘AS’ (Ambulatory Surgery Initiative for HCARe). Client Listing Status = 2, 3 = Staged, Deferred (Not Ready for Care) Cases with Date of Death is not null. Cases waiting within boundary for their category at census date. Scope . Public Hospitals (metropolitan and rural)

. Joondalup Health Campus, publicly funded activity

. Peel Health Campus, publicly funded activity

For a particular report, please refer to that report’s scoping to determine which sites are included. Formula {Days on list} If ([Feeder System] = (TOPAS or webPAS) and [Urgency Reassignment Date] = [Listing Date]) OR if [Feeder System] = (HCARe), then {days on list} = [Census Date] minus [Listing Date], minus [Time Not Ready for Care]. If [Feeder System] = (TOPAS or webPAS) and [Urgency Reassignment Date] ≠ [Listing Date] then {days on list} = If [Clinical Urgency Category] = 1 then {days on list} = [Event Days in Urgency Category 1] If [Clinical Urgency Category] = 2 then {days on list} = [Event Days in Urgency Category 1] + [Event Days in Urgency Category 2] If [Clinical Urgency Category] = 3 then {days on list} = [Event Days in Urgency Category 1] + [Event Days in Urgency Category 2] + [Event Days in Urgency Category 3] If [Feeder System] = (JHC or PHC), then {days on list} = [List Days]. {Days on list over Calculate separately for each [Clinical Urgency Category]: boundary} {Days on list} minus any days the patient was waiting within boundary (i.e., Urgency Category 1 = 30 days, Urgency Category 2 = 90 days and Urgency Category 3 = 365 days).

Numerator Calculate separately for each [Clinical Urgency Category]: Sum {days on list over boundary} where {days on list over boundary} > 0 and [Event Type] = ONL and [Client Listing Status] = 1 or 4. Minus [Ward Type] = ‘R’ or [Financial Class] = ‘AS’, and for ICD-10 Coded Cases ICD-10 code is not on the DOH “Excluded Procedures” list for Non-ICD-10 Coded Cases [Wait List Type] = 2 and [Wait List Category] = 1.

Denominator Calculate separately for each [Clinical Urgency Category]: Count cases where {days on list over boundary} > 0 and [Event Type] = ONL and [Client Listing Status] = 1 or 4. Minus [Ward Type] = ‘R’ or [Financial Class] = ‘AS’, and for ICD-10 Coded Cases ICD-10 code is not on the DOH “Excluded Procedures” list for Non-ICD-10 Coded Cases

[Wait List Type] = 2 and [Wait List Category] = 1.

Calculate the average Calculate separately for each [Clinical Urgency Category]: wait time over Numerator divided by denominator boundary: i.e. Sum of total {days on list over boundary} divided by total patients waiting over boundary.

Verification Rules 0

Data Collection Identification Items

Source WLDC which uses extracts from TOPAS, webPAS, HCARe, PHC and JHC as follows: TOPAS Weekly file extracted at 0600 hours each Monday

Monthly file extracted to capture all activity to 2400 on last day of calendar month. webPAS Weekly file extracted at 0600 hours each Monday Monthly file extracted to capture all activity to 2400 on last day of calendar month.

HCARe Weekly file extracted at 0600 hours each Monday

Monthly file extracted to capture all activity to 2400 on last day of calendar month PHC Weekly file provided via email – amalgamated to produce a monthly file JHC Weekly file provided via email – amalgamated to produce a monthly file Governance Items Purpose of the data A measure of the current average overdue wait time (in days) for cases waiting beyond the boundary period for each urgency category on elective surgery waiting lists.

Source of the . National Health Data Dictionary–Elective surgery waiting definition lists episode–waiting time (at a census date), total days N[NNN]

. OD 0189/09 Elective Surgery Access Policy – WA Health Services

. Data Integrity, DoH

Version number 1.2 Approval date 15/09/2014

EA4.a: Elective surgery patients treated within boundary times: a) % Cat 1 < 30days

Reported Data Description Items Identifier MDG-03-013

Name National Elective Surgery Target (NEST) Category 1 cases treated within clinically recommended time

Aliases . NEST Cat 1 seen in boundary

. Urgency 1 cases admitted within boundary Definition The proportion of all elective surgery wait list patients who have been clinically assessed as Urgency Category 1 whose waiting time to treatment (admission) is within the clinically desirable time of 30 days, expressed as a percentage Related Metadata Category 1 cases treated within clinically recommended time Guide for Use Department of Health (DOH) reportable cases, that had been admitted, less than or equal to 30 days at urgency category

[URGENT] 1, are considered to be within boundary.

‘DOH reportable cases’ includes waiting list cases with procedures that are not listed on the DOH excluded procedures list. The DOH excluded procedures list is consistent with the AIHW excluded procedures list and includes additional procedure codes which are intended to better reflect those identified in the AIHW excluded procedures list. Ambulatory Surgery Initiative cases are excluded. For cases that have days recorded at more than one urgency category [URGENT], any days awaited at a less urgent category

(than the current one) are excluded. These webPAS and TOPAS cases are selected where the listing date [WAITDATE] is not equal to the urgency reassignment date [URGDATE]. To include this criteria in the calculation of days on list, we count the days awaited in the current and higher urgency categories ([URGxDAYS], this excludes any days not ready for care). For cases that have no days recorded at more than one urgency category, the number of days is calculated by subtracting the listing

date [WAITDATE] for care from the admission date [ADMISSON], minus any days when the patient was 'not ready for care' [TIMENR]. For Joondalup (JHC) and Peel Health Campus (PHC) the days on list [LISTDAYS] are used. Days when the patient was not ready for care are calculated by subtracting the date(s) the person was recorded as 'not ready for care' from the date(s) the person was subsequently recorded as again being 'ready for care'.

As part of the National Partnership Agreement (the Agreement) on Improving Hospital Services (2011) the States and Territories report on the National Elective Surgery Target (NEST) from 2012 to 2016. For the purpose of ongoing reporting of elective surgery admissions under Part 1 of the Agreement, cases are reported for patients that are admitted as “elective” and for patients that are admitted as “emergency patient for awaited procedure”. Limitations Non-ICD-10 coded cases are only considered to be reportable if the wait list type [WLTYPE] equals 2 ‘Surgical’ and the wait list category [WLC] equals 1 ‘Elective’. Reported Data Validation Items Format Numeric 7 NNN.NN% Data Values Inclusions Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or

(Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Urgency Category [URGENT] = 1 ICD-10 Coded Cases with DOH reportable procedures. Non-ICD-10 Coded Cases with wait list type [WLTYPE] = 2. (Surgical) and wait list category [WLC] = 1 (Elective).

Exclusions Event type [EXTA] = ONL or Event type [EXTA] = REM and [source_table] = HCARe and [DELETION] is not equal to 2)

Event type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] is not equal to 1D, 1E, 2)) Urgency Category [URGENT] = 2, 3, 4 or missing (HCARe). ICD-10 Coded Cases with procedures from the DOH “Excluded Procedures” List.

Non-ICD-10 Coded Cases where the [WAIT LIST TYPE] is not equal to 2 (Surgical) or the [WAIT LIST CATEGORY] is not equal to 1 (Elective). Ward Type [WARDTYPE] = ‘R’ (Ambulatory Surgery Initiative). Scope . Public Hospitals (metropolitan and rural)

. Joondalup Health Campus, publicly funded activity

. Peel Health Campus, publicly funded activity

Numerator Count records with Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Select all Urgency Category [URGENT] = 1 where days to admission [ADMWT] <= 30 days for DOH reportable cases and for

non-ICD-10 Coded Cases: Wait List Type [WLTYPE] = 2 and Wait List Category [WLC] = 1. Minus Ward Type = ‘R’

Denominator Count records with Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Select all Urgency Category [URGENT] = 1 for DOH reportable cases and for non-ICD-10 Coded Cases: Wait List Type [WLTYPE]

= 2 and Wait List Category [WLC] = 1. Minus Ward Type = ‘R’

Calculation Numerator divided by denominator, x 100. Verification Rules Data Collection Identification Items Source Wait List Data Collection which uses extracts from TOPAS, HCARe, PHC and JHC as follows: webPAS webPAS wait list extracts

TOPAS TOPAS wait list extracts

HCARe HCARe wait list extracts

PHC PHC wait list extracts

JHC JHC wait list extracts

Governance Items Purpose of the data The proportion of the most urgent patients who have been admitted for surgery within clinically desirable times represents a measure of the system’s performance in the provision of elective hospital care.

Source of the . National Health Data Dictionary and DOH definition . Elective Surgery Access Policy – Public And Private Patients – OP 2075/06

. Performance Activity and Quality Division, DoH

. Health Reform Implementation Group, Hospitals National

Partnership Agreement Reporting Working Group (8 November 2011 meeting) Version number 1.0 Approval date 20130510

EA4.b: Elective surgery patients treated within boundary times: b) % Cat 2 < 90days

Reported Data Description Items Identifier MDG-03-014

Name National Elective Surgery Target (NEST) Category 2 cases treated within clinically recommended time

Aliases . NEST Cat 2 seen in boundary

. Urgency 2 cases admitted within boundary Definition The proportion of all elective surgery wait list patients who have been clinically assessed as Urgency Category 2 whose waiting time to treatment (admission) is within the clinically desirable time of 90 days, expressed as a percentage. Related Metadata Category 2 cases treated within clinically recommended time Guide for Use Department of Health (DOH) reportable cases, that had been admitted, less than or equal to 90 days at urgency category

[URGENT] 2, are considered to be within boundary.

date [WAITDATE] for care from the admission date [ADMISSON], minus any days when the patient was 'not ready for care' [TIMENR]. For Joondalup (JHC) and Peel (PHC) the days on list [LISTDAYS] are used to calculate waiting time to treatment (admission).

Days when the patient was not ready for care are calculated by subtracting the date(s) the person was recorded as 'not ready for care' from the date(s) the person was subsequently recorded as

again being 'ready for care'. As part of the National Partnership Agreement (the Agreement) on Improving Hospital Services (2011) the States and Territories report on the National Elective Surgery Target (NEST) from 2012 to 2016. For the purpose of ongoing reporting of elective surgery admissions under Part 1 of the Agreement, patients that are admitted as “elective” and for patients that are admitted as “emergency patient for awaited procedure” are included. Limitations Non-ICD-10 coded cases are only considered to be reportable if the wait list type [WLTYPE] equals 2 ‘Surgical’ and the wait list category [WLC] equals 1 ‘Elective’. Reported Data Validation Items Format Numeric 7 NNN.NN% Data Values Inclusions Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2))

Urgency Category [URGENT] = 2

ICD-10 Coded Cases with DOH reportable procedures.

Non-ICD-10 Coded Cases with wait list type [WLTYPE] = 2. (Surgical) and wait list category [WLC] = 1 (Elective).

Exclusions Event type [EXTA] = ONL or Event type [EXTA] = REM and [source_table] = HCARe and [DELETION] is not equal to 2)

Event type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] is not equal to 1D, 1E, 2)) Urgency Category [URGENT] = 1, 3, 4 or missing (HCARe). ICD-10 Coded Cases with procedures from the DOH “Excluded Procedures” List.

Scope . Public Hospitals (metropolitan and rural)

. Joondalup Health Campus, publicly funded activity

. Peel Health Campus, publicly funded activity

Numerator Count records with Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Select all Urgency Category [URGENT] = 2 where days to admission [ADMWT] <= 90 days for DOH reportable cases and for

non-ICD-10 Coded Cases: Wait List Type [WLTYPE] = 2 and Wait List Category [WLC] = 1. Minus Ward Type = ‘R’

Denominator Count records with Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Select all Urgency Category [URGENT] = 2 for DOH reportable cases and for non-ICD-10 Coded Cases: Wait List Type [WLTYPE] = 2 and Wait List Category [WLC] = 1. Minus Ward Type = ‘R’

Calculation Numerator divided by denominator, x 100 Verification Rules Data Collection Identification Items Source Wait List Data Collection which uses extracts from TOPAS, HCARe, PHC and JHC as follows:

TOPAS TOPAS wait list extracts

HCARe HCARe wait list extracts

PHC PHC wait list extracts

JHC JHC wait list extracts

Governance Items Purpose of the data The proportion of moderately urgent patients who have been admitted for surgery within clinically desirable times represents a measure of the system’s performance in the provision of elective hospital care.

Source of the . National Health Data Dictionary and DOH definition . Elective Surgery Access Policy – Public And Private Patients – OP 2075/06

. Performance Activity and Quality Division, DoH

. Health Reform Implementation Group, Hospitals National

Partnership Agreement Reporting Working Group (8 November 2011 meeting)

Version number 1.0 Approval date 20130510

EA4.c: Elective surgery patients treated within boundary times c) % Cat 3 <365 days

Reported Data Description Items Identifier MDG-03-015

Name National Elective Surgery Target (NEST) Category 3 cases treated within clinically recommended time

Aliases . NEST Cat 3 seen in boundary

. Urgency 3 cases admitted within boundary

Definition The proportion of all elective surgery wait list patients who have been clinically assessed as Urgency Category 3 whose waiting time to treatment (admission) is within the clinically desirable time of 365 days, expressed as a percentage.

Related Metadata Category 3 cases treated within clinically recommended time Guide for Use Department of Health (DOH) reportable cases, that had been admitted, less than or equal to 365 days at urgency category [URGENT] 3, are considered to be within boundary. ‘DOH reportable cases’ includes waiting list cases with procedures that are not listed on the DOH excluded procedures list. DOH excluded procedures list is consistent with the AIHW excluded procedures list and includes additional procedure codes which are intended to better reflect those identified in the AIHW excluded procedures list. Ambulatory Surgery Initiative cases are excluded. For cases that have days recorded at more than one urgency category [URGENT], any days awaited at a less urgent category (than the current one) are excluded. These webPAS and TOPAS cases are selected where the listing date [WAITDATE] is not equal to the urgency reassignment date [URGDATE]. To include this criteria in the calculation of days on list, we count the days awaited in the current and higher urgency categories ([URGxDAYS], this excludes any days not ready for care). For cases that have no days recorded at more than one urgency category, the number of days is calculated by subtracting the listing date [WAITDATE] for care from the admission date [ADMISSON], minus any days when the patient was 'not ready for care' [TIMENR]. For Joondalup (JHC) and Peel Health Campuses (PHC) the days on list [LISTDAYS] are used to calculate waiting time to treatment (admission). Days when the patient was not ready for care are calculated by subtracting the date(s) the person was recorded as 'not ready for

care' from the date(s) the person was subsequently recorded as again being 'ready for care'. As part of the National Partnership Agreement (the Agreement) on Improving Hospital Services (2011) the States and Territories report on the National Elective Surgery Target (NEST) from 2012 to 2016. For the purpose of ongoing reporting of elective surgery admissions under Part 1 of the Agreement, cases are reported for patients that are admitted as “elective” and for patients that are admitted as “emergency patient for awaited procedure”. Limitations Non-ICD-10 coded cases are only considered to be reportable if the wait list type [WLTYPE] equals 2 ‘Surgical’ and the wait list category [WLC] equals 1 ‘Elective’. Reported Data Validation Items Format Numeric 7 NNN.NN % Data Values Inclusions Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and [DELETION] = 2) or

(Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Urgency Category [URGENT] = 3 ICD-10 Coded Cases with DOH reportable procedures. Non-ICD-10 Coded Cases with wait list type [WLTYPE] = 2. (Surgical) and wait list category [WLC] = 1 (Elective). Exclusions Event type [EXTA] = ONL or Event type [EXTA] = REM and [source_table] = HCARe and [DELETION] is not equal to 2)

Event type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] is not equal to 1D, 1E, 2)) Urgency Category [URGENT] = 1, 2, 4 or missing (HCARe). ICD-10 Coded Cases with procedures from the DOH “Excluded Procedures” List.

Numerator Count records with Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and

[DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Select all Urgency Category [URGENT] = 3 where days to admission [ADMWT] <= 365 days for DOH reportable cases and for non-ICD-10 Coded Cases: Wait List Type [WLTYPE] = 2 and Wait List Category [WLC] = 1. Minus Ward Type = ‘R’

Denominator Count records with Event Type [EXTA] = ADM or ((Event Type [EXTA] = REM and [source_table] = HCARe and

[DELETION] = 2) or (Event Type [EXTA] = REM and [source_table] is not equal to HCARe and [TOPASREM] = 1D, 1E, 2)) Select all Urgency Category [URGENT] = 3 for DOH reportable cases and for non-ICD-10 Coded Cases: Wait List Type [WLTYPE] = 2 and Wait List Category [WLC] = 1. Minus Ward Type = ‘R’

Calculation Numerator divided by denominator, x 100. Verification Rules

Data Collection Identification Items Source Wait List Data Collection which uses extracts from TOPAS, HCARe, PHC and JHC as follows:

TOPAS TOPAS wait list extracts

HCARe HCARe wait list extracts

PHC PHC wait list extracts

JHC JHC wait list extracts

Governance Items Purpose of the data The proportion of less urgent patients who have been admitted for surgery within a clinically desirable time represents a measure of the system’s performance in the provision of elective hospital care.

Source of the . National Health Data Dictionary and DOH definition . Elective Surgery Access Policy – Public And Private Patients – OP 2075/06

. Performance Activity and Quality Division, DoH

. Health Reform Implementation Group, Hospitals National Partnership Agreement Reporting Working Group (8 November 2011 meeting) Version number 1.0

Approval date 20130510

EA5: Percentage of selected elective cancer surgery cases (for bladder cancer, bowel cancer and breast cancer) treated within boundary time

Reported Data Description Items Identifier (office use only) Name: Percentage of selected elective cancer surgery cases (or bladder cancer, bowel cancer and breast cancer) treated within boundary time Aliases: Cancer surgery wait time for selected cancers The percentage of admissions for cancer surgery within boundary Definition: The percentage of elective surgery wait list admissions within boundary for selected types of cancer (1) bladder cancer, (2) bowel cancer, (3) breast cancer. Related Metadata: MDG-03-012 - Elective Surgery Wait List Excluded Procedures Guide for Use: This definition is dependent on coded hospital inpatient data (via the Hospital Morbidity Data System (HMDS)) linked to data from Wait List Data Collections (WLDC).

Data are linked between the WLDC and HMDS using the following data items: [ESTABLISHMENT CODE], [UMRN], [ACCOUNT NUMBER] and [ADMISSION DATE].

The HMDS principal diagnosis [DIAG] ICD-10-AM code is used to determine the type of cancer, as per those listed in the inclusions section below. Limitations: The coding completeness of the HMDS data should be assessed prior to determining the reporting period. At time of approval of this definition a six month lag should be applied.

This definition is based on a proposed MyHospitals definition (as at 17 April 2012) that may change. Data reported in MyHospitals are sourced from the Elective Surgery Waiting Times National Minimum Data Set (NMDS). These data contain a link to the relevant HMDS case. The NMDS are provided as a static extract and therefore may result in less cases than selections using updated HMDS data. Other NMDS reporting inclusions and exclusions may also contribute to slight differences in results.

Reported Data Validation Items Format Percentage 4 NNN.N% Data Values Inclusions: HMDS The types of cancer and the principal diagnosis [DIAG] ICD-10- AM codes to be selected from the HMDS are as follows:

Bladder cancer (C67, D09.0) Bowel cancer (C18-C20, D01.0-D01.2) Breast cancer (C50, D05)

All public hospitals publicly funded activity at Joondalup Health Campus (642) and Peel Health Campuses (645).

Publicly funded activity is defined as cases with a [FUNDING SOURCE] of: Australian Health Care Agreement (21), Correctional facility (29), Reciprocal Health Care Agreement (30).

Elective wait list admissions are selected where the admission status [ATYPE] is reported as elective wait list (3).

WLDC

Elective Surgery Wait List reportable admissions ([EVENT TYPE] ‘adm’).

These admissions are considered reportable if they have an ICD- 10-AM procedure code that is not listed on the excluded procedures list (see the definition MDG-03-012 - Elective Surgery Wait List Excluded Procedures).

Exclusions: HMDS

Standard exclusions have been applied: unqualified (healthy) newborns, boarders, posthumous organ procurements, aged care residents, and funding hospital (duplicate) cases. These have [CLIENT STATUS] values of 0,2,3,7,8.

WLDC

Ambulatory Surgery Initiative (ASI) cases, these are identified by: [WARDTYPE] = “R” (TOPAS) [WARDTYPE] = “AMB” (webPAS) [WARDTYPE] = ‘AS’ (HCARe) Scope: All hospitals offering ESWL with 10 or more selected elective cancer surgery cases admitted from a waiting list during the reference period. Formula: HMDS selection

Principal diagnosis [DIAG] ICD-10-AM codes of cancer, as per those listed in the inclusions.

Public hospitals plus public patients ([PCLASS] value of 21, 29 or 30) at Joondalup Health Campus ([HOSP] value of 642) and Peel Health Campus ([HOSP] value of 645).

Admission status of elective wait list ([ATYPE] value of 3).

Minus cases that are usually excluded: unqualified (healthy) newborns, boarders, posthumous organ procurements, aged care residents, and funding hospital (duplicate) cases. These have client status [PATTYP] values of 0,2,3,7,8.

WLDC selection

Event type [EXTA] of ‘adm’ (admission). ICD-10-AM procedure code [PROC] that is considered to be surgical, see MDG-03-012 - Elective Surgery Wait List Excluded Procedures.

Selection

From the HMDS selection and the WLDC selection, only cases that match both datasets are selected. This match is determined by creating a unique identifier for each dataset using the [ESTABLISHMENT CODE], [UMRN], [ACCOUNT NUMBER] and [ADMISSION DATE].

Numerator All cases that meet the selection criteria where the admission waiting time [admwt] for each [URGENCY CATEGORY] meet the following criteria: [URGENT] 1: <= 30days [URGENT] 2: <= 90 days [URGENT] 3: <=365 days

Denominator All cases that meet the selection criteria.

Calculation: Numerator divided by the denominator expressed as a percentage. Verification Rules: 0-100% Data Collection Identification Items Source: Hospital Morbidity Data System and Wait List Data Collections Governance Items Purpose of the data: This information is used for Activity Based Funding and Management reporting (currently 36 hospitals), other internal performance reporting and for internal checking of proposed national reporting definition. Source of the MyHospitals Cancer Surgery Specification- MyHospitals definition definition: (17/4/2012 draft definition). Further revisions made by the Performance Directorate and Data Integrity Directorate in the Performance Activity and Quality Division. Version number: 1.1 Approval date: 20130605

2.2 Effectiveness Appropriateness (EAP) PIs

There are 4 EAP PIs proposed in the 2014-15 PMF, including 1 outcome measure.

EAP1: Rate of selected potentially preventable chronic condition hospitalisations (for specified chronic conditions)

Reported Data Description Items Identifier Office use Name Preventable hospitalisations: Preventable chronic conditions Aliases Preventable chronic condition hospitalisation rate Definition Preventable chronic condition hospitalisations are hospitalisations due to chronic conditions that could be managed by means other than hospitalisation. The preventable chronic condition hospitalisation rate is the number of age-standardised hospitalisations per 1,000 person- years. A direct age-standardisation based on Australian National Census population data (2001) is employed in the calculation of the age-standardised rate of preventable chronic condition hospitalisations in order to enable valid comparisons between Health Services. Related Metadata Guide for Use Preventable chronic hospitalisations among residents of each Health Service (HS) in WA are counted from hospital inpatient separation records extracted from the Hospital Morbidity Data System (HMDS). Preventable chronic conditions are identified by ICD-10-AM diagnosis codes of diseases. For some conditions, certain hospitalisations are excluded based on procedures reported using defined Australian Classification of Health Interventions (ACHI) procedure codes.

The allocation of separation data to HS is based on the location of usual residence of the patient, and not where the hospitalisation occurred. Patient residential details are collected upon admission to hospital and each record is subsequently assigned the relevant Statistical Area 2 (SA2) by the Data Linkage Branch. The Epidemiology Branch then assigns records to the correct HS based on their SA2 of usual residence. Records with missing SA2 information are assigned to a HS by the Epidemiology Branch using the record’s locality or postcode information.

The population figures used (for calculating age-standardised rates) are the Estimated Resident Population data sourced from the Australian Bureau of Statistics. Where this is not available for the most recent year/s, population projections are sourced from the WA Department of Planning.

Limitations A year of data is reported if the proportion of hospitalisations

coded is greater than or equal to 95%. Consequently the reported rates may be an underestimate of the true rates, particularly for the country areas.

Reported Data Validation Items Format Numeric 8 NNNNNNNN Data Values Inclusions Hospital separation records where patients are identified as WA residents and where conditions are identified by the following ICD-10-AM diagnosis codes: Asthma: J45, J46 as principal diagnosis only. Congestive cardiac failure:I50, I110, J81 as principal diagnosis only, exclude cases with the following ACHI procedure codes: 33172-00, 35304-00, 35305-00, 35310-02, 35310-00, 38281-11, 38281-07, 38278-01, 38278-00, 38281-02, 38281-01, 38281-00, 38256-00, 38278-03, 38284-00, 38284-02, 38521-09, 38270-01, 38456-19, 38456-15, 38456-12, 38456-11, 38456-10, 38456-07, 38456-01, 38470-00, 38475-00, 38480-02, 38480-01, 38480-00, 38488-06, 38488-04, 38489-04, 38488-02, 38489-03, 38487-00, 38489-02, 38488-00, 38489-00, 38490-00, 38493-00, 38497-04, 38497-03, 38497-02, 38497-01, 38497-00, 38500-00, 38503-00, 38505-00, 38521-04, 38606-00, 38612-00, 38615-00, 38653-00, 38700-02, 38700-00, 38739-00, 38742-02, 38742-00, 38745-00, 38751-02, 38751-00, 38757-02, 38757-01, 38757-00, 90204-00, 90205-00, 90219-00, 90224-00

COPD: J20, J41, J42, J43, J44, J47 as principal diagnosis only, J20 only with additional diagnoses of J41, J42, J43, J44, J47. Angina: I20, I240, I248, I249 as principal diagnosis only, exclude cases with procedure codes NOT in blocks 1820 to 2016. Iron deficiency anaemia: D501, D508, D509 as principal diagnosis only. Hypertension: I10, I119 as principal diagnosis only, exclude cases with procedure codes according to the list of procedures excluded from the congestive cardiac failure category above. Nutritional deficiencies: E40, E41, E42, E43, E550, E643 as principal diagnosis only. Rheumatic heart disease: I00 to I09 as principal diagnosis only. Population figures: All WA residents assigned to a health service (North Metro, South Metro and WACHS) according to SA2 based on boundaries outlined by the Epidemiology Branch.

Exclusions Hospital records of non-WA residents (overseas and other Australian states and territories), as well as WA residents with no

postcode or locality information recorded. Healthy newborns, boarders, posthumous organ procurements, aged care residents, and funding hospital (duplicate) cases.

Non-inpatient, Christmas Island, HITH-only private establishments and residential aged care facilities

Diabetes complications are excluded due to significant coding changes over time.

Scope All public and private hospital records for Western Australian residents with a postcode or locality recorded. Formula Direct standardisation employs population weights from an external standard population. Directly standardised rates

(calculated with the same external standard population) are comparable measures. Rates and corresponding confidence intervals can be compared to one another to determine whether significant differences in rates exist (for example, Metro VS non- Metro populations). The 2001 Australian Census population is used as the standard population. The following formula is used to calculate the age-standardised potentially preventable hospitalisation rates.

Directly standardised rate =  wi(di / ni)

Where:

wi = the standard population weight in the ith age group.

di = the number of events in the population in the ith age group.

ni = the population in the ith age group.

To calculate the 95% confidence intervals around the age- standardised rates, the following formula is used: 95% confidence interval = standardised rate ± 1.96 * standard error The standard error is calculated as follows:

Age standardised rate 2 2 = wi di / ni standard error  Where:

wi = the standard population weight in the ith age group.

di = the number of events in the population in the ith age group.

ni = the population in the ith age group.

If confidence intervals for two populations do not overlap, it can be said that the two age-standardised rates are significantly different. Verification Rules If public hospital separation data for any year are <95% coded at the time of data extraction, rates for this year will be omitted from

reporting. When data are extracted for the calculation of the rate for the new year, data from the same extract are also used for the re- calculation of all previously reported years to ensure that those rates are based on the most up-to-date available data. For statistical validity the ASR will not be reported if the number of hospitalisations is less than 20.

Data Collection Identification Items Source Hospitalisation data: Hospital Morbidity Data System Population data: Australian Bureau of Statistics and WA Department of Planning. Governance Items Purpose of the For ABF/M KPI reporting data

Source of the Epidemiology Branch, Public Health and Clinical Services definition Division Version number 1.2 Approval Date 20140423 (Noted by PRGC)

2.3 Effectiveness Quality (EQ) PIs

There are 13 EQ PIs proposed in the 2014-15 PMF, including 6 outcome measures.

EQ1: Age-Adjusted Rate (AAR) of avoidable deaths

Reported Data Description Items Identifier ABF/M-KPI-EQ1

Name Age-Adjusted Rate (AAR) of avoidable deaths

Aliases Age-Adjusted Rate of avoidable deaths Avoidable Mortality

Definition Avoidable mortality is the number of premature deaths from conditions considered to be potentially avoidable through the application of existing effective public health or medical interventions.

The age-adjusted rate of avoidable mortality is the number of age- standardised avoidable deaths in people aged 0-74 per 100,000 person-years.

Direct age-standardisations based on Australian National Census population data (2001) is employed in the calculation of the age- adjusted rate of avoidable deaths in order to enable valid comparisons of Health Services.

Related Metadata New South Wales Chief Health Officer's report 2006

Guide for Use Avoidable and amenable causes of death are defined as causes that are potentially avoidable at the present time, given current knowledge of social and economic policy impacts, health behaviours, and health care (the latter relating to the subset of amenable causes). Only deaths <75 years of age are included. Thus avoidable deaths are unnecessary, untimely deaths.

Avoidable deaths are identified by selected ICD-10-AM cause of death codes, following the New South Wales Chief Health Officer's report 2006: http://www0.health.nsw.gov.au/pubs/2006/chorep_06.html

The allocation of deaths to Health Service (HS) is based on the location of usual residence of the deceased, and not where the death occurred. Residential details are collected upon registration of the death and each record is subsequently assigned the relevant Statistical Area 2 (SA2) by the Data Linkage Branch. The Epidemiology Branch then assigns records to the correct HS based on their SA2 of usual residence. Records with missing SA2 information are assigned to a HS by the Epidemiology Branch using the record’s locality or postcode information.

Limitations Indicator to be presented annually (by calendar year) as new death data is made available from the ABS. Due to the time lag in the receipt of data, reported deaths are likely to be from at least

two years prior.

Reported Data Validation Items Format Numeric

NNNNN.N

Data Values

Inclusions Deaths occurring in WA residents for selected causes and prior to the age of 75 years.

ICD-10 codes: Diarrhoeal diseases A00-A09 Tuberculosis A15-A19, B90 Diphtheria, whooping cough, A35-A37, A49.1, A49.2, tetanus, polio, Hib, measles, rubella A80, B01, B05-B06, J11

Selected invasive bacterial and A38-A41, A46, A48.1, protozoal infection B50-B54, G00, G03, J13-J15, J18, L03 Sexually transmitted diseases A50-A64, M02.3, N34.1, N70-N73, N75.0, N75.1, N76.4, N76.6, O00

HIV/AIDS B20-B24 Hepatitis B15-B19 Viral pneumonia and Influenza J10, J12, J17.1, J21 Cancer of the lip, oral cavity and C00-C14 pharynx Cancer of the oesophagus C15 Stomach cancer C16 Colorectal cancer C18-C21 Liver cancer C22 Lung cancer C33-C34 Melanoma of skin C43 Nonmelanotic skin cancer C44 Breast cancer (Females only) C50 Cancer of the uterus C54-C55 Cancer of the cervix C53 Bladder cancer C67 Cancer of testis C62 Eye cancer C69 Thyroid cancer C73 Hodgkins disease C81 Leukemia (age < 44 only) C91.0, C91.1 Benign cancer D10-D36 Anaemia D50-D53 Thyroid disorders E00-E07 Diabetes E10-E14 Adrenal disorders E24, E27

Congenital hypothyroidism, CAH, E25, E70.0, E74.2 PKU, galatosaemia Alcohol related disease F10, I42.6, K29.2, K70 Illicit drug use disorders F11-F16, F18-F19 Epilepsy G40-G41 Rheumatic and other valvular heart I01-I09 disease Hypertensive heart disease I11 Ischaemic heart disease I20-I25 Cerebrovascular diseases I60-I69 Aortic aneurysm I71 Nephritis and nephrosis I12-I13, N00-N09, N17- N19 Obstructive uropathy and prostatic N13, N20-N21, N35, hyperplasia N40, N99.1 DVT with pulmonary embolism I26, I80.2 COPD J40-J44 Asthma J45-J46 Upper respiratory tract infection J00-J06, H66, H70 Peptic ulcer disease K25-K28 Acute abdomen, appendicitis, K35-K38, K40-K46, intestinal obstruction, cholecystitis / K80-K83, K85-K86, lithiasis, pancreatitis, hernia K91.5 Chronic liver disease (excluding K73, K74 alcohol related disease) Osteomyelitis and other M86, M89-M90 osteopathies of bone (skin, bone and joint infections) Birth defect H31.1, P00, P04, Q00- Q99 Complications of pregnancy O01-O99 Complications of perinatal period P03, P05-P95 Sudden infant death syndrome R95 Road traffic injuries, other transport V01-V04, V06, V09- injuries V80, V87, V89, V99 Accidental Poisonings X40-X49 Falls W00-W19 Fires, burns X00-X09 Drownings (Swimming) W65-W74 Suicide and self inflicted injuries X60-X84, Y87.0, Y10- Y34 Violence X85-Y09, Y87.1 War Y36 Complications of treatment Y60-Y84

ICD-10-AM codes refer to the underlying cause of death, as determined by the Australian Bureau of Statistics.

Population figures: All WA residents are assigned to a Health Service (North Metro, South Metro and WACHS) according to SA2 based on boundaries outlined by the Epidemiology Branch.

Exclusions Deaths of non-WA residents (overseas and other Australian states and territories), as well as WA residents with no postcode or

locality information recorded. Scope All death registrations for WA residents with at least postcode or locality, age at death and cause of death coding from the ABS.

Formula The age-adjusted rate of avoidable deaths is the number of avoidable deaths in people aged 0-74 per 100,000 persons age- standardised to the 2001 Australian population and presented with a 95% confidence interval.

Numerator: Number of avoidable deaths by HS among persons aged 0-74 years. Denominator: Total population by HS aged 0-74 years.

Verification Rules > 0

For statistical validity the AAR will not be reported if the number of deaths is less than 20.

When data are extracted for the calculation of the rate for the new year, data from the same extract are also used for the re- calculation of all previously reported years to ensure that those rates are based on the most up-to-date available data.

Data Collection Identification Items Source Death data: WA Death Registrations and Australian Bureau of Statistics (ABS) Death Data Population: Australian Bureau of Statistics, Department of Planning

Governance Items Purpose of the data For ABF/M KPI reporting.

Source of the definition Epidemiology Branch, Public Health and Clinical Services Division.

Version number 1.2 Approval date 20140423 (Noted by PRGC)

EQ3: Staphylococcus aureus bacteraemia (SAB) infections per 10,000 patient days

Reported Data Description Items

Identifier

Name Healthcare associated Staphylococcus aureus bacteraemia (SAB) per 10,000 patient days

Aliases SAB

Definition Cases of healthcare associated Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus (MRSA)) bacteraemia

Related Metadata Total Length of Stay (MDG-02-001)

Guide for Use Only those cases of SAB that are associated with care provided at the particular hospital should be counted. If a case is associated with care provided in another hospital then it is reported (where known) by the hospital where the care associated with the SAB occurred.

If a hospital was not included in the SAB surveillance arrangements for part of the year, then the patient days for that part of the year are excluded. If part of the hospital was not included in the SAB surveillance arrangements (e.g. children's wards, psychiatric wards), then patient days for that part of the hospital are excluded.

This indicator is susceptible to small numbers that will lead to fluctuation of results between reporting periods. If reported on a monthly basis at hospital level, this indicator loses its meaningfulness.

Does not include activity contracted to private facilities.

Limitations Measuring Total Length of Stay of all acute, non-sub acute and newborn episodes of care separated during the reporting period is not a measure of patient days of patients receiving care in that reporting period. Long stay patients discharged during the reporting period can affect patient days for a particular period.

Length of stay provided in this report is preliminary. Final length of stay is available through the Hospital Morbidity Data System (HMDS). NB. Coding and edit requirements mean the HMDS data usually has a substantial lag.

Length of stay may also include hospital in the home care days.

Reported Data Validation Items

Format Numeric

NNNNN.N

Data Values N/A

Inclusions Numerator: A patient-episode of SAB is defined as a positive blood culture for Staphylococcus aureus. For surveillance purposes, only the first isolate per patient is counted, unless at least 14 days has passed without a positive blood culture, in which case an additional episode is recorded.

A SAB will be considered to be healthcare-associated if: the first positive blood culture is collected more than 48 hours after hospital admission or less than 48 hours after discharge OR if the first positive blood culture is collected 48 hours or less after admission and one or more of the following key clinical criteria was met for the patient- episode of SAB:  SAB is a complication of the presence of an indwelling medical device (e.g. Intravascular line, haemodialysis vascular access, CSF shunt, urinary catheter);

 SAB occurs within 30 days of a surgical procedure where the SAB is related to the surgical site;

 SAB was diagnosed within 48 hours of a related invasive instrumentation or incision;  SAB is associated with neutropenia (Neutrophils: 9 <1 x 10 /L) contributed to by cytotoxic therapy.

Denominator: Number of patient days for public acute care hospitals (only for hospitals included in the surveillance arrangements). Note: When calculating Total Length of Stay for a specified period:  Count the total patient days of those patients separated during the specified period including those admitted before the specified period;  Do not count the patient days of those patients admitted during the specified period who did not separate until the following reference period.

Exclusions Numerator exclusions Cases where a known previous positive test has been obtained within the last 14 days are excluded. For

example: If a patient has SAB in which 4 sets of blood cultures are positive over the initial 3 days of the patient’s admission only one episode of SAB is recorded. If the same patient had a further set of positive blood cultures on day 6 of the same admission, these would not be counted again, but would be considered part of the initial patient-episode. Note: If the same patient had a further positive blood culture 20 days after admission (i.e. greater than 14 days after their last positive on day 5), then this would be considered a second patient-episode of SAB.

Denominator exclusions Client Status] = Contracting Service/Funding Hospital (0) Boarder (3) Organ procurement (7) Resident (8)

Private facilities are excluded from the counts.

Scope Public Hospitals (metropolitan and rural), except Next Step Drug and Alcohol services, East Perth

Formula Numerator: Patient episode of Healthcare associated SAB

Denominator: The total number of days for all patients who were admitted for an episode of care and who separated during a specified reference period.

[Length of Stay] is defined as: [Separation Date] – [Admission Date] – [Total Leave Days]

Where a same-day episode has [Length of Stay] of 1.

Calculation: Numerator / Denominator x 10,000

Verification Rules Value is >/= to zero

Data Collection Identification Items

Source Numerator: Healthcare Associated Infection Unit, Communicable Disease Control Directorate

Denominator: TOPAS Discharge Extract – Weekly

WebPAS Discharge Extract - Weekly HCARe CMS Patient Discharge Extract – Weekly

Governance Items

Purpose of the data WA State Performance Indicator Definition

Source of the definition National core hospital-based outcome indicators of safety and quality version 0.5.2 (Australian Commission on Safety and Quality in Health Care)

National Healthcare Agreement: PI 39- Healthcare- associated Staphylococcus aureus (including MRSA) bacteraemia in acute care hospitals, 2012

Version number 1.1

Approval date 20130605

EQ5: Hospital standardised mortality ratio

Reported Data Description Items

Identifier Name Hospital Standardised Mortality Ratio Aliases HSMR Definition The ratio comparing the observed number of hospital separations that result in the patient’s death, with the number of separations expected to result in death, based on the patients’ risk profile and National all hospital (public and private) model.

Related Metadata Guide for Use Limitations The size of hospital and the number of separations within the same peer group may vary. Smaller hospitals with fewer separations are more likely to have wider confidence intervals than larger hospitals. This may affect the precision of estimating the current thresholds.

Reported Data Validation Items

Format Numeric 7 NNNNNNN Data Values Inclusions and exclusions The criteria for separations to be included in the analysis were as follows: • admission to hospital for acute care (including GEM and Maintenance Care) • age at admission >=29 days (see Ben-Tovim et al. 2009:42) • gender, sex recorded as male or female (i.e. not ‘missing’) • length of hospital stay up to 365 days (number of days admitted, including leave days) • urgency of admission category: either elective or emergency • Principal Diagnosis high risk for mortality. The proportion of in-hospital deaths within each year was calculated for the set of cases with each three-character ICD-10-AM code. Diagnosis codes were ranked in descending order of this proportion. Records were included in the analysis for those three-character ICD-10-AM codes that ranked highest in terms of the diagnosis-specific number of deaths and which, together, accounted for 80% of all in-hospital deaths. Three sets of codes were generated, one each for the corresponding year’s analysis (see the Appendix).

The criteria for separations to be excluded from the study were as follows: • neonates (infant age ≥0 and ≤ 28 days)  Sex = Intersex or indeterminate.

Scope • death in hospital was defined as Mode of Separation = died

Patient variables The patient level variables included were as follows: • age (in years at time of admission) • sex • Length of stay (LOS, including leave days) is between 1 and 365 days, inclusive (1 ≤ LOS ≤ 365) • urgency of admission category (emergency or elective) • diagnosis group (based on the first three digits of the principal diagnosis)

Public Hospitals (metropolitan and rural), except Next Step Drug and Alcohol services, East Perth

Joondalup Health Campus, publically funded activity

Peel Health Campus, publically funded activity Formula Numerator: Observed number of in-hospital deaths amongst selected principal diagnosis groups: Separations with high-risk principal diagnoses, associated with 80% of in-hospital deaths. Denominator: Expected number of in-hospital deaths amongst selected principal diagnosis groups. Separations with high-risk principal diagnoses, associated with 80% of in-hospital deaths.

Rates are risk adjusted The logistic regression model The independent variables used for the model were: • age (in years at time of admission) • sex • length of stay group (as six separate categories; i.e. 1 day, 2 days, 3–9 days, 10–15 days, 16–21 days and 22–365 days) (same day admission/separation cases were included in the ‘1 day’ category) • urgency of admission category (emergency or elective) • crude risk decile of the 3–digit principal diagnosis (this was formed by using the ratio of the sum of the observed number of deaths to the observed number of admissions for each 3– digit principal diagnosis. Only those 3–digit principal diagnoses responsible for 80% of all in-hospital deaths for any particular year, were included in the dataset). (See the Appendix for the three-character ICD-10-AM codes in each relevant year) • comorbidity group (either 0, 1 or 2 and based on the Charlson Index score (Quan et al. 2005)). Comorbidity status was derived from the additional diagnosis codes in the NHMD, which were used to generate a Charlson Index score for each patient based on Quan’s method (Quan et al. 2005). The Charlson Index was converted to a score of 0, 1 or 2. Patients whose Charlson Index value is 0 remain 0,

scores of 1 remain 1. Scores of 2 are recoded to 1. Scores of 3 to 20 are recoded to 2. Admission mode (inward transfer status) = admitted patient transferred from another hospital.

Calculation of 95% confidence intervals for HSMR point estimates 95% confidence intervals were calculated using Byar's approximation: Lower confidence limit = O/E*(1–1/(9*O) – 1.96 / (3*sqrt (O)))3 * 100 Upper confidence limit = (O + 1)/E*(1– (1/(9*(O+1))) + 1.96 / (3*sqrt (O+1)))3 * 100 where O = observed number of deaths and E = Expected number of deaths. Verification Rules

Data Collection Identification Items

Source National Hospital Morbidity Database

Governance Items

Purpose of the data WA State Performance Indicator Definition

Source of the definition National core hospital-based outcome indicators of safety and quality: draft specifications Version number 1.2 Approval date 20140423 (Noted by PRGC)

EQ7: Death in low-mortality DRGs

Reported Data Description Items Identifier (office use only) Name Death in low-mortality Diagnosis Related Groups (DRGs) Aliases Death in low-mortality DRGs Definition In-hospital deaths in Diagnosis Related Groups with a mortality rate less than 0.5%. Related Metadata Guide for Use: Hospital mortality indicators should be used as screening tools, rather than being assumed to be definitively diagnostic of poor quality and/or safety. This indicator is intended to signal that a problem may exist and that further detailed investigation is required. This indicator is intended to identify in-hospital deaths in patients unlikely to die during hospitalisation. The underlying assumption is that when patients admitted for an extremely low- mortality condition or procedure die, a health care error is more likely to be responsible. Limitations Value only reliable and released for reporting for hospitals with 30 or more separations per year.

Reported Data Validation Items Format 7 Numeric NNNN.NN Data Values Inclusions Inclusions for denominator Age at date of admission: 18–120 years of age. Episode of admitted patient care - diagnosis related group, code (AR-DRG v 5.1): low mortality DRGs. (see Appendix 1). Hospital service-care type, code: acute care. Exclusions Exclusions for denominator Episodes with principal or additional diagnosis codes for trauma, immuno-compromised state or cancer. (See Appendix 2). Scope Public Hospitals (metropolitan and rural) Joondalup Health Campus, publically funded activity Peel Health Campus, publically funded activity Formula: (Numerator  Denominator) x 10,000 Units Rate per 10,000 separations Numerator Episodes with a separation type of “death” meeting the inclusion and exclusion rules for the denominator; and Episode of admitted patient care-separation mode: died. Denominator Episodes in low-mortality DRGs, defined as DRGs with a total mortality rate less than 0.5% over the previous 3 years or less than 0.5% in any of the previous 3 years.

Verification Rules Value is greater than or equal to zero and less than or equal to 1,000 Data Collection Identification Items Source WA Hospital Morbidity Data System (HMDS)

National Hospital Morbidity Database (NHMD)

Governance Items

Purpose of the data ABF/ABM Performance Management Reports. Source of the definition National core hospital -based outcome indicators of safety and quality: Draft Specifications, version 1.1, August 2012, (Australian Commission on Safety and Quality in Health Care (ACSQHC). Note: These specifications are Preliminary only and subject to change by ACSQHC. Version number 1.2 Approval date 20140423 (Noted by PRGC)

Appendix 1: List of low mortality DRG codes

The list of low mortality DRGs (Australian Refined Diagnosis Related Groups version 5.1) was calculated by Australian Institute of Health and Welfare (AIHW) for the previous three years exclusive of the reference year for the total population of Australia.

2006–07 902Z 962Z 963Z B01Z B03A B03B B04B B05Z B06B B07B B40Z B41Z B61B B62Z B65Z B68B B69C B71B B73Z B75Z B76B B77Z B81B C02Z C03Z C04Z C05Z C06Z C07Z C08Z C09Z C10Z C11Z C12Z C13Z C14Z C60B C61Z C62Z C63A C63B D01Z D02A D02B D03Z D04A D04B D05Z D06Z D07Z D08Z D09Z D10Z D11Z D12Z D13Z D40Z D60B D61Z D62Z D63A D63B D64Z D65Z D66B D67Z E01B E02B E02C E60A E60B E63Z E67B E67C E69B E69C E70A E70B E71B E72Z E73C E75C F01Z F04B F05B F06B F12Z F14B F14C F15Z F16Z F17Z F19Z F20Z F21B F41B F42A F42B F60A F60B F63B F64Z F66B F67A F67B F69B F71B F72B F73B F74Z G01B G02B G03C G04B G04C G05A G05B G06Z G07A G07B G08Z G09Z G10Z G11A G11B G40B G41B G42B G43Z G44B G44C G45A G45B G61B G63Z G64Z G65B G66B G67B G68A G68B G69Z G70B H01B H01C H02A H02C H03B H04B H05B H41B H42B H61C H62B H64B I01Z I02B I03B I03C I04B I05Z I06Z I08B I08C I09A I09B I10A I10B I11Z I12B I12C I13A I13B I13C I14Z I15Z I16Z I17Z I18Z I19Z I20Z I21Z I22Z I23Z I24Z I25Z I26Z I27Z I28B I63Z I64B I65B I66B I67B I68B I68C I69B I69C I70Z I71B I71C I72B I73B I73C I74B I74C I75B I75C I76B I76C J01Z J02B J03B J04B J05Z J06A J06B J07A J07B J08A J08B J09Z J10Z J11Z J60B J61Z J62A J62B J62C J63Z J64B J65B J66B J67B K02Z K03Z K04Z K05Z K06Z K07Z K08Z K40Z K60B K62C K63Z K64B L03B L04B L05B L06B L07B L08A L08B L09B L09C L40Z L41Z L42Z L62B L63C L64Z L65B L66Z L67C M01Z M02A M02B M03A M03B M04A M04B M05Z M06A M06B M40Z M60A M60B M61B M62A M62B M63Z M64Z N01Z N02B N03A N03B N04Z N05A N05B N06Z N07Z N08Z N09Z N10Z N11A N11B N60B N61Z N62A N62B O01A O01B O01C O01D O02Z O03Z O04Z O40Z O60A O60B O60C O60D O61Z O62Z O63Z O64Z O65A O65B P63Z P64Z P65B P65C P65D P66B P66C P66D P67B P67C P67D Q02B Q60B Q61C Q62B R01B R02A R02B R04A R04B R61C R62B R63Z R64Z T01B T01C T61A T61B T62B T63A T63B T64B U40Z U60Z U61A U61B U62A U62B U63A U63B U64Z U65Z U66Z U67Z U68Z V60Z V61A V61B V62A V62B V63Z V64Z X01Z X02Z X03Z X04B X05Z X06B X60B X60C X61Z X62B X63B Z01B Z40Z Z60B Z60C Z61Z Z62Z Z63B

2007–08 902Z B01Z B03A B03B B04B B05Z B06B B07B B40Z B41Z B61B B62Z B64B B65Z B68B B69B B71B B72B B73Z B75Z B76B B77Z B81B C02Z C03Z C04Z C05Z C10Z C11Z C12Z C13Z C14Z C15A C15B C16A C16B C60A C60B C61Z C62Z C63A C63B D01Z D02B D02C D03Z D04A D04B D05Z D06Z D09Z D10Z D11Z D12Z D13Z D14Z D40Z D60B D61Z D62Z D63A D63B D64Z D65Z D66B D67A D67B E01B E02B E02C E60A E60B E63Z E67B E69B E69C E70A E70B E71C E73C E75C F01A F01B F04B F05B F06B F07B F12Z F14B F14C F15Z F16Z F17Z F19Z F20Z F41B F42A F42B F60A F60B F63B F66B F67A F67B F68Z F69B F71B F72B F73B F74Z G01B G02B G03C G04B G04C G05B G06Z G07A G07B G08A G08B G09Z G10Z G11A G11B G42B G43Z G44B G44C G45A G45B G46B G46C G61B G63Z G64Z G65B G66B G67B G68A G68B G69Z G70B H01B H02C H05B H07B H08A H08B H41B H42B H42C H62B H64B I01Z I02B I03B I03C I04Z I05Z I06Z I08B I09A I09B I10A I10B I11Z I12B I12C I13A I13B I13C I14Z I15Z I16Z I17Z I18Z I19Z I20Z I21Z I23Z I24Z I25Z I27B I28B I29Z I30Z I63Z I64B I65B I66B I67B I68B I68C I69B I69C I70Z I71B I71C I72B I73B I73C I74B I74C I75B I75C I76B I76C J01Z J06A J06B J07A J07B J08A J08B J09Z J10Z J11Z J12B J12C J13A J13B J14Z J60B J62A J62B J63Z J64B J65B J67B J68B K02Z K03Z K04Z K05Z K06Z K07Z K08Z K40Z K60B K62C K63Z K64B L02A L02B L03B L04B L04C L05B L06B L07A L07B L08A L08B L09C L40Z L41Z L42Z L62B L63C L64Z L65B L66Z L67C M01Z M02A M02B M03A M03B M04A M04B M05Z M06A M06B M40Z M60A M60B M61B M62A M62B M63Z M64Z N01Z N02B N03A N03B N04Z N05A N05B N06Z N07Z N08Z N09Z N10Z N11A N11B N60B N61Z N62A N62B O01A O01B O01C O02A O02B O03Z O04Z O05Z O60A O60B O60C O61Z O63Z O64A O64B O66A O66B P63Z P64Z P65B P65C P65D P66B P66C P66D P67B P67C P67D Q02B Q60B Q60C Q61C R01B R02A R02B R04A R04B R61C R62B R63Z R64Z T01B T01C T61A T61B T62B T63A T63B T64B U40Z U60Z U61A U61B U62A U62B U63A U63B U64Z U65Z U66Z U67Z U68Z V60A V60B V61Z V62A V62B V63A V63B V64Z W61Z X02Z X04B X05Z X06B X07A X07B X60B X60C X61Z X62B X63B Z01B Z40Z Z60B Z60C Z61Z Z62Z Z63B Z64B

2008–09, 2009-10, 2010-11

902Z 961Z B01Z B03B B04B B05Z B06B B07B B40Z B41Z B61B B62Z B65Z B68B B69B B71B B72B B73Z B75Z B76B B77Z B81B C02Z C03Z C04Z C05Z C10Z C11Z C12Z C13Z C14Z C15A C15B C16A C16B C60A C60B C61Z C62Z C63A C63B D01Z D02B D02C D03Z D04A D04B D05Z D06Z D09Z D10Z D11Z D12Z D13Z D14Z D40Z D61Z D62Z D63A D63B D64Z D65Z D66B D67A D67B E01B E02B E02C E60A E60B E63Z E67B E69B E69C E70A E70B E72Z E73C E75C F01A F01B F04B F05B F06B F07B F12Z F14B F14C F15Z F16Z F17Z F19Z F20Z F41B F42A F42B F60A F60B F63B F66B F67A F67B F69B F71B F72B F73B F74Z G01B G02B G03C G04B G04C G05B G06Z G07A G07B G08A G08B G09Z G10Z G11A G11B G42B G43Z G44B G44C G45A G45B G46B G46C G61B G63Z G64Z G65B G66B G67B G68A G68B G69Z G70B H01B H02B H02C H05B H07B H08A H08B H41B H42B H42C H61B H62B H64B I01Z I02A I02B I03B I03C I04Z I05Z I06Z I08B I09A I09B I10A I10B I11Z I12B I12C I13A I13B I13C I14Z I15Z I16Z I17Z I18Z I19Z I20Z I21Z I23Z I24Z I25Z I27B I28B I29Z I30Z I63Z I64B I65B I66B I67B I68B I68C I69B I69C I70Z I71B I71C I72B I73B I73C I74B I74C I75B I75C I76B I76C J01Z J06A J06B J07A J07B J08B J09Z J10Z J11Z J12B J12C J13B J14Z J60B J62A J62B J63Z J64B J65B J67B J68B K02Z K03Z K04Z K05Z K06Z K07Z K08Z K40Z K60B K62C K63Z K64B L02B L03A L03B L04B L04C L05B L06B L07A L07B L08A L08B L09C L40Z L41Z L42Z L62B L63C L64Z L65B L66Z L67C M01Z M02A M02B M03A M03B M04A M04B M05Z M06A M06B M40Z M60A M60B M61B M62A M62B M63Z M64Z N01Z N02A N02B N03A N03B N04Z N05A N05B N06Z N07Z N08Z N09Z N10Z N11A N11B N60A N60B N61Z N62A N62B O01A O01B O01C O02A O02B O03Z O04Z O05Z O60A O60B O60C O61Z O63Z O64A O64B O66A O66B P63Z P64Z P65A P65B P65C P65D P66B P66C P66D P67B P67C P67D Q02B Q60B Q60C Q61C R01B R02A R02B R03B R04B R61C R62B R63Z R64Z T01B T01C T61A T61B T62A T62B T63A T63B T64B U40Z U60Z U61A U61B U62A U62B U63A U63B U64Z U65Z U66Z U67Z U68Z V60A V60B V61Z V62A V62B V63A V63B V64Z W61Z X02Z X04B X05Z X06B X07B X60B X60C X61Z X62B X63B Z01B Z40Z Z60B Z60C Z61Z Z62Z Z63B Z64B

2011-12 801C 963Z A08B A09B A11B A12Z B01A B01B B03A B03B B04B B05Z B06B B07B B40Z B41Z B62Z B65Z B68B B69B B71B B72B B73Z B75Z B76B B77Z B79B B80Z B81B C01Z C02Z C03Z C04Z C05Z C10Z C11Z C12Z C13Z C14Z C15A C15B C16Z C60B C61A C61B C62Z C63Z D01Z D02B D02C D03Z D04A D04B D05Z D06Z D10Z D11Z D12Z D13Z D14Z D15Z D40Z D61Z D62Z D63Z D64Z D65Z D66B D67A D67B E01B E02C E42C E60A E60B E63Z E66C E67B E68B E69B E70A E70B E72Z E73C E75C F01B F03B F04B F05B F06B F07C F10B F12B F13B F14B F14C F15B F16B F17B F18B F20Z F41B F42B F42C F63B F64B F67B F68B F69B F72B F73B F74Z G01B G02B G03B G03C G04B G04C G05B G05C G06Z G07A G07B G10B G11Z G12C G46B G46C G47B G47C G48B G48C G63Z G64B G66Z G67B G70B H01B H02C H05B H06B H07B H08A H08B H43B H62B H64B I01B I02B I03B I04A I04B I05A I05B I06Z I08B I09B I10B I11Z I12B I12C I13B I15Z I16Z I17A I17B I18Z I19A I19B I20Z I21Z I23Z I24Z I25B I27B I28B I29Z I30Z I31B I32B I32C I61B I63B I64B I66B I67B I68B I68C I69B I71B I72B I73B I74Z I75B I76B I77B J01A J01B J06Z J07Z J08B J09Z J10Z J11Z J12B J12C J13B J14Z J60C J63A J63B J64B J65B J67A J67B J68B

J68C K01B K02B K03Z K04A K04B K05B K06A K06B K07Z K08Z K09B K09C K40B K40C K60B K62B K63B K64B L02B L03B L03C L04B L04C L05B L06B L07B L08A L08B L09B L09C L40Z L41Z L42Z L61Z L63B L64Z L65B L66Z L67B L68Z M01A M01B M02B M03Z M04Z M05Z M06B M40Z M61Z M62Z M63Z M64Z N01Z N04A N04B N05A N05B N06A N06B N07Z N08Z N09Z N10Z N11Z N12B N61Z N62Z O01A O01B O02A O02B O03A O03B O04A O04B O05Z O60Z O61Z O63Z O64Z O66Z P63Z P64Z P65B P65C P65D P66A P66B P66C P66D P67A P67B P67C P67D Q02B Q60B Q60C Q61B R01B R02C R03B R04B R61C R63Z R64Z S60Z T01B T01C T61B T62B T63Z T64C U40Z U60Z U61Z U62A U62B U63Z U64Z U65Z U66Z U67Z U68Z V60Z V61Z V62A V62B V63Z V64Z W02B W03Z W04A W04B X02A X02B X04B X05A X05B X06B X07B X60B X61Z X62B X63B Y02A Y02B Y03Z Y60Z Y62B Z01B Z40Z Z60B Z60C Z61B Z63B Z64B

Appendix 2: ICD-10-AM codes for trauma, immuno-compromised state or cancer.

ICD-10-AM 7th Edition Trauma diagnosis codes:

S010 Open wound of scalp S011 Open wound of eyelid and periocular area S0120 Open wound of nose part unspecified S0121 Open wound of nose external skin S0122 Open wound of nares (nostril) S0123 Open wound of nasal septum S0129 Open wound oth & multiple parts nose S0130 Open wound of external ear part unsp S0131 Open wound of auricle S0133 Open wound of tragus S0134 Open wound of external auditory meatus S0135 Open wound of eustachian tube S0136 Open wound of ossicles S0137 Open wound of ear drum S0138 Open wound of inner ear S0139 Open wound oth mult sites ear & aud str S0141 Open wound of cheek S0142 Open wound of maxillary region S0143 Open wound of mandibular region S0149 Open wound oth mult site cheekTMJ area S0150 Open wound of mouth part unspecified S0151 Open wound of lip S0152 Open wound of buccal mucosa S0153 Open wound of gum (alveolar process) S0154 Open wound of tongue and floor of mouth S0155 Open wound of palate S0159 Open wound oth mult parts liporal cv S017 Multiple open wounds of head S0181 Open wound head w communicating fx S0182 Open wound head comm w disloc S0183 Open wound head comm w intrcran inj S0188 Open wound of other parts of head S019 Open wound of head part unspecified

S020 Fracture of vault of skull S021 Fracture of base of skull S022 Fracture of nasal bones S023 Fracture of orbital floor S024 Fracture of malar and maxillary bones S025 Fracture of tooth S0260 Fracture of mandible part unspecified S0261 Fracture of condylar process S0262 Subcondylar fracture S0263 Fracture of coronoid process S0264 Fracture of ramus unspecified S0265 Fracture of angle of jaw S0266 Fracture of symphysis of body S0267 Fracture of alveolar border of body S0268 Fx mandible body other & unsp parts S0269 Fracture of mandible multiple sites S027 Mult fractures inv skull facial bones S028 Fractures of oth skull and facial bones S029 Fracture skull & facial bones part unsp

S030 Dislocation of jaw S031 Dislocation of septal cartilage of nose S032 Dislocation of tooth S033 Disloc other & unsp parts of head

S040 Injury of optic nerve and pathways S041Injury of oculomotor nerve S042 Injury of trochlear nerve S043 Injury of trigeminal nerve S044 Injury of abducent nerve S045 Injury of facial nerve S046 Injury of acoustic nerve S047 Injury of accessory nerve S048 Injury of other cranial nerves S049 Injury of unspecified cranial nerve

S052 Oclr lacr w prolps loss intraoculartis S053 Oclr lacr wo prolps loss intraoculartis S054 Penetrating wound orbit w or wo FB S055 Penetrating wound eyeball w foreign body S056 Penetrating wound eyeball wo FB S057 Avulsion of eye S058 Other injuries of eye and orbit

S0600 Concussion S0601 Loss of consciousness of unsp duration S0602 LOC brief dur [less than 30 minutes] S0603 LOC moderate duration [30 mins- 24hrs] S0604 LOC prolong dur w return conscious lvl S0605 LOC prolong dur wo return conscious lvl S061 Traumatic cerebral oedema S0620 Dfs cerebral cerebellar brain inj nsp S0621 Diffuse cerebral contusions S0622 Diffuse cerebellar contusions S0623 Mult intracerebral cerebellar haematomas

S0628 Oth diffuse cerebral & cerebellar injury S0630 Focal cerebral & cerebellar injury unsp S0631 Focal cerebral contusion S0632 Focal cerebellar contusion S0633 Focal cerebral haematoma S0634 Focal cerebellar haematoma S0638 Oth focal cerebral and cerebellar injury S064 Epidural haemorrhage S065 Traumatic subdural haemorrhage S066 Traumatic subarachnoid haemorrhage S068 Other intracranial injuries S069 Intracranial injury unspecified

S070 Crushing injury of face S071 Crushing injury of skull S078 Crushing injury of other parts of head S079 Crushing injury of head part unsp

S080 Avulsion of scalp S081 Traumatic amputation of ear S088 Traumatic amputation oth parts head S089 Traumatic amputatn of unsp part of head

S090 Injury of blood vessels of head NEC S092 Traumatic rupture of ear drum S099 Unspecified injury of head

S1101 Open wound of larynx S1102 Open wound of trachea S111 Open wound involving thyroid gland S1121 Open wound of pharynx S1122 Open wound of cervical oesophagus S117 Multiple open wounds of neck S1181 Open wound neck w comm fx S1182 Open wound neck comm w disloc S1188 Open wound of other parts of neck S119 Open wound of neck part unspecified

S120 Fracture of first cervical vertebra S121 Fracture of second cervical vertebra S1221 Fracture of third cervical vertebra S1222 Fracture of fourth cervical vertebra S1223 Fracture of fifth cervical vertebra S1224 Fracture of sixth cervical vertebra S1225 Fracture of seventh cervical vertebra S127 Multiple fractures of cervical spine S128 Fracture of other parts of neck S129 Fracture of neck part unspecified

S130 Traum rupt cervical intervertebral disc S1310 Dislocation cervical vertebra level unsp S1311 Dislocation of C1/C2 cervical vertebrae S1312 Dislocation of C2/C3 cervical vertebrae S1313 Dislocation of C3/C4 cervical vertebrae S1314 Dislocation of C4/C5 cervical vertebrae

S1315 Dislocation of C5/C6 cervical vertebrae S1316 Dislocation of C6/C7 cervical vertebrae S1317 Disloc C7/T1 cervicothoracic vertebrae S1318 Other dislocation of cervical vertebrae S132 Disloc of oth & unsp parts of neck S133 Multiple dislocations of neck

S140 Concussion & oedema cervical spinal cord S1410 Injury of cervical spinal cord unsp S1411 Complete lesion of cervical spinal cord S1412 Central cord syndrome cervical S1413 Oth incomp cord synd cerv spinal cord S142 Injury of nerve root of cervical spine S143 Injury of brachial plexus S144 Injury of peripheral nerves of neck S145 Injury of cervical sympathetic nerves S1470 Fn spin cord inj cerv lvl unsp S1471 Functional spinal cord injury, C1 S1472 Functional spinal cord injury, C2 S1473 Functional spinal cord injury, C3 S1474 Functional spinal cord injury, C4 S1475 Functional spinal cord injury, C5 S1476 Functional spinal cord injury, C6 S1477 Functional spinal cord injury, C7 S1478 Functional spinal cord injury, C8

S1500 Injury of carotid artery unspecified S1501 Injury of common carotid artery S1502 Injury of external carotid artery S1503 Injury of internal carotid artery S151 Injury of vertebral artery S152 Injury of external jugular vein S153 Injury of internal jugular vein S157 Injury mult blood vessels at neck level S158 Injury oth blood vessels at neck level S159 Injury unsp blood vessel at neck level

S170 Crushing injury of larynx and trachea S178 Crushing injury of other parts of neck S179 Crushing injury of neck part unsp

S18 Traumatic amputation at neck level

S210 Open wound of breast S211 Open wound of front wall of thorax S212 Open wound of back wall of thorax S217 Multiple open wounds of thoracic Wall S2181 Open wound (of any part thrx) comm w fx S2182 Open wound thrx comm w disloc S2183 Open wound thrx comm w intrathor inj S2188 Open wound of other parts of thorax S219 Open wound of thorax part unspecified

S2200 Fracture of thoracic vertebra level unsp S2201 Fracture thoracic vertebra T1 & T2 level

S2202 Fracture thoracic vertebra T3 & T4 level S2203 Fracture thoracic vertebra T5 & T6 level S2204 Fracture thoracic vertebra T7 & T8 level S2205 Fracture thoracic vertebra T9 T10 level S2206 Fracture thoracic vertebra T11 T12 level S221 Multiple fractures of thoracic spine S222 Fracture of sternum S2231 Fracture of first rib S2232 Fracture of one rib oth than first rib S2240 Multiple rib fractures unspecified S2241 Multiple rib fractures inv first rib S2242 Multiple rib fractures inv two ribs S2243 Multiple rib fractures inv three ribs S2244 Multiple rib fractures inv >= four ribs S225 Flail chest S228 Fracture of other parts of bony thorax S229 Fracture of bony thorax part unsp

S230 Traum rupt thoracic intervertebral disc S2310 Dislocation thoracic vertebra level unsp S2311 Disloc T1/T2 & T2/T3 thoracic vertebrae S2312 Disloc T3/T4 & T4/T5 thoracic vertebrae S2313 Disloc T5/T6 & T6/T7 thoracic vertebrae S2314 Disloc T7/T8 & T8/T9 thoracic vertebrae S2315 Disloc T9/T10 T10/T11 thoracic vertebrae S2316 Dislocation T11/T12 thoracic vertebrae S2317 Disloc T12/L1 thoracolumbar vertebrae S232 Disloc of oth & unsp parts of thorax

S240 Concussion & oedema thoracic spinal cord S2410 Injury of thoracic spinal cord unsp S2411 Complete lesion of thoracic spinal cord S2412 Incomp cord synd thoracic spinal cord S242 Injury of nerve root of thoracic spine S244 Injury of thoracic sympathetic nerves S2470 Fn spin cord inj thor lvl unsp S2471 Functional spinal cord injury, T1 S2472 Functional spinal cord injury, T2/T3 S2473 Functional spinal cord injury, T4/T5 S2474 Functional spinal cord injury, T6/T7 S2475 Functional spinal cord injury, T8/T9 S2476 Functional spinal cord injury, T10/T11 S2477 Functional spinal cord injury, T12

S250 Injury of thoracic aorta S251 Injury innominate or subclavian artery S252 Injury of superior vena cava S253 Injury of innominate or subclavian vein S254 Injury of pulmonary blood vessels S255 Injury of intercostal blood vessels S257 Injury multiple blood vessels thorax S258 Injury of other blood vessels of thorax S259 Injury of unsp blood vessel of thorax

S260 Traumatic haemopericardium

S2681 Contusion of heart S2682 Lacr heart wo penetration into chamber S2683 Lacr heart w penetration into chamber S2688 Other injuries of heart S269 Injury of heart unspecified

S270 Traumatic pneumothorax S271 Traumatic haemothorax S272 Traumatic haemopneumothorax S2731 Contusion and haematoma of lung S2732 Laceration of lung S2738 Other and unspecified injuries of lung S274 Injury of bronchus S275 Injury of thoracic trachea S276 Injury of pleura S277 Multiple injuries of intrathoracic org S2781 Injury of diaphragm S2782 Injury of lymphatic thoracic duct S2783 Injury of oesophagus (thoracic part) S2784 Injury of thymus gland S2788 Inj oth spec intrathor organs & str S279 Injury of unsp intrathoracic organ

S280 Crushed chest S281 Traumatic amputation of part of thorax

S310 Open wound of lower back and pelvis S311 Open wound of abdominal wall S312 Open wound of penis S313 Open wound of scrotum and testes S314 Open wound of vagina and vulva S315 Open wound oth & unsp ext gen organs S317 Mult open wounds abdo lower back pelvis S3180 Open wound oth & unsp parts abdomen S3181 Opn wound abdo low back pelv w comm fx S3182 Opn wnd abdo low back pelv comm disloc S3183 Opn wnd abdo low back comm. intrabdo inj

S32.00 Fracture of lumbar vertebrae, level unspecified S3201 Fracture of lumbar vertebra L1 level S3202 Fracture of lumbar vertebra L2 level S3203 Fracture of lumbar vertebra L3level S3204 Fracture of lumbar vertebra L4level S3205 Fracture of lumbar vertebra L5level S321 Fracture of sacrum S322 Fracture of coccyx S323 Fracture of ilium S324 Fracture of acetabulum S325 Fracture of pubis S327 Multiple fractures lumbar spine w pelvis S3281 Fracture of ischium S3282 Fracture lumbosacral spine, part unsp S3283 Fracture of pelvis, part unspecified S3289 Other and multiple pelvic fractures

S330 Traum rupt lumbar intervertebral disc S3310 Dislocation of lumbar vertebra lvl unsp S3311 Dislocation of L1/L2 lumbar vertebrae S3312 Dislocation of L2/L3 lumbar vertebrae S3313 Dislocation of L3/L4 lumbar vertebrae S3314 Dislocation of L4/L5 lumbar vertebrae S3315 Dislocation of L5/S1 lumbar vertebrae S332 Disloc sacroiliac sacrococcygeal joint S333 Disloc oth unsp parts lmbr spine & pelv S334 Traumatic rupture of symphysis pubis

S340 Concussion & oedema lumbar spinal cord S341 Other injury of lumbar spinal cord S342 Injury nerve root lumbar & sacral spine S343 Injury of cauda equina S344 Injury of lumbosacral plexus S345 Injury of lumbar, sacral and pelvic sympathetic nerves S3470 Fn spin cord inj, lmbr lvl unsp S3471 Functional spinal cord injury, L1 S3472 Functional spinal cord injury, L2 S3473 Functional spinal cord injury, L3 S3474 Functional spinal cord injury, L4 S3475 Functional spinal cord injury, L5 S3476 Functional spinal cord injury, sacrum

S350 Injury of abdominal aorta S351 Injury of inferior vena cava S352 Injury of coeliac or mesenteric artery S353 Injury of portal or splenic vein S354 Injury of renal blood vessels S355 Injury of iliac blood vessels S357 Inj mult bl vesl abdo low back pelvis S358 Inj oth bl vesl abdo low back pelvis lvl S359 Inj unsp bl vessel abdo low back pelv

S3600 Injury of spleen unspecified S3601 Haematoma spleen S3602 Capsule tear spleen wo disrupt parench S3603 Lacr spleen extending into parenchyma S3604 Massive parenchymal disruption of spleen S3608 Other injury of spleen S3610 Injury of liver unspecified S3611 Contusion and haematoma of liver S3612 Laceration of liver unspecified S3613 Minor laceration of liver S3614 Moderate laceration of liver S3615 Major laceration of liver S3616 Other injury of liver S3617 Injury of gallbladder S3618 Injury of bile duct S3620 Injury of pancreas, part unspecified S3621 Injury of head of pancreas S3622 Injury of body of pancreas S3623 Injury of tail of pancreas S3629 Injury oth & multiple parts pancreas

S363 Injury of stomach S3640 Injury of small intestine part unsp S3641 Injury of duodenum S3649 Injury oth & multiple parts sm intestine S3650 Injury of colon part unspecified S3651 Injury of ascending [right] colon S3652 Injury of transverse colon S3653 Injury of descending [left] colon S3654 Injury of sigmoid colon S3659 Injury of oth & multiple parts of colon S366 Injury of rectum S367 Injury of multiple intra-abdominal S3681 Injury of peritoneum S3682 Injury of mesentery S3683 Injury of retroperitoneum S3688 Injury of other intra-abdominal organs S369 Injury of unsp intra-abdominal organ

S3700 Injury of kidney unspecified S3701 Contusion & haematoma of kidney S3702 Laceration of kidney S3703 Complete disruption of kidney parenchyma S371 Injury of ureter S3720 Injury of bladder unspecified S3721 Contusion of bladder S3722 Rupture of bladder S3728 Other injury of bladder S3730 Injury of urethra part unspecified S3731 Injury of membranous urethra S3732 Injury of penile urethra S3733 Injury of prostatic urethra S3738 Injury of other part of urethra S374 Injury of ovary S375 Injury of fallopian tube S376 Injury of uterus S377 Injury of multiple pelvic organs S3781 Injury of adrenal gland S3782 Injury of prostate S3783 Injury of seminal vesicle S3784 Injury of vas deferens S3788 Injury of other pelvic organ S379 Injury of unspecified pelvic organ

S380 Crushing injury of external genital org S381 Crush inj oth parts abdo low back pelv S382 Traumatic amputatn external genital org S383 Traum amputatn oth abdo low back pelv

S396 Injury intrabdo org(s) w pelvorg(s) S397 Oth mult inj abdomen lower back pelvis S410 Open wound of shoulder S411 Open wound of upper arm S417 Multiple open wounds shoulder upper arm S4180 Open wound of oth / unsp shoulder rgn S4181 Open wound shoulder upp arm w comm fx

S4182 Opn wnd shold upp arm comm w disloc S4200 Fracture of clavicle part unspecified S4201 Fracture of sternal end of clavicle S4202 Fracture of shaft of clavicle S4203 Fracture of acromial end of clavicle S4209 Multiple fractures of clavicle S4210 Fracture of scapula part unspecified S4211 Fracture of body of scapula S4212 Fracture of acromial process S4213 Fracture of coracoid process S4214 Fracture glenoid cavity & neck scapula S4219 Multiple fractures of scapula

S4220 Fracture upper end humerus part unsp S4221 Fracture of head of humerus S4222 Fracture of surgical neck of humerus S4223 Fracture of anatomical neck of humerus S4224 Fracture greater tuberosity humerus S4229 Fracture oth mult part upper end humerus S423 Fracture of shaft of humerus S4240 Fracture lower end humerus part unsp S4241 Supracondylar fracture of humerus S4242 Fracture of lateral condyle of humerus S4243 Fracture of medial condyle of humerus S4244 Fracture of condyle(s) of humer usunsp S4245 T-shaped fracture of distal humerus S4249 Oth multiple fractures lower end humerus S427 Mult fractures clavicle scapula humerus S428 Fracture oth parts shoulder &upper arm S429 Fracture of shoulder girdle partunsp

S4300 Dislocation of shoulder unspecified S4301 Anterior dislocation of humerus S4302 Posterior dislocation of humerus S4303 Inferior dislocation of humerus S4308 Dislocation of other part of shoulder S431 Dislocation of acromio clavicular joint S432 Dislocation of sterno clavicular joint S433 Disloc oth unsp parts shoulder girdle

S450 Injury of axillary artery S451 Injury of brachial artery S452 Injury of axillary or brachial vein S453 Inj spfl vein shoulder upp arm lvl S457 Injury mult bl vesl shoulder upparm lvl S458 Injury oth bl vesl shoulder upparm lvl S459 Inj unsp bl vessel shoulder upparm lvl

S47 Crushing injury of shoulder &upper arm

S480 Traumatic amputation at shoulder joint S481 Traum amputatn lvl b shoulder &elbow S489 Traum amputatn shoulder upp arm lvl unsp

S510 Open wound of elbow

S517 Multiple open wounds of forearm S5181 Open wound forearm w comm. fracture S5182 Open wound forearm w comm. disloc S5188 Open wound of other parts of forearm S519 Open wound of forearm part unspecified

S5200 Fracture of upper end of ulna part unsp S5201 Fracture of olecranon process of ulna S5202 Fracture of coronoid process of ulna S5209 Oth & multiple fractures upper end ulna S5210 Fx of upper end of radius part unsp S5211 Fracture of head of radius S5212 Fracture of neck of radius S5219 Oth multiple fractures upper end radius S5220 Fracture of shaft of ulna part unsp S5221 Fx prx shaft ulna w disloc head radius S5230 Fracture shaft of radius part unsp S5231 Fx distal shaft radius, disloc head ulna S524 Fracture of shafts of both ulna &radius S5250 Fracture of lower end of radius unsp S5251 Fx low end radius w dorsal angulation S5252 Fx low end radius w volar angulation S5253 Fx low rds volar angl & intrartclr fx S5259 Oth multiple fractures lower end radius S526 Fracture lower end both ulna &radius S527 Multiple fractures of forearm S528 Fracture of other parts of forearm S529 Fracture of forearm part unspecified

S530 Dislocation of radial head S5310 Dislocation of elbow unspecified S5311 Anterior dislocation of elbow S5312 Posterior dislocation of elbow S5313 Medial dislocation of elbow S5314 Lateral dislocation of elbow S5318 Other dislocation of elbow S532 Traumatic ruputre of radial collateral ligament S533 Traumatic rupture of ulnar collateral ligament

S550 Injury of ulnar artery at forearm level S551 Injury of radial artery at forearm level S552 Injury of vein at forearm level S557 Inj mult blood vessels at forearm level S558 Inj oth blood vessels at forearm level S559 Injury unsp blood vessel atforearm lvl

S570 Crushing injury of elbow S578 Crushing injury of oth parts offorearm S579 Crushing injury of forearm part unsp

S580 Traumatic amputation at elbow joint S581 Traum amputatn lvl between elbow wrist S589 Traumatic amputation forearm level unsp

S617 Multiple open wounds of wrist and hand

S6181 Open wound wrist hand w commfx S6182 Open wound wrist hand w comm. disloc S6188 Open wound other parts of wrist &hand S619 Open wound of wrist & hand part unsp

S620 Fracture navicular [scaphoid] bone hand S6210 Fracture of carpal bone unspecified S6211 Fracture of lunate bone of wrist S6212 Fracture of triquetral bone of wrist S6213 Fracture of pisiform S6214 Fracture of trapezium bone S6215 Fracture of trapezoid bone S6216 Fracture of capitate bone S6217 Fracture of hamate bone S6219 Fracture of oth & multiple carpal bones S6220 Fracture first metacarpal bone part unsp S6221 Fracture of base first metacarpal bone S6222 Fracture of shaft first metacarpal bone S6223 Fracture of neck first metacarpal bone S6224 Fracture of head first metacarpal bone S6230 Fx oth metacarpal bone(s) part unsp S6231 Fracture base oth metacarpal bone(s) S6232 Fracture shaft oth metacarpal bone(s) S6233 Fracture neck oth metacarpal bone(s) S6234 Fracture head oth metacarpal bone(s) S624 Multiple fractures of metacarpal bones S628 Fracture oth & unsp parts wrist &hand

S6300 Dislocation of wrist part unspecified S6301 Dislocation radio ulnar (joint) distal S6302 Dislocation of radio carpal (joint) S6303 Dislocation of mid carpal (joint) S6304 Dislocation of carpo metacarpal(joint) S6308 Dislocation of other part of wrist

S633 Traumatic rupture of ligament of wrist and carpus S634 Traumatic rupture of ligamament of finger at MCP and IPJ(s)

S650 Injury ulnar art at wrist & hand level S651 Injury radial art at wrist & hand level S652 Injury of superficial palmar arch S653 Injury of deep palmar arch S654 Injury of blood vessel(s) of thumb S655 Injury of blood vessel(s) of oth finger S657 Inj mult blood vesl at wrist & hand lvl S658 Inj oth blood vesl at wrist & hand level S659 Inj unsp bl vessel at wrist & hand level

S670 Crushing injury of thumb & oth finger(s) S678 Crush injury oth & unsp parts wrist hand

S683 Cmb traum amputatn fngr w wrst hand S684 Traumatic amputation hand at wrist level S688 Traumatic amputatn oth parts wrist hand S689 Traumatic amputatn wrist hand level unsp

S710 Open wound of hip S711 Open wound of thigh S717 Multiple open wounds of hip and thigh S7180 Open wound oth & unsp parts pelv girdle S7181 Open wound hip thigh w comm fx S7182 Open wound hip thigh w comm. Disloc

S7200 Fracture of neck femur part unsp S7201 Fracture intracapsular section femur S7202 Fx upp epiphysis (separation) femur S7203 Fracture of subcapital section of femur S7204 Fracture of midcervical section of femur S7205 Fracture of base of neck of femur S7208 Fracture of other parts of neck o ffemur S7210 Fracture trochanteric section femur unsp S7211 Fracture intertrochanteric section femur S722 Subtrochanteric fracture S723 Fracture of shaft of femur S7240 Fracture of lower end femur part unsp S7241 Fracture of femoral condyle S7242 Fx low epiphysis (separation)femur S7243 Supracondylar fracture of femur S7244 Intercondylar fracture of femur S727 Multiple fractures of femur S728 Fractures of other parts of femur S729 Fracture of femur part unspecified

S7300 Dislocation of hip unspecified S7301 Posterior dislocation of hip S7302 Anterior dislocation of hip S7308 Other dislocation of hip

S750 Injury of femoral artery S751 Injury femoral vein at hip & thigh level S752 Inj greater saphenous vein hip thigh lvl S757 Inj mult blood vesl at hip thigh level S758 Inj oth blood vessels at hip thigh level S759 Inj unsp bl vessel at hip thigh level

S770 Crushing injury of hip S771 Crushing injury of thigh S772 Crushing injury of hip with thigh

S780 Traumatic amputation at hip joint S781 Traum amputatn at level between hip knee S789 Traumatic amputatn hip & thighlvl unsp

S810 Open wound of knee S817 Multiple open wounds of lower leg S8181 Open wound (low leg) w comm fx S8182 Open wound (low leg) w comm. disloc S8188 Open wound of oth parts of lower leg S819 Open wound of lower leg part unsp

S820 Fracture of patella S8211 Fx upp end tibia w fx fibula (anypart) S8218 Other fracture of upper end oftibia S8221 Fx shaft tibia w fx fibula (anypart) S8228 Other fracture of shaft of tibia S8231 Oth fx low end tibia w # fibula S8238 Oth fracture of lower end of tibia S8240 Fracture of fibula part unspecified S8241 Fracture of upper end of fibula S8242 Fracture of shaft of fibula S8249 Multiple fractures of fibula S825 Fracture of medial malleolus S826 Fracture of lateral malleolus S827 Multiple fractures of lower leg S8281 Bimalleolar fracture ankle S8282 Trimalleolar fracture ankle S8288 Fracture of other parts of lower leg S829 Fracture of lower leg partunspecified

S830 Dislocation of patella S8310 Dislocation of knee unspecified S8311 Anterior dislocation tibia proximal end S8312 Posterior dislocation tibia proximalend S8313 Medial dislocation tibia proximal end S8314 Lateral dislocation tibia proximal end S8318 Other dislocation of knee S832 Tear of meniscus current S833 Tear articular cartilage knee current S8343 Rupture of lateral collateral ligament S8344 Rupture of medial collateral ligament S8353 Rupture of anterior cruciate ligament S8354 Rupture of posterior cruciate ligament S837 Injury to multiple structures of knee

S850 Injury of popliteal artery S851 Inj (anterior)(posterior) tibial artery S852 Injury of peroneal artery S853 Inj greater saphenous vein low leg lvl S854 Inj lesser saphenous vein at lowleg lvl S855 Injury of popliteal vein S857 Inj mult blood vessels at low leg level S858 Inj oth blood vessels at lower leg level S859 Inj unsp blood vessel at lower leg level

S870 Crushing injury of knee S878 Crushing injury oth unsp parts lower leg

S880 Traumatic amputation at knee joint S881 Traum amputatn at lvl between knee ankle S889 Traumatic amputation lower leg lvl unsp

S910 Open wound of ankle S913 Open wound of other parts of foot S917 Multiple open wounds of ankle and foot S9181 Open wound ankle foot w comm fx

S9182 Open wound ankle foot w comm. Disloc

S920 Fracture of calcaneus S921 Fracture of talus S9220 Fracture of tarsal bone(s) unspecified S9221 Fracture of navicular [scaphoid]foot S9222 Fracture of cuboid foot S9223 Fracture of cuneiform foot S9228 Fracture of other part of tarsal bone S923 Fracture of metatarsal bone S927 Multiple fractures of foot S929 Fracture of foot unspecified

S930 Dislocation of ankle joint S9310 Dislocation of toe(s) unspecified S9311 Dislocation metatarso phalangeal(joint) S9312 Dislocation interphalangeal (joint) foot S932 Rupture of ligaments at ankle and foot level S9330 Dislocation of foot part unspecified S9331 Dislocation of tarsal (bone) joint unsp S9332 Dislocation of midtarsal (joint) S9333 Dislocation of tarso metatarsal(joint) S9334 Dislocation metatarsal (bone) joint unsp S9338 Dislocation of other part of foot

S950 Injury of dorsal artery of foot S951 Injury of plantar artery of foot S952 Injury of dorsal vein of foot S957 Inj mult blood vesl at ankle foot level S958 Inj oth blood vesl at ankle foot level S959 Inj unsp blood vessel at ankle foot lvl

S970 Crushing injury of ankle S971 Crushing injury of toe(s) S978 Crushing injury oth parts ankle & foot

S980 Traumatic amputation foot at ankle level S983 Traumatic amputation oth parts foot S984 Traumatic amputation of foot level unsp

T010 Open wounds involving head with neck T011 Open wound thorax w abdo low back pelv T012 Open wounds inv mult regions upp limb(s) T013 Open wounds inv mult regions low limb(s) T016 Open wound mult regions upp w low limb T018 Open wounds inv oth cmb body regions T019 Multiple open wounds unspecified

T0200 Fractures involving head w neck closed T0201 Fractures involving head with neck, open T0210 Fx inv thorax w lower back pelvis closed T0211 Fx inv thorax w lower back pelvis open T0220 Fractures inv mult rgn one upp limb clsd T0221 Fractures inv mult rgn one upp limb open T0230 Fractures inv mult rgn 1 low limb clsd

T0231 Fractures inv mult rgn one low limb open T0240 Fx inv mult regions both upp limbs clsd T0241 Fx inv mult regions both upp limbs T0250 Fx inv mult regions both low limbs clsd T0251 Fx inv mult regions both low limbs open T0260 Fx inv mult regions upp w low limb clsd T0261 Fx inv mult regions upp w low limb open T0270 Fx thorax w low back pelv w limb(s) clsd T0271 Fx thorax w low back pelv w limbs open T0280 Fractures inv oth cmb body regions clsd T0281 Fractures inv oth cmb body regions open T0290 Multiple fractures, unspecified,closed T0291 Multiple fractures, unspecified,open

T030 Disloc sprains strains inv head w neck T031 Disloc sprain thrx w low back pelv T032 Disloc sprain strain mult rgn upp limb T033 Disloc sprain strain mult rgn low limb T034 Disloc sprain mult rgn upp w low limb T038 Disloc sprain strain inv oth cmb bdrgn T039 Mult dislocations sprains strain sunsp

T040 Crushing injuries involving head w neck T041 Crush inj inv thrx w abdo low back pelv T042 Crush inj inv mult regions upper limb(s) T043 Crush inj inv mult regions lowl imb(s) T044 Crush inj inv mult rgn upp w low limb T047 Crush inj thrx abdo low back pelv limb T048 Crush inj inv oth cmb body regions T049 Multiple crushing injuries unspecified

T050 Traumatic amputation of both hands T051 Traum amputatn one hand & otharm T052 Traumatic amputatn both arms[any level] T053 Traumatic amputation of both feet T054 Traum amputatn one foot & oth leg T055 Traumatic amputatn both legs[any level] T056 Traum amputatn upp low limbs any cmb T058 Traum amputatn inv oth cmb body regions T059 Multiple traumatic amputations unsp

T060 Inj brain cranial nrv w nrv spin cd neck T061 Inj nrv spinal cord inv oth mult bdrgn T063 Injuries bl vesl inv mult body regions T065 Inj intrathor org w intrabdo pelv org

T080 Fracture of spine, level unsp closed T081 Fracture of spine, level unsp open

T091 Open wound of trunk leve unspecified T093 Injury of spinal cord level unspecified T094 Inj ? nrv spin nrv root & plexus oftrnk T096 Traumatic amputation of trunk level unsp

T100 Fracture of upper limb, lvl unsp closed

T101 Fracture of upper limb, level unsp open

T111 Open wound of upper limb level unsp T112 Disloc sprain jt ligmt upp limb lvl unsp T114 Inj unsp bl vessel upper limb level unsp T116 Traumatic amputatn upper limb level unsp

T120 Fracture of lower limb, lvl unsp closed T121 Fracture of lower limb, level unsp open

T131 Open wound of lower limb level unsp T132 Disloc sprain jt ligmt low limb lvl unsp T134 Inj unsp blood vessel low limb lvl unsp T136 Traumatic amputatn lower limb level unsp

T141 Open wound of unspecified body region T1420 Fracture of unspecified body region clsd T1421 Fracture of unspecified body region open T143 Disloc sprain strain unsp body region T145 Injury blood vessel(s) unsp body region T147 Crush inj traum amputatn unsp body rgn

T200 Burn of unsp thickness of head and neck T201 Erythema of head and neck T202 Partial thickness burn of head & neck T203 Full thickness burn of head and neck

T2100 Brn of unsp thickness of trunk unsp site T2101 Burn of unspecified thickness of breast T2102 Brn thck unsp chst wall excl brst,thrx T2103 Burn of unsp thickness of abdominal wall T2104 Brn of unsp thickness of back [anypart] T2105 Burn unsp thickness genitalia [external] T2109 Burn unsp thickness other sites of trunk T2110 Erythema of trunk unspecified site T2111 Erythema of breast T2112 Erythema chest wall excl breast &thorax T2113 Erythema of abdominal wall T2114 Erythema of back [any part] T2115 Erythema of genitalia [external] T2119 Erythema of other sites of trunk T2120 Partial thickness burn trunk site unsp T2121 Partial thickness burn breast T2122 Prt thck brn chest excl brst &thorax T2123 Partial thickness burn abdo wall T2124 Partial thickness burn back [any part] T2125 Partial thickness burn genitalia ext T2129 Prt thck burn oth & mult sites trunk T2130 Full thickness burn of trunk unsp site T2131 Full thickness burn of breast T2132 Full thck brn chst excl brst & thorax T2133 Full thickness burn of abdominal wall T2134 Full thickness burn of back [any part] T2135 Full thickness burn of genitalia ext T2139 Full thickness burn oth mult sites trunk

T2200 Burn thck unsp shoulder upp limb T2201 Burn thickness unsp forearm and elbow T2202 Burn thck unsp upp arm shoulder region T2210 Erythema shoulder upper limb unsp site T2211 Erythema of forearm and elbow T2212 Erythema arm (upper) & shoulder region T2220 Prt thck burn shold upp limb site unsp T2221 Prt thickness burn forearm elbow T2222 Prt thck burn upp arm shoulder region T2230 Full thck burn upper limb T2231 Full thickness burn of forearm and elbow T2232 Full thck burn arm (upp) shoulder region

T230 Burn of unsp thickness of wrist and hand T231 Erythema of wrist and hand T232 Prt thck burn wrist hand T233 Full thickness burn of wrist and hand

T240 Burn unsp thck hip low limb T241 Erythema hip low limb except ankle foot T242 Prt thck burn hip low limb T243 Full thck burn hip low limb

T250 Burn of unsp thickness of ankle and foot T251 Erythema of ankle and foot T252 Prt thck burn ankle foot T253 Full thickness burn of ankle and foot

T260 Burn of eyelid and periocular area T261 Burn of cornea and conjunctival sac T262 Burn w rupt destruction eyeball T263 Burn of other parts of eye and adnexa T264 Burn of eye and adnexa part unspecified

T270 Burn of larynx and trachea T271 Burn involving larynx & trachea w lung T272 Burn of other parts of respiratory tract T273 Burn of respiratory tract part unsp

T280 Burn of mouth and pharynx T281 Burn of oesophagus T282 Burn of other parts of alimentary tract T283 Burn of internal genitourinary organs T284 Burn of other and unsp internal organs

T290 Burns of multiple regions unsp thickness T291 Burns mult rgn erythema burns only T292 Burns mult rgn prt thck burns only T293 Burns mult rgn at least one full thck

T300 Burn of unsp body region unsp thickness T301 Erythema body region unspecified T302 Burn partial thickness body region unsp T303 Burn of full thickness body region unsp

T3100 Burns < 10% BSA < 10% / ? full thck brn T3110 Burns 10-19% BSA < 10% / ? full thck brn T3111 Burns 10-19% BSA 10-19% full thck burns T3120 Burns 20-29% BSA < 10% / unsp full thck T3121 Burns 20-29% BSA 10-19% full thck burns T3122 Burns 20-29% BSA 20-29% full thck burns T3130 Burn 30-39% BSA < 10% / unsp full thck T3131 Burns 30-39% BSA 10-19% full thck burns T3132 Burns 30-39% BSA 20-29% full thck burns T3133 Burns 30-39% BSA 30-39% full thck burns T3140 Burns 40-49% BSA < 10% / unsp full thck T3141 Burns 40-49% BSA 10-19% full thck burns T3142 Burns 40-49% BSA 20-29% full thck burns T3143 Burns 40-49% BSA 30-39% full thck burns T3144 Burns 40-49% BSA 40-49% full thck burns T3150 Burns 50-59% BSA < 10% / unsp full thck T3151 Burns 50-59% BSA 10-19% full thck burns T3152 Burns 50-59% BSA 20-29% full thck burns T3153 Burns 50-59% BSA 30-39% full thck burns T3154 Burns 50-59% BSA 40-49% full thck burns T3155 Burns 50-59% BSA 50-59% full thck burns T3160 Burns 60-69% BSA < 10% / unsp full thck T3161 Burns 60-69% BSA 10-19% full thck burns T3162 Burns 60-69% BSA 20-29% full thck burns T3163 Burns 60-69% BSA 30-39% full thck burns T3164 Burns 60-69% BSA 40-49% full thck burns T3165 Burns 60-69% BSA 50-59% full thck burns T3166 Burns 60-69% BSA 60-69% full thck burns T3170 Burns 70-79% BSA < 10% / unsp full thck T3171 Burns 70-79% BSA 10-19% full thck burns T3172 Burns 70-79% BSA 20-29% full thck burns T3173 Burns 70-79% BSA 30-39% full thck burns T3174 Burns 70-79% BSA 40-49% full thck burns T3175 Burns 70-79% BSA 50-59% full thck burns T3176 Burns 70-79% BSA 60-39% full thck burns T3177 Burns 70-79% BSA 70-79% full thck burns T3180 Burns 80-89% BSA < 10% / unspfull thck T3181 Burns 80-89% BSA 10-19% full thck burns T3182 Burns 80-89% BSA 20-29% full thck burns T3183 Burns 80-89% BSA 30-39% full thck burns T3184 Burns 80-89% BSA 40-49% full thck burns T3185 Burns 80-89% BSA 50-59% full thck burns T3186 Burns 80-89% BSA 60-69% full thck burns T3187 Burns 80-89% BSA 70-79% full thck burns T3188 Burns 80-89% BSA 80-89% full thck burns T3190 Burns =< 90% BSA < 10% / ? full thck brn T3191 Burns =< 90% BSA 10-19% full thck burns T3192 Burns => 90% BSA 20-29% full thck burns T3193 Burns => 90% BSA 30-39% full thck burns T3194 Burns => 90% BSA 40-49% full thck burns T3195 Burns => 90% BSA 50-59% full thck burns T3196 Burns => 90% BSA 60-69% full thck burns T3197 Burns => 90% BSA 70-79% full thck burns T3198 Burns => 90% BSA 80-89% full thck burns

T3199 Burns => 90% BSA => 90% BSA full thck

T340 Frostbite with tissue necrosis of head T341 Frostbite with tissue necrosis of neck T342 Frostbite with tissue necrosis of thorax T343 Frostbite with tissue necrosis of abdominal wall, lower back and pelvis T344 Frostbite with tissue necrosis of arm T345 Frostbite with tissue necrosis of wrist and hand T346 Frostbite with tissue necrosis of hip and thigh T347 Frostbite with tissue necrosis of knee and lower leg T348 Frostbite with tissue necrosis of ankle and foot T349 Frostbite with tissue necrosis of other and unspecified sites

T351 Frostbite with tissue necrosis involving multiple body regions

T790 Air embolism (traumatic) T791 Fat embolism (traumatic) T792 Traumatic secondary & recurrent haem T793 Post traumatic wound infection NEC T794 Traumatic shock T795 Traumatic anuria T796 Traumatic ischaemia of muscle T797 Traumatic subcutaneous emphysema T798 Other early complications of trauma T799 Unspecified early complication of trauma

T8900 Complications of open wounds unsp T8901 Open wound w FB (w or wo infectn) T8902 Open wound with infection T8903 Other complications of open wounds

ICD-10-AM 7th Edition immunocompromised state diagnosis codes:

B20 HIV resulting in infect & parasitic dis B21 HIV resulting in malignant neoplasms B22 HIV resulting in other spec diseases B230 Acute HIV infection syndrome B238 HIV resulting in other spec conditions B24 Unspecified HIV disease B59 Pneumocystosis (J17.3*) D70 Agranulocytosis D71 Fn disrd polymorphonuclearneutrophils D720 Genetic anomalies of leukocytes D728 Other specified disorders of white blood cells D730 Hyposplenism D800 Hereditary hypogammaglobulinaemia D801 Nonfamilial hypogammaglobulinaemia D802 Selective deficiency of immunoglobulin A D803 Selective deficiency of IgG subclasses D804 Selective deficiency of immunoglobulin M D805 Immunodeficiency with increased IgM D806 Ab def nr norm Ig or hyperimmunoglobem D807 Transient hypogammaglobulinaemia infancy D808 Oth immunodef w predom antibody defects

D809 Immunodef w predom antibody defects unsp D810 Sev cmb immunodef w reticlrdysgenesis D811 Sev cmb immunodef w low T & B cellno D812 Sev cmb immunodef w norm-low B cell no D813 Adenosine deaminase [ADA] deficiency D814 Nezelof's syndrome D815 Purine nucleoside phosphorylase [PNP deficiency D816 Major histocompat complex class I def D817 Major histocompat complex class II def D818 Other combined immunodeficiencies D819 Combined immunodeficiency unspecified D820 Wiskott-Aldrich syndrome D821 Di George's syndrome D822 Immunodeficiency w short limbed stature D823 Immunodef fol hered dfct respn to EBV D824 Hyperimmunoglobulin E [IgE] syndrome D828 Immunodef ass w oth spec major defects D829 Immunodef ass w major defect unsp D830 Com var immunodef predom abn B cell no fn D831 Com var immunodef predom I/r Tcell disrd D832 Com var immunodef w auto- Ab B or T cell D838 Other common variable immunodeficiencies D839 Common variable immunodeficiency unsp D840 Lymphocyte function antigen-1defect D841 Defects in the complement system D848 Other specified immunodeficiencies D849 Immunodeficiency unspecified D893 Immune reconstitution syndrome D898 Other spec disrd inv immune mechn NEC D899 Disorder involving immune mechanism unsp E40 Kwashiorkor E41 Nutritional marasmus E42 Marasmic kwashiorkor E43 Unsp severe protein-energy maln I120 Hypertensive kidney dis w kidney failure I131 H/T heart & kidney dis w kidney failure I132 H/T heart & kidney dis w heart kidney fail K912 Postprocedural malabsorption NEC M359 Systemic inv connective tissue unsp N181 Chronic kidney disease, stage 1 N182 Chronic kidney disease, stage 2 N183 Chronic kidney disease, stage 3 N184 Chronic kidney disease, stage 4 N185 Chronic kidney disease, stage 5 N189 Chronic kidney disease, unspecified N19 Unspecified kidney failure T860 Bone marrow transplant rejection T861 Kidney transplant failure and rejection T862 Heart transplant failure and rejection T863 Heart-lung transplant failure rejection T864 Liver transplant failure and rejection T8681 Failure and rejection of lung transplant T8682 Pancreas or pancreatic islet cell transplant failure and rejection T8688 Fail & rejct oth transplanted org tis T869 Fail & rejection trnsplnt org tis unsp

Z490 Preparatory care for dialysis Z491 Extracorporeal dialysis Z492 Other dialysis Z940 Kidney transplant status Z941 Heart transplant status Z942 Lung transplant status Z943 Heart and lungs transplant status Z944 Liver transplant status Z948 Oth transplanted organ and tissue status Z992 Dependence on renal dialysis

ICD-10-AM 7th Edition Immunocompromised State intervention codes:

1370600 Allo bm/sc trnsplnt rel don wo invitro 1370606 Allo bm/sc trnsplnt rel don w invitro 1370607 Autolgs bm/stem cel trnsplnt wo invitro 1370608 Autolgs bm/stem cell trnsplnt w invitro 1370609 Allo bm/sc trnsplnt oth don wo invitro 1370610 Allo bm/sc trnsplnt oth don w invitro 1420301 Direct living tissue implantation 3650300 Renal transplantation 9017200 Sequential single lung trnsplnt bil 9017201 Other transplantation of lung 9020500 Heart transplantation 9020501 Heart and lung transplantation 9031700 Transplantation of liver 9032400 Transplantation of pancreas

ICD-10-AM 7th Edition cancer diagnosis codes: C000 Malignant neoplasm of external upper lip C001 Malignant neoplasm of external lower lip C002 Malignant neoplasm external lip unsp C003 Malg neoplasm upper lip inner aspect C004 Malg neoplasm lower lip inner aspect C005 Malg neoplasm lip unsp inner aspect C006 Malignant neoplasm of commissure of lip C008 Overlapping malignant lesion of lip C009 Malignant neoplasm of lip unspecified C01 Malignant neoplasm of base of tongue C020 Malg neoplasm dorsal surface of tongue C021 Malignant neoplasm of border of tongue C022 Malg neoplasm ventral surface tongue C023 Malg neoplasm ant tongue part unsp C024 Malignant neoplasm of lingual tonsil C028 Malg neoplasm overlapping lesion tongue C029 Malignant neoplasm tongue unspecified C030 Malignant neoplasm of upper gum C031 Malignant neoplasm of lower gum C039 Malignant neoplasm of gum unspecified C040 Malignant neoplasm ant floor of mouth C041 Malignant neoplasm lat floor of mouth C048 Overlapping malg lesion floor of mouth C049 Malg neoplasm of floor of mouth unsp

C050 Malignant neoplasm of hard palate C051 Malignant neoplasm of soft palate C052 Malignant neoplasm of uvula C058 Overlapping malignant lesion of palate C059 Malignant neoplasm of palate unspecified C060 Malignant neoplasm of cheek mucosa C061 Malignant neoplasm of vestibule of mouth C062 Malignant neoplasm of retro molar area C068 Overlap malg lesion oth / unsp mouth C069 Malignant neoplasm of mouth unspecified C07 Malignant neoplasm of parotid gland C080 Malignant neoplasm submandibular gland C081 Malignant neoplasm of sublingual gland C088 Overlapping malg lesion major sal glands C089 Malg neoplasm major salivary gland unsp C090 Malignant neoplasm of tonsillar fossa C091 Malg neoplasm tonsillar pillar C098 Overlapping malignant lesion of tonsil C099 Malignant neoplasm tonsil unspecified C100 Malignant neoplasm of vallecula C101 Malg neoplasm ant surface epiglottis C102 Malignant neoplasm lat wall oropharynx C103 Malignant neoplasm post wall oropharynx C104 Malignant neoplasm of branchial cleft C108 Overlapping malignant lesion oropharynx C109 Malignant neoplasm oropharynx unsp C110 Malg neoplasm superior wall nasophrynx C111 Malignant neoplasm post wall nasopharynx C112 Malignant neoplasm lat wall nasopharynx C113 Malignant neoplasm ant wall nasopharynx C118 Overlapping malg lesion of nasopharynx C119 Malignant neoplasm nasopharynx unsp C12 Malignant neoplasm of pyriform sinus C130 Malignant neoplasm of postcricoid region C131 Malg neoplasm hypophrnglaryepigltc fold C132 Malignant neoplasm post wall hypopharynx C138 Overlapping malignant lesion hypopharynx C139 Malignant neoplasm hypopharynx unsp C140 Malignant neoplasm pharynx unspecified C142 Malignant neoplasm of Wald eyerring C148 Overlap malg neoplasm lip oral cvphrynx C150 Malignant neoplasm cervical esophagus C151 Malignant neoplasm thoracic oesophagus C152 Malignant neoplasm abdominal oesophagus C153 Malg neoplasm upper third oesophagus C154 Malg neoplasm middle third oesophagus C155 Malg neoplasm lower third oesophagus C158 Overlapping malignant lesion oesophagus C159 Malignant neoplasm oesophagus unsp C160 Malignant neoplasm of cardia C161 Malignant neoplasm of fundus of stomach C162 Malignant neoplasm of body of stomach C163 Malignant neoplasm of pyloricantrum C164 Malignant neoplasm of pylorus C165 Malg neoplasm lesser curve stomach unsp

C166 Malg neoplasm greater curve stomach unsp C168 Overlapping malignant lesion of stomach C169 Malignant neoplasm stomach unspecified C170 Malignant neoplasm of duodenum C171 Malignant neoplasm of jejunum C172 Malignant neoplasm of ileum C173 Malignant neoplasm Meckel's diverticulum C178 Overlap malg lesion of small intestine C179 Malignant neoplasm small intestine unsp C180 Malignant neoplasm of caecum C181 Malignant neoplasm of appendix C182 Malignant neoplasm of ascending colon C183 Malignant neoplasm of hepatic flexure C184 Malignant neoplasm of transverse colon C185 Malignant neoplasm of splenic flexure C186 Malignant neoplasm of descending colon C187 Malignant neoplasm of sigmoid colon C188 Overlapping malignant lesion of colon C189 Malg neoplasm of colon, unspecified part C19 Malignant neoplasm rectosigmoid junction C20 Malignant neoplasm of rectum C210 Malignant neoplasm of anus unspecified C211 Malignant neoplasm of anal canal C212 Malignant neoplasm of cloacogenic zone C218 Overlap malg lesion rectum anus anal cnl C220 Liver cell carcinoma C221 Intrahepatic bile duct carcinoma C222 Hepatoblastoma C223 Angiosarcoma of liver C224 Other sarcomas of liver C227 Other specified carcinomas of liver C229 Malignant neoplasm of liver unspecified C23 Malignant neoplasm of gallbladder C240 Malignant neoplm extrahepaticbile duct C241 Malignant neoplasm of ampulla of Vater C248 Overlapping malg lesion of biliary tract C249 Malignant neoplasm biliary tract unsp C250 Malignant neoplasm of head of pancreas C251 Malignant neoplasm of body of pancreas C252 Malignant neoplasm of tail of pancreas C253 Malignant neoplasm of pancreatic duct C254 Malignant neoplasm of endocrine pancreas C257 Malignant neoplasm other parts pancreas C258 Overlapping malignant lesion of pancreas C259 Malignant neoplasm pancreas part unsp C260 Malg neoplasm intest tract part unsp C261 Malignant neoplasm of spleen C268 Overlap malg lesion of digestive system C269 Malg neoplasm ill-def site digest system C300 Malignant neoplasm of nasal cavity C301 Malignant neoplasm of middle ear C310 Malignant neoplasm of maxillary sinus C311 Malignant neoplasm of ethmoidal sinus C312 Malignant neoplasm of frontal sinus C313 Malignant neoplasm of sphenoidal sinus

C318 Overlap malg lesion of accessory sinus C319 Malignant neoplasm accessory sinus unsp C320 Malignant neoplasm of glottis C321 Malignant neoplasm ofsupraglottis C322 Malignant neoplasm of subglottis C323 Malignant neoplasm laryngeal cartilage C328 Overlapping malignant lesion of larynx C329 Malignant neoplasm larynx unspecified C33 Malignant neoplasm of trachea C340 Malignant neoplasm of main bronchus C341 Malg neoplm upper lobe bronchus or lung C342 Malg neoplasm mid lobe bronchus or lung C343 Malg neoplm lower lobe bronchus or lung C348 Overlap malg lesion of bronchus & lung C349 Malignant neoplasm bronchus or lung unsp C37 Malignant neoplasm of thymus C380 Malignant neoplasm of heart C381 Malignant neoplasm anterior mediastinum C382 Malignant neoplasm posterior mediastinum C383 Malg neoplasm mediastinum, part unsp C384 Malignant neoplasm of pleura C388 Overlap malg lsn heart mediast &pleura C390 Malg neoplm upper resp tract part unsp C398 Overlap malg lesion resp &intrathor org C399 Malg neoplasm ill-def sites resp system C400 Malg neoplasm scapula long bones upp lmb C401 Malg neoplasm short bones upper limb C402 Malignant neoplasm long bones lower limb C403 Malg neoplasm short bones lower limb C408 Overlap malg lesion bone artlr cart limb C409 Malg neoplm bne & artlr cart limb unsp C4101 Malignant neoplasm of craniofacial bones C4102 Malignant neoplasm maxillofacial bones C411 Malignant neoplasm of mandible C412 Malignant neoplasm of vertebral column C413 Malignant neoplasm ribs sternum clavicle C414 Malg neoplasm pelvic bones sacrum coccyx C418 Overlap malignant lesion bone artlr cart C419 Malg neoplm bne & artlr cartilage unsp C430 Malignant melanoma of lip C431 Malg melanoma eyelid including canthus C432 Malg melanoma ear & extauricular canal C433 Malg melanoma other & unsp parts face C434 Malignant melanoma of scalp and neck C435 Malignant melanoma of trunk C436 Malg melanoma upper limb incl shoulder C437 Malignant melanoma lower limb incl hip C438 Overlapping malignant melanoma of skin C439 Malignant melanoma of skin unspecified C450 Mesothelioma of pleura C451 Mesothelioma of peritoneum C452 Mesothelioma of pericardium C457 Mesothelioma of other sites C459 Mesothelioma unspecified C460 Kaposi sarcoma of skin

C461 Kaposi sarcoma of soft tissue C462 Kaposi sarcoma of palate C463 Kaposi sarcoma of lymph nodes C467 Kaposi sarcoma of other sites C468 Kaposi sarcoma of multiple organs C469 Kaposi sarcoma unspecified C470 Malg neoplm perph nerve head face & neck C471 Malg neoplm perph nerve upp lmb shoulder C472 Malg neoplm perph nrv low limb incl hip C473 Malg neoplasm peripheral nerves thorax C474 Malg neoplasm peripheral nerves abdomen C475 Malg neoplasm peripheral nerves pelvis C476 Malg neoplasm perph nerves of trunk unsp C478 Overlap malg lsn perph nrv autnrvs sys C479 Malg neoplm perph nrv & aut nrvssys ? C480 Malignant neoplasm of retroperitoneum C481 Malg neoplasm spec parts of peritoneum C482 Malignant neoplasm peritoneum unsp C488 Overlap malg lsn retperitonm peritoneum C490 Malg neoplm con & soft tis head face nek C491 Malg neoplm con / soft tis upp lmbs hold C492 Malg neoplm con & soft tis low limb hip C493 Malg neoplasm con & soft tissue thorax C494 Malg neoplasm con & soft tissue abdomen C495 Malg neoplasm con & soft tissue pelvis C496 Malg neoplasm con / soft tis trunk unsp C498 Overlap malg lesion con & soft tissue C499 Malg neoplasm con & soft tissue unsp C500 Malignant neoplasm of nipple and areola C501 Malg neoplasm of central portion breast C502 Malg neoplasm upp inner quadrant breast C503 Malg neoplasm low inner quadrant breast C504 Malg neoplasm upp outer quadrant breast C505 Malg neoplasm low outer quadrant breast C506 Malignant neoplasm axillary tail breast C508 Overlapping malignant lesion ofbreast C509 Malignant neoplasm breast part unsp C510 Malignant neoplasm of labium majus C511 Malignant neoplasm of labium minus C512 Malignant neoplasm of clitoris C518 Overlapping malignant lesion of vulva C519 Malignant neoplasm of vulva unspecified C52 Malignant neoplasm of vagina C530 Malignant neoplasm of endocervix C531 Malignant neoplasm of exocervix C538 Overlap malignant lesion cervix uteri C539 Malignant neoplasm cervix uteri unsp C540 Malignant neoplasm of isthmus uteri C541 Malignant neoplasm of endometrium C542 Malignant neoplasm of myometrium C543 Malignant neoplasm of fundus uteri C548 Overlap malignant lesion corpus uteri C549 Malignant neoplasm corpus uteri unsp C55 Malignant neoplasm uterus part unsp C56 Malignant neoplasm of ovary

C570 Malignant neoplasm of fallopian tube C571 Malignant neoplasm of broad ligament C572 Malignant neoplasm of round ligament C573 Malignant neoplasm of parametrium C574 Malignant neoplasm uterine adnexa unsp C577 Malg neoplm other spec femle genorgan C578 Overlap malg lesion female genital organ C579 Malg neoplasm female genital organ unsp C58 Malignant neoplasm of placenta C600 Malignant neoplasm of prepuce C601 Malignant neoplasm of glans penis C602 Malignant neoplasm of body of penis C608 Overlapping malignant lesion of penis C609 Malignant neoplasm of penis unspecified C61 Malignant neoplasm of prostate C620 Malignant neoplasm of undescended testis C621 Malignant neoplasm of descended testis C629 Malignant neoplasm of testis unspecified C630 Malignant neoplasm of epididymis C631 Malignant neoplasm of spermatic cord C632 Malignant neoplasm of scrotum C637 Other specified male genital organs C638 Overlap malg lesion male genital organs C639 Malg neoplasm male genital organ unsp C64 Malg neoplasm kidney except renal pelvis C65 Malignant neoplasm of renal pelvis C66 Malignant neoplasm of ureter C670 Malignant neoplasm of trigone of bladder C671 Malignant neoplasm of dome of bladder C672 Malignant neoplasm lateral wall bladder C673 Malignant neoplasm anterior wall bladder C674 Malg neoplasm of posterior wall bladder C675 Malignant neoplasm of bladder neck C676 Malignant neoplasm of ureteric orifice C677 Malignant neoplasm of urachus C678 Overlapping malignant lesion of bladder C679 Malignant neoplasm of bladder unsp C680 Malignant neoplasm of urethra C681 Malignant neoplasm of paraurethral gland C688 Overlap malignant lesion urinary organs C689 Malignant neoplasm urinary organ unsp C690 Malignant neoplasm of conjunctiva C691 Malignant neoplasm of cornea C692 Malignant neoplasm of retina C693 Malignant neoplasm of choroid C694 Malignant neoplasm of ciliary body C695 Malignant neoplasm lacrimal gland& duct C696 Malignant neoplasm of orbit C698 Overlap malignant lesion eye & adnexa C699 Malignant neoplasm of eye unspecified C700 Malignant neoplasm of cerebral meninges C701 Malignant neoplasm of spinal meninges C709 Malignant neoplm of meninges,unsp C710 Malg neoplasm cerebrum ex lobes& ventrl C711 Malignant neoplasm of frontal lobe

C712 Malignant neoplasm of temporal lobe C713 Malignant neoplasm of parietal lobe C714 Malignant neoplasm of occipital lobe C715 Malignant neoplasm of cerebral ventricle C716 Malignant neoplasm of cerebellum C717 Malignant neoplasm of brain stem C718 Overlapping malignant lesion of brain C719 Malignant neoplasm of brain unspecified C720 Malignant neoplasm of spinal cord C721 Malignant neoplasm of cauda equina C722 Malignant neoplasm of olfactory nerve C723 Malignant neoplasm of optic nerve C724 Malignant neoplasm of acoustic nerve C725 Malg neoplasm oth / unsp cranial nerves C728 Overlap malg lesion brain & other CNS C729 Malignant neoplasm CNS unspecified C73 Malignant neoplasm of thyroid gland C740 Malignant neoplasm cortex adrenal gland C741 Malignant neoplasm medulla adrenal gland C749 Malignant neoplasm adrenal gland unsp C750 Malignant neoplasm of parathyroid gland C751 Malignant neoplasm of pituitary gland C752 Malignant neoplasmcraniopharyngeal duct C753 Malignant neoplasm of pineal gland C754 Malignant neoplasm of carotid body C755 Malg neoplm aortic body othparaganglia C758 Malg neoplasm pluri glandular inv Unsp C759 Malignant neoplasm endocrine gland unsp C760 Malignant neoplasm head face & neck C761 Malignant neoplasm of thorax C762 Malignant neoplasm of abdomen C763 Malignant neoplasm of pelvis C764 Malignant neoplasm of upper limb C765 Malignant neoplasm of lower limb C767 Malignant neoplasm other ill-defsites C768 Overlap malg lesion oth & ill-def sites C770 Sec / unsp neoplm lymph n head fce neck C771 Sec / unsp neoplm intrathorlymph n C772 Sec / unsp neoplm intrabdo lymphn C773 Sec / unsp neoplm axil upp lmblymph n C774 Sec / unsp neoplm ing & low limblymph n C775 Sec / unsp neoplm intrapelviclymph n C778 Sec / unsp neoplm lymph n multregion C779 Sec / unsp neoplm unsp lymphnode C780 Secondary malignant neoplasm of lung C781 Sec malignant neoplasm mediastinum C782 Secondary malignant neoplasm of pleura C783 Sec malg neoplasm oth / unsp resp organ C784 Sec malignant neoplasm small intestine C785 Sec malg neoplm large intestine &rectum C786 Sec malg neoplm retperitonm &peritoneum C787 Secondary malignant neoplasm of liver and intrahepatic bile duct C788 Sec malg neoplasm oth / unsp digest org C790 Sec malg neoplasm kidney & renal pelvis C791 Sec neoplm bladder oth / unsp urin org

C792 Secondary malignant neoplasm of skin C793 Sec malg neoplm brain cerebral meninges C794 Sec malg neoplasm oth / unsp nrvs system C795 Sec malg neoplasm bone & bone C796 Secondary malignant neoplasm of ovary C797 Sec malignant neoplasm adrenal gland C7981 Secondary malignant neoplasm of breast C7982 Sec malignant neoplasm genital organs C7988 Sec malignant neoplasm other spec sites C79.9 Secondary malignant neoplasm, unspecified site C800 Malignant neoplasm, primary site unknown, so stated C809 Malignant neoplasm, primary site, unspecified C810 Nodular lymphocyte predominant Hodgkin lymphoma C811 Nodular sclerosis classical Hodgkin lymphoma C812 Mixed cellularity classical Hodgkin lymphoma C813 Lymphocyte depleted classical Hodgkin lymphoma C817 Other classical Hodgkin lymphoma C819 Hodgkin lymphoma, unspecified C820 Follicular lymphoma grade 1 C821 Follicular lymphoma grade 2 C822 Follicular lymphoma grade 3, unspecified C823 Follicular lymphoma grade 3a C824 Follicular lymphoma grade 3b C825 Diffuse follicle centre lymphoma C826 Cutaneous follicle centre lymphoma C827 Other types of follicular lymphoma C829 Follicular lymphoma, unspecified C830 Small cell B-cell lymphoma C831 Mantle cell lymphoma C833 Diffuse large B-cell lymphoma C835 Lymphoblastic (diffuse) lymphoma C837 Burkitt lymphoma C838 Other non-follicular lymphoma C839 Non-follicular (diffuse) lymphoma, unspecified C840 Mycosis fungoides C841 Sézary disease C842 T-zone lymphoma C844 Peripheral T-cell lymphoma, NEC C845 Other mature T/NK-cell lymphomas C846 Anaplastic large cell lymphoma, ALK-positive C847 Anaplastic large cell lymphoma, ALK-negative C848 Cutaneous T-cell lymphoma, unspecified C849 Mature T/NK-cell lymphoma, unspecified C851 B-cell lymphoma unspecified C852 Mediastinal (thymic) large B-cell lymphoma C857 Other specified types of non-Hodgkin lymphoma C859 Non-Hodgkin lymphoma, unspecified C860 Extranodal NK/T-cell lymphoma, nasal type C861 Hepatosplenic T-cell lymphoma C862 Enteropathy-type (intestinal) T-cell lymphoma C863 Subcutaneous panniculitis-like T-cell lymphoma C864 Blastic NK-cell lymphoma C865 Angioimmunoblastic T-cell lymphoma C866 Primary cutaneous CD30-positive T-cell proliferations C8800 Waldenström macroglobulinaemia wo rem

C8801 Waldenström macroglobulinaemia in rem C8820 Other heavy chain disease wo remission C8821 Other heavy chain disease in remission C8830 Immunoproliferative sm intest dis wo rem C8831 Immunoproliferative sm intest dis in rem C8840 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] wo rem C8841 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] in rem C8870 Oth malg immunoproliferative dis wo rem C8871 Oth malg immunoproliferative dis in rem C8890 Unsp immunoproliferative dis wo rem C8891 Unsp immunoproliferative dis in rem C9000 Multiple myeloma without remission C9001 Multiple myeloma in remission C9010 Plasma cell leukaemia wo remission C9011 Plasma cell leukaemia in remission C9020 Extramedullary plasmacytoma wo remission C9021 Extramedullary plasmacytoma in rem C9030 Solitary plasmacytoma wo rem C9031 Solitary plasmacytoma in rem C9100 Acute lymphoblastic leukaemia [ALL] wo rem C9101 Acute lymphoblastic leukaemia [ALL] in rem C9110 Chronic lymphocytic leukaemia of B-cell type wo rem C9111 Chronic lymphocytic leukaemia of B-cell type in rem C9130 Prolymphocytic leukaemia of B-cell type wo remission C9131 Prolymphocytic leukaemia of B-cell type in remission C9140 Hairy-cell leukaemia without remission C9141 Hairy-cell leukaemia in remission C9150 Adult T-cell leukaemia/lymphoma (HTLV-1 associated) without remission C9151 Adult T-cell leukaemia/lymphoma (HTLV-1 associated) in remission C9160 Prolymphocytic leukaemia of T-cell type wo rem C9161 Prolymphocytic leukaemia of T-cell type in rem C9170 Other lymphoid leukaemia wo remission C9171 Other lymphoid leukaemia in remission C9180 Mature B-cell leukaemia Burkitt-type in rem C9181 Mature B-cell leukaemia Burkitt-type wo rem C9190 Lymphoid leukaemia unsp wo remission C9191 Lymphoid leukaemia unsp in remission C9200 Acute myeloblastic leukaemia wo remission C9201 Acute myeloblastic leukaemia in remission C9210 Chronic myeloid leukaemia [CML], BCR/BL-positive wo remission C9211 Chronic myeloid leukaemia [CML], BCR/BL-positive in remission C9220 Atypical chronic myeloid leukaemia, BCR/ABL-negative wo remission C9221 Atypical chronic myeloid leukaemia, BCR/ABL-negative in remission C9230 Myeloid sarcoma without remission C9231 Myeloid sarcoma in remission C9240 Acute promyelocytic leukaemia [PML] wo rem C9241 Acute promyelocytic leukaemia [PML] in rem C9250 Acute myelomonocytic leukaemia wo rem C9251 Acute myelomonocytic leukaemia in rem C9260 Acute myeloid leukaemia with 11q23-abnormality wo rem C9261 Acute myeloid leukaemia with 11q23-abnormality in rem C9270 Other myeloid leukaemia wo remission C9271 Other myeloid leukaemia in remission

C9280 Acute myeloid leukaemia with multilineage dysplasia wo rem C9281 Acute myeloid leukaemia with multilineage dysplasia in rem C9290 Myeloid leukaemia unsp wo remission C9291 Myeloid leukaemia unsp in remission C9300 Acute monoblastic/monocytic leukaemia wo remission C9301 Acute monoblastic/monocytic leukaemia in remission C9310 Chronic myelomonocytic leukaemia [CMML] wo remission C9311 Chronic myelomonocytic leukaemia [CMML] in remission C9330 Juvenile myelomonocytic leukaemia wo rem C9331 Juvenile myelomonocytic leukaemia in rem C9370 Other monocytic leukaemia wo remission C9371 Other monocytic leukaemia in remission C9390 Monocytic leukaemia unsp wo remission C9391 Monocytic leukaemia unsp in remission C9400 Acute erythroid leukaemia wo rem C9401 Acute erythroid leukaemia in rem C9420 Acute megakaryoblastic leukaemia wo rem C9421 Acute megakaryoblastic leukaemia in rem C9430 Mast cell leukaemia without remission C9431 Mast cell leukaemia in remission C9440 Acute panmyelosis with myelofibrosis without remission C9441 Acute panmyelosis with myelofibrosis in remission C9460 Myelodysplastic and myeloproliferative disease, NEC wo rem C9461 Myelodysplastic and myeloproliferative disease, NEC in rem C9470 Other specified leukaemias wo remission C9471 Other specified leukaemias in remission C9500 Acute leukaemia unsp cell type wo rem C9501 Acute leukaemia unsp cell type in rem C9510 Chr leukaemia unsp cell type wo rem C9511 Chr leukaemia unsp cell type in rem C9570 Oth leukaemia of unsp cell type wo rem C9571 Oth leukaemia of unsp cell type in rem C9590 Leukaemia unspecified without remission C9591 Leukaemia unspecified in remission C960 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis [Letterer- Siwe disease] C962 Malignant mast cell tumour C964 Sarcoma of dendritic cells (accessory cells) C965 Multifocal and unisytemic Langerhans-cell histiocytosis C966 Unifocal Langerhans-cell histiocytosis C967 Other spec malignant neoplm lymphoid,haemat & tis C968 Histiocytic sarcoma C969 Neoplasm lymphoid haemat tissue unsp Z850 Persl h/o malg neoplasm digestive organs Z851 Persl h/o malg neoplasm trach bronc lung Z852 Persl h/o malg neoplasm oth resp organ Z853 Persl h/o malignant neoplasm of breast Z854 Persl h/o malignant neoplasm genital org Z855 Persl h/o malg neoplasm urinary tract Z856 Personal history of leukaemia Z857 Persl h/o oth malg neoplasm lymph haemat Z858 Persl h/o malg neoplm oth organ & system Z859 Personal history of malg neoplasm unsp

EQ8.a: In Hospital mortality rates for AMI

Reported Data Description Items Identifier (office use only) Name In-hospital mortality of patients admitted for acute myocardial infarction (AMI) Aliases In-hospital mortality for AMI Definition In-hospital deaths of patients admitted for acute myocardial infarction. Related Metadata Guide for Use: Hospital mortality indicators should be used as screening tools, rather than being assumed to be definitively diagnostic of poor quality and/or safety. This indicator is intended to signal that a problem may exist and that further detailed investigation is required. High outlier rates should be seen as a prompt to further investigation. Learnings may be applied from low outlier rates. Limitations Value only reliable and released for reporting for hospitals with 30 or more separations per year.

The size of hospital and the number of separations within the same peer group may vary. Smaller hospitals with fewer separations are more likely to have wider confidence intervals than larger hospitals. This may affect the precision of estimating the current thresholds.

Hospital service-care type, code: acute care Episode of admitted patient care-admission urgency status, code: urgency status assigned – emergencyLength of stay (LOS), including leave days) is between 1 and 30 days, inclusive (1 ≤ LOS ≤ 30) (but not including same day).

Also include in the denominator episodes of care occurring prior to the admission for AMI (as identified above) where:

 Date of separation of prior episode = date of admission of AMI episode (as identified under denominator inclusions and

exclusions above).

AND

 Principal diagnosis of prior episode is Angina (I20) OR Chest pain

(R07.4).

AND

 Separation mode of prior episode = discharge / transfer to (an) other acute hospital. AND

Care type of prior episode = acute care.

1 Exclusions  Additional diagnosis of Cardiac arrest (I46.x) AND Condition onset flag = Condition not noted as arising during the episode of admitted patient care.  Same day separations (where date of admission is equal to the date of separation).

Scope Public Hospitals (metropolitan and rural) Joondalup Health Campus, publically funded activity Peel Health Campus, publically funded activity Formula: Risk adjustment Risk adjustment should be performed using a logistic regression model. The response variable will be whether a patient died or survived during the hospital stay, and the predictor variables include those listed under the risk adjustment. There are no interaction terms specified in the risk adjustment model.

Variables for risk adjustment: Age group (5 year categories) (at date of admission) Sex Episode of care-additional diagnosis, code: Additional diagnoses ICD-10-AM 7th Edition codes Dementia Any code from categories: F00 Dementia in Alzheimer's disease (G30.-†) F01 Vascular dementia F02* Dementia in other diseases classified elsewhere F03 Unspecified dementia Alzheimer’s disease Any code from categories: G30 Alzheimer’s disease Individual codes: G31.0 Circumscribed brain atrophy G31.1 Senile degeneration of brain, NEC Hypotension Any code from category: I95 Hypotension Shock Any code from category: R57 Shock Individual codes: A48.3 Toxic shock syndrome

Kidney (renal) failure Any code from categories:

1 ICD-10-AM 7th edition.

N17 Acute kidney failure N19 Unspecified kidney failure Individual codes: N18.3 Chronic kidney disease, stage 3 N18.4 Chronic kidney disease, stage 4 N18.5 Chronic kidney disease, stage 5 N18.9 Chronic kidney disease, unspecified R34 Anuria and oliguria Heart failure Any code from category: I50 Heart failure Individual codes: I11.0 Hypertensive heart disease with (congestive) heart failure I13.0 Hypertensive heart and kidney disease with (congestive) heart failure I13.2 Hypertensive heart and kidney disease with both (congestive) heart failure and kidney failure Dysrhythmia Any code from categories: I46 Cardiac arrest I47 Paroxysmal tachycardia I49 Other cardiac arrhythmias Individual code: I48 Atrial fibrillation and flutter Malignancy Any code in the following range: (see also Appendix 2) Malignant neoplasms (C00- C96), except category: C44 Other malignant neoplasms of skin Hypertension Any code in the following range: Hypertensive diseases (I10-I15) Individual codes: I27.0 Primary pulmonary hypertension I27.2 Other secondary pulmonary hypertension I67.4 Hypertensive encephalopathy K76.6 Portal hypertension Cerebrovascular disease Any code in the following range: Cerebrovascular diseases (I60- I69) Note: Symbols: † dagger (aetiology) – this symbol immediately following a code denotes that the code describes the underlying cause or aetiology of a disease. It is known as a ‘dagger’ code and is usually paired with an ‘asterisk’ code.

* asterisk (manifestation) – this symbol immediately following a code denotes that the code describes the manifestation of the disease. It is known as an ‘asterisk’ code, and must always be paired and sequenced after the ‘aetiology’ code.

Risk adjusted in-hospital mortality rate of the condition for hospital h

n H n h Y h Y ˆ i1 h,i h1 i1 h,i = Rh  n  , where pˆ h,i are from the logistic h pˆ n i1 h,i model.

X100

where the risk adjustment factor = observed number of in-hospital deaths in a specified hospital meeting the inclusion and exclusion rules for the denominator  expected number of deaths in a specified hospital

where the national crude rate = national total number of deaths  national total number of patients

Units Rate per 100 separations Numerator Observed number of in-hospital deaths for patients meeting the inclusion and exclusion rules for the denominator; and Episode of admitted patient care-separation mode: died. Denominator Expected number of deaths for patients meeting the inclusion and exclusion rules for the denominator Confidence 95% Confidence Intervals intervals =  Rˆ 1.96 vaˆr(Rˆ ) 100  h h 

H n 2  h Y  h1 i1 h,i nh where vaˆr(Rˆ )    pˆ (1 pˆ ) h n i1 h,i h,i  n h pˆ   i1 h,i  Verification Rules Value is greater than or equal to zero and less than or equal to 100. Data Collection Identification Items Source WA Hospital Morbidity Data System (HMDS) National Hospital Morbidity Database (NHMD) Governance Items Purpose of the ABF/ABM Performance Management Reports. data

Source of the National core hospital-based outcome indicators of safety and quality: definition Draft Specifications, version 1.1, August 2012, (Australian Commission on Safety and Quality in Health Care (ACSQHC). Note: These specifications are Preliminary only and subject to change by ACSQHC. Version number 1.2 Approval date 20140423 (Noted by PRGC)

EQ8.b: In Hospital mortality rates for stroke

Reported Data Description Items

Identifier (office use only) Name In-hospital mortality of patients admitted for heart stroke Aliases Definition In-hospital deaths of patients admitted for stroke Related Metadata Guide for Use: Hospital mortality indicators should be used as screening tools, rather than being assumed to be definitively diagnostic of poor quality and/or safety. This indicator is intended to signal that a problem may exist and that further detailed investigation is required. High outlier rates should be seen as a prompt to further investigation. Learnings may be applied from low outlier rates. Limitations Value only reliable and released for reporting for hospitals with 30 or more separations per year.

Reported Data Validation Items

Format 6 Numeric NNN.NN Data Values Inclusions Inclusions for denominator Age at date of admission: 18-89 years of age. Episode of care-principal diagnosis, code: ICD-10-AM 7th Edition codes Any code from category: I61 Intracerebral haemorrhage I62 Other nontraumatic intracranial haemorrhage I63 Cerebral infarction I64 Stroke, not specified as haemorrhage or infarction) Hospital service-care type, code: acute care Episode of admitted patient care— Length of stay (LOS, including leave days) is between 1 and 30 days, inclusive (1 ≤ LOS ≤ 30).

Exclusions Exclusions for denominator

Episode of admitted patient care–procedure code : Intervention ACHI 7th Edition codes Carotid endarterectomy 33500-00 [700] Resection of carotid artery with 32703-00 [718] reanastomosis

Scope Public Hospitals (metropolitan and rural) Joondalup Health Campus, publically funded activity Peel Health Campus, publically funded activity Formula: Risk adjustment

Risk adjustment should be performed using a logistic regression model. The response variable will be whether a patient died or survived during the hospital stay, and the predictor variables include those listed under the risk adjustment. There are no interaction terms specified in the risk adjustment model. Variables for risk adjustment: Age group (5 year categories) (at date of admission) Episode of care-additional diagnosis, code:

Additional diagnoses ICD-10-AM 7th Edition codes Kidney (renal) failure Any code from categories: N17 Acute kidney failure N19 Unspecified kidney failure Individual codes: N18.3 Chronic kidney disease, stage 3 N18.4 Chronic kidney disease, stage 4 N18.5 Chronic kidney disease, stage 5 N18.9 Chronic kidney disease, unspecified R34 Anuria and oliguria Heart failure Any code from category: I50 Heart failure Individual codes: I11.0 Hypertensive heart disease with (congestive) heart failure I13.0 Hypertensive heart and kidney disease with (congestive) heart failure I13.2 Hypertensive heart and kidney disease with both (congestive) heart failure and kidney failure Malignancy Any code in the following range: (see also Appendix 2) Malignant neoplasms (C00- C96), except category: C44 Other malignant neoplasms of skin Note: Symbols

† dagger (aetiology) – this symbol immediately following a code denotes that the code describes the underlying cause or aetiology of a disease. It is known as a ‘dagger’ code and is usually paired with an ‘asterisk’ code.

Risk adjusted in-hospital mortality rate of the condition for hospital

h n H n h Y h Y ˆ i1 h,i h1 i1 h,i = Rh  n  , where pˆ h,i are from the logistic model. h pˆ n i1 h,i

X100

where the national crude rate = national total number of deaths  national total number of patients Units Rate per 100 separations Numerator Observed number of in-hospital deaths for patients meeting the inclusion and exclusion rules for the denominator; and Episode of admitted patient care-separation mode: died. Denominator Expected number of deaths for patients meeting the inclusion and exclusion rules for the denominator Confidence 95% Confidence Intervals intervals =  Rˆ 1.96 vaˆr(Rˆ ) 100  h h  H n 2  h Y  h1 i1 h,i nh where vaˆr(Rˆ )    pˆ (1 pˆ ) h n i1 h,i h,i  n h pˆ   i1 h,i  Verification Value is greater than or equal to zero and less than or equal to 100. Rules Data Collection Identification Items Source WA Hospital Morbidity Data System (HMDS) National Hospital Morbidity Database (NHMD) Governance Items Purpose of the ABF/ABM Performance Management Reports. data Source of the National core hospital-based outcome indicators of safety and quality: definition Draft Specifications, version 1.1, August 2012, (Australian Commission on Safety and Quality in Health Care (ACSQHC). Note: These specifications are Preliminary only and subject to change by ACSQHC. Version number 1.2 Approval date 20140423 (Noted by PRGC)

EQ8.c: In Hospital mortality rates for fractured neck of femur

Reported Data Description Items Identifier (office use only) Name In-hospital mortality of patients admitted for fractured neck of femur Aliases Definition In-hospital deaths of patients admitted for fractured neck of femur operative intervention Related Metadata Guide for Use: Hospital mortality indicators should be used as screening tools, rather than being assumed to be definitively diagnostic of poor quality and/or safety. This indicator is intended to signal that a problem may exist and that further detailed investigation is required. High outlier rates should be seen as a prompt to further investigation. Learnings may be applied from low outlier rates. Limitations Value only reliable and released for reporting for hospitals with 30 or more separations per year.

Reported Data Validation Items

Format 6 Numeric NNN.NN Data Values Inclusions Inclusions for denominator Age at date of admission: 50-120 years of age Episode of care-principal diagnosis, code: ICD-10-AM 7th Edition codes Any code from category: S72.0 Fracture of neck of femur Individual codes: S72.10 Fracture of trochanteric section of femur, unspecified S72.11 Fracture of intertrochanteric section of femur and at least one of the following Episode of admitted patient care- procedure, code: Intervention ACHI 7th Edition codes Internal fixation of fracture of 47519-00 [1479] trochanteric or subcapital femur Hemiarthroplasty of femur 47522-00 [1489] Open reduction of fracture of 47528-01 [1486] femur with internal fixation Closed reduction of fracture of 47531-00 [1486] femur with internal fixation Partial arthroplasty of hip 49315-00 [1489]

Injury event—external cause, code: External cause ICD-10-AM 7th Edition codes Falls Any codes from code range:

Falls (W00-W19) OR secondary diagnosis code2 of Tendency to fall not elsewhere classified (R29.6).

Episode of admitted patient care—Length of stay (LOS, including leave days) is between 1 and 30 days, inclusive (1 ≤ LOS ≤ 30).

Exclusions Exclusions for denominator If not in the inclusion. Scope Public Hospitals (metropolitan and rural) Joondalup Health Campus, publically funded activity Peel Health Campus, publically funded activity Formula: Risk adjustment Risk adjustment should be performed using a logistic regression model. The response variable will be whether a patient died or survived during the hospital stay, and the predictor variables include those listed under the risk adjustment. There are no interaction terms specified in the risk adjustment model.

Variables for risk adjustment: Age group (5 year categories) (at date of admission) Sex Episode of care-additional diagnosis, code:

2 ICD-10-AM 7th edition.

Additional diagnoses ICD-10-AM 7th Edition codes Ischaemic heart disease Any code from code range: Ischaemic heart diseases (I20- I25), except individual code: I25.2 Old myocardial infarction Dysrhythmia Any code from categories: I46 Cardiac arrest I47 Paroxysmal tachycardia I49 Other cardiac arrhythmias Individual code: I48 Atrial fibrillation and flutter Acute lower respiratory tract Any code in the following infection (LRTI) and influenza ranges: Influenza and pneumonia (J09-J18) Other acute LRTIs (J20-J22) Kidney (renal) failure Any code from categories: N17 Acute kidney failure N19 Unspecified kidney failure Individual codes: N18.3 Chronic kidney disease, stage 3 N18.4 Chronic kidney disease, stage 4 N18.5 Chronic kidney disease, stage 5 N18.9 Chronic kidney disease, unspecified R34 Anuria and oliguria Heart failure Any code from category: I50 Heart failure Individual codes: I11.0 Hypertensive heart disease with (congestive) heart failure I13.0 Hypertensive heart and kidney disease with (congestive) heart failure I13.2 Hypertensive heart and kidney disease with both (congestive) heart failure and kidney failure Note: Symbols

Risk adjusted in-hospital mortality rate of the condition for hospital h

n H n h Y h Y ˆ i1 h,i h1 i1 h,i = Rh  n  , where pˆ h,i are from the logistic h pˆ n i1 h,i model.

X100

where the risk adjustment factor = observed number of in- hospital deaths in a specified hospital meeting the inclusion and exclusion rules for the denominator  expected number of deaths in a specified hospital

Data Collection Identification Items Source WA Hospital Morbidity Data System (HMDS) National Hospital Morbidity Database (NHMD) Governance Items Purpose of the data ABF/ABM Performance Management Reports. Source of the definition National core hospital -based outcome indicators of safety and quality: Draft Specifications, version 1.1, August 2012, (Australian Commission on Safety and Quality in Health Care (ACSQHC). Note: These specifications are Preliminary only and subject to change by ACSQHC. Version number 1.2 Approval date 20140423 (Noted by PRGC)

EQ8.d: In Hospital mortality rates for pneumonia

Reported Data Description Items Identifier (office use only)

Name In-hospital mortality of patients admitted for pneumonia Aliases

Definition In-hospital deaths of patients admitted for pneumonia Related Metadata

Guide for Use: Hospital mortality indicators should be used as screening tools, rather than being assumed to be definitively diagnostic of poor quality and/or safety. This indicator is intended to signal that a problem may exist and that further detailed investigation is required. High outlier rates should be seen as a prompt to further investigation. Learnings may be applied from low outlier rates. Limitations Value only reliable and released for reporting for hospitals with 30 or more separations per year.

Reported Data Validation Items Format 6 Numeric NNN.NN Data Values Inclusions Inclusions for denominator Age at date of admission: 18-89 years of age. Episode of care-principal diagnosis, code: ICD-10-AM 7th Edition codes Any code from category: J13 Pneumonia due to Streptococcus pneumoniae J14 Pneumonia due to Haemophilus influenzae); J15 Bacterial pneumonia; not elsewhere classified J16 Pneumonia due to other infectious organisms; not elsewhere classified J18 Pneumonia, organism unspecified Hospital service-care type, code: acute care Episode of admitted patient care—length of stay (including leave days): 1 to 30 days Exclusions Exclusions for denominator If not in the inclusion.

Scope Public Hospitals (metropolitan and rural) Joondalup Health Campus, publically funded activity Peel Health Campus, publically funded activity

Formula: Risk adjustment Risk adjustment should be performed using a logistic regression model. The response variable will be whether a patient died or survived during the hospital stay, and the predictor variables include

those listed under the risk adjustment. There are no interaction terms specified in the risk adjustment model.

Variables for risk adjustment: Age group (5 year categories) (at date of admission) Episode of care-additional diagnosis, code: Additional diagnoses ICD-10-AM 6th Edition codes Dementia Any code from categories: F00 Dementia in Alzheimer's disease (G30.-†) F01 Vascular dementia F02* Dementia in other diseases classified elsewhere F03 Unspecified dementia Alzheimer’s disease Any code from categories: G30 Alzheimer’s disease Individual codes: G31.0 Circumscribed brain atrophy G31.1 Senile degeneration of brain, NEC Hypotension Any code from category: I95 Hypotension Shock Any code from category: R57 Shock Individual codes: A48.3 Toxic shock syndrome

Kidney (renal) failure Any code from categories: N17 Acute kidney failure N19 Unspecified kidney failure Individual codes: N18.3 Chronic kidney disease, stage 3 N18.4 Chronic kidney disease, stage 4 N18.5 Chronic kidney disease, stage 5 N18.9 Chronic kidney disease, unspecified R34 Anuria and oliguria Other chronic obstructive Any code from the following pulmonary disease categories: J43 Emphysema J44 Other chronic obstructive pulmonary disease J47 Bronchiectasis Heart failure Any code from category: I50 Heart failure Individual codes: I11.0 Hypertensive heart disease with (congestive) heart failure I13.0 Hypertensive heart and

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kidney disease with (congestive) heart failure I13.2 Hypertensive heart and kidney disease with both (congestive) heart failure and kidney failure Dysrhythmia Any code from categories: I46 Cardiac arrest I47 Paroxysmal tachycardia I49 Other cardiac arrhythmias Individual code: I48 Atrial fibrillation and flutter Malignancy Any code in the following range: Malignant neoplasms (C00- C96), except category: C44 Other malignant neoplasms of skin Liver disease Any code from range: Diseases of liver (K70-K77) Cerebrovascular disease Any code in the following range: Cerebrovascular diseases (I60-I69) Parkinson’s disease Individual code: G20 Parkinson’s disease Note: Symbols † dagger (aetiology) – this symbol immediately following a code denotes that the code describes the underlying cause or aetiology of a disease. It is known as a ‘dagger’ code and is usually paired with an ‘asterisk’ code. * asterisk (manifestation) – this symbol immediately following a code denotes that the code describes the manifestation of the disease. It is known as an ‘asterisk’ code, and must always be paired and sequenced after the ‘aetiology’ code.

Risk adjusted in-hospital mortality rate of the condition for hospital h

n H n h Y h Y ˆ i1 h,i h1 i1 h,i = Rh  n  , where pˆ h,i are from the logistic h pˆ n i1 h,i model.

X100

where the risk adjustment factor = observed number of in-hospital

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deaths in a specified hospital meeting the inclusion and exclusion rules for the denominator  expected number of deaths in a specified hospital

=  Rˆ 1.96 vaˆr(Rˆ ) 100  h h  H n 2  h Y  h1 i1 h,i nh where vaˆr(Rˆ )    pˆ (1 pˆ ) h n i1 h,i h,i  n h pˆ   i1 h,i  Verification Rules Value is greater than or equal to zero and less than or equal to 100.

Data Collection Identification Items Source WA Hospital Morbidity Data System (HMDS) National Hospital Morbidity Database (NHMD)

Governance Items Purpose of the data ABF/ABM Performance Management Reports. Source of the National core hospital-based outcome indicators of safety and definition quality: Draft Specifications, version 1.1, August 2012, (Australian Commission on Safety and Quality in Health Care (ACSQHC). Note: These specifications are Preliminary only and subject to change by ACSQHC. Version number 1.2 Approval date 20140423 (Noted by PRGC)

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EQ10: Rate of total hospital readmissions within 28 days to an acute designated mental health inpatient unit

Reported Data Description Items Identifier (office use only)

Name Rate of total hospital readmissions within 28 days to an acute designated mental health inpatient unit Aliases 28 day readmission rate Definition Proportion of in-scope overnight public patient separations from the mental health service organisations’ acute psychiatric inpatient units, that are followed by readmission to the same or to another designated acute psychiatric inpatient unit within 28 days of discharge. Same day separations, which are excluded, are defined as inpatient episodes where the admission and separation dates are the same. An acute psychiatric inpatient unit is defined as services that provide voluntary and involuntary short-term inpatient management and treatment during an acute phase of mental illness, until the person has recovered enough to be treated effectively and safely in the community. International literature identifies the concept of one month as an appropriate defined time period for the measurement of unplanned readmissions following separation from an acute inpatient mental health service. Based on this the target of 28 days for this indicator has been set and endorsed by the AHMAC Mental Health Standing Committee (as at 24 March 2011). Related Rate of community follow up within first 7 days of discharge from Metadata psychiatric admission. Guide for Use: Mental health inpatient services aim to provide treatment that enables individuals to return to the community as soon as possible. Readmissions to a psychiatric facility following a recent discharge may indicate that inpatient treatment was either incomplete or ineffective, or that follow-up care was inadequate to maintain the person out of hospital Also, avoidable rapid readmission rates place pressure on finite beds. This indicator is reported at the facility at which the initial admission occurred rather than the facility at which the patient was readmitted. This indicator is reported at a facility level and is based on the location of the acute psychiatric inpatient unit (e.g., as Boronia Lodge is located at Swan Districts hospital, any readmissions from Boronia Lodge will be reported under Swan Districts hospital). The target for this indicator is 12%. This is based on the Fourth National Mental Health Plan (May 2011)

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http://www.health.gov.au/internet/mhsc/publishing.nsf/Content/pub-plan4- meas Limitations Due to the limitations of the data, planned and unplanned readmissions cannot be differentiated. This reporting definition relies on coded data from HMDS. By its nature, this indicator also requires at least 28 days to elapse from the date of separation prior to being able to report. To overcome these limitations, a lag is included in the reporting of data. Figures reported for recent months may not be complete due to delays in data coding and quality checking. It is recommended that this indicator is reported on a quarterly basis with a 6 month lag in the reference period for the data. Reported Data Validation Items Format Percentage 4 NN.N% Data Values Inclusions All public patient separations from designated mental health acute inpatient units within WA. All readmissions occurring within the specified readmission interval are counted. There can be multiple readmissions associated with an index separation. Exclusions The following separations are excluded:  Same day separations and subsequent readmissions.  Statistical and change of care type separations.  Separations that end by transfer to another acute or psychiatric hospital.  Separations that end by death, left against medical advice/discharge at own risk.

Scope All acute mental health wards at WA designated psychiatric mental health facilities (as listed below).

Acute mental health units Excludes the following non- at the following facilities: acute/rehabilitation units Albany Hospital Armadale Hospital Karri Ward Bentley Hospital John Milne Centre Broome Hospital Bunbury Hospital

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Fremantle Hospital Graylands Hospital Ellis, Plaistowe, Casson, Red Wing, Murchison and Plaistowe Forensic Hutchison excluded from 9 January 2014 Joondalup Health Campus Kalgoorlie hospital King Edward Memorial Hospital

Osborne Park Hospital Princess Margaret Hospital Rockingham Hospital Royal Perth Hospital Sir Charles Gairdner Hospital Swan Districts Hospital

For a particular report, please refer to that report’s scoping to determine which sites are included. Formula Numerator: Number of in-scope overnight public separations from designated acute mental health inpatient unit(s) occurring within the reference period, that are followed by a readmission to the same or other acute designated mental health inpatient unit within 28 days. Denominator: Number of in-scope overnight public separations from acute designated mental health inpatient unit(s) occurring within the reference period. Calculation (Numerator ÷ Denominator) x 100, expressed as a percentage.

Verification Rules Value =< 100% Data Collection Identification Items Source Hospital Morbidity Data System (HMDS) Governance Items Purpose of the To monitor readmissions within a short time frame that may flag data deficiencies in inpatient treatment and/or follow-up care.

Source of the Manager Mental Health Information System.

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definition AHMAC National Mental Health Performance subcommittee. Version number 1.2 Approval date 20140423 (Noted by PRGC)

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2.4 Efficiency Inputs per output unit (EI) KPIs

There are 11 EI PIs proposed in the 2014-15 PMF, including 4 outcome measures.

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EI1.a: Volume of activity weighted year to date: inpatients (variance from target)

Reported Data Element Definition Reported Data Description Items Identifier Name Percentage Variance from Target - Total Estimated Weighted Inpatient Activity (including LSMH) Aliases Volume of inpatient activity Percentage inpatient activity to target Definition The percentage variance (difference) between Total Estimated Weighted Inpatient Activity (including LSMH) and the Weighted Inpatient Activity Target (including LSMH). LSMH (Long Stay Admitted Mental Health) is activity at Graylands Selby-Lemnos measured in beddays and converted to nWAUs. Related Total Estimated Unweighted Inpatient Activity Metadata Total Estimated Weighted Inpatient Activity Percentage Variance from Target – Weighted Emergency Department Attendances Percentage Variance from Target – Weighted Outpatient Occasions of Service Unweighted Long Stay Admitted Mental Health Beddays Guide for Use Percentage Variance from Target – Total Estimated Weighted Inpatient Activity is the ({Total Estimated Weighted Inpatient Activity (inc. LSMH)} less the {Total Weighted Inpatient Activity Target (inc. LSMH)}), divided by the {Total Weighted Inpatient Activity Target (inc. LSMH)}, expressed as a percentage. Total Estimated Weighted Inpatient Activity (inc. LSMH) is the product of the {Total Estimated Unweighted Inpatient Activity} and corresponding cost weights (nWAUs or ‘Specialty on Admission’ weights) plus the product of [Unweighted Long Stay Admitted Mental Health Beddays] and the per diem nWAU cost weight. Total Estimated Unweighted Inpatient Activity is counted from HMDS extracts (coded data) and TOPAS, HCARe, JHC and PHC discharge extracts (uncoded data) using the [Client Status] or [Patient Type], [Separation Date], [Account Number], and [Establishment Code] fields. Graylands Selby-Lemnos activity, referred to as Long Stay Admitted Mental Health (or LSMH) is based on bedday data from BedState, using the [Data date] and [Occupied Beds] fields. The counts include publicly funded activity at Peel and Joondalup Health Campuses. Historical data are updated in each extract. Note: Difference from National Operating Model This definition reflects the West Australian Department of Health (DoH)

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methodology used in the Service Level Agreements (SLAs) between the DoH and the health services. This methodology incorporates the national methodology where available; however, the scope of included activity which is subject to ABF is wider in the WA SLAs than what is currently required at the national level. Specifically, the WA inpatient indicator includes sub-acute care, long stay mental health (Graylands Selby- Lemnos), and non-acute care, which are not subject to ABF nationally. The national model also restricts which separations are included based on funding source, specifically only including public and private patients with a funding source of Australian Health Care Agreements, Private Health Insurance, Self Funded and Reciprocal Health Care Agreements. The WA model does not have this restriction. The national model only reports on coded activity; the WA model uses an estimation methodology to account for the delays in coding (see following section). As at publication, WA is awaiting detailed documentation of the final national model (currently in draft) from the Independent Hospitals Pricing Authority (IHPA); should any national rules change, this definition may be updated accordingly. Total Estimated Weighted Inpatient activity (separation based data) The coded information takes precedence for inclusion in the count, and uncoded information is used to complete the count due to the delay in available coded data. This method of counting unweighted separations allows for a timely estimate of unweighted activity. This methodology also excludes TOPAS and HCARe records, and JHC and PHC discharge records where the record has been deleted, replaced or removed from the Hospital Morbidity Data System, to avoid over counting. As the {Total Estimated Unweighted Inpatient Activity} count uses both coded (HMDS) and uncoded (discharge extracts) data, different weighting methodologies are applied to the unweighted records, depending on the source. For coded data (i.e., from HMDS) the records are multiplied by their corresponding national Weighted Activity Unit (nWAU). The nWAU is determined by the DRG v6.0x, nights of stay, ICU days, indigenous status of the patient, remoteness of the hospital, whether the DRG meets the criteria for a sameday DRG, whether the episode of care occurs at a paediatric hospital and if the patient is within the paediatric age group.. The definition of an ICU is restricted based on the College of Intensive Care Medicine Australia and New Zealand level 3 definition of an ICU. For WA, these are the ICUs at Fremantle, Royal Perth, Sir Charles Gairdner and Princess Margaret. National and local documentation will be available on the http://activity intranet site which will provide more detail regarding the calculation of nWAUs. The uncoded records are multiplied by ‘Specialty on Admission’ cost weights. The cost weight is determined by the [Specialty of Clinician on Admission], {Nights of stay}, indigenous status of the patient and remoteness of the hospital. There are separate ‘Specialty on Admission’ cost weight schedules for each {Hospital Type} (i.e., tertiary, non-tertiary, regional, integrated district health service, and paediatric). The schedules are produced by the Business and Financial Modelling Directorate, PAQ.

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Contracted dialysis is included in the model (e.g., dialysis activity contracted by the hospitals to non-government organisations, Sir Charles Gairdner contract to Joondalup Health Campus). Under current local and national definitions for admitted patients, the following patient types are considered non-admitted patients – Ambulatory Surgery Initiative (ASI), Organ Procurement, Boarders, Cancelled Elective Surgery, Aged Care & and Flexible Care Residents. Apart from ASI patient types, the other above listed patient types are excluded from the WA ABF model in 2012/13. Note that Cancelled Elective Surgery is identified using the [Principal Diagnosis] field, and therefore can only be identified in coded data. Unqualified newborns are also excluded from the local ABF model as the costs are attributed to the mother’s episode of care. Although the exclusions are excluded from reporting, they are first identified in the data set and labelled within the {Ctyp12} field. The {Ctyp12} field contains values that identify the episode of care type or ‘sub-group’ defined for ABF inpatient activity in 2012/13 . {Ctyp12} contains the following subgroups (asterisked groups are excluded from reporting): Boarders*, Unqualified Newborns*, Organ Procurement*, Flexible Care Residents*, Cancelled Elective Surgery*, Aged Care*, Area Mental Health Service (AMHS), Sub Acute (Rehab, Palliative, Geriatric Evaluation and Management, Psychogeriatric cases not captured in the AMHS grouping), Non Acute (Maintenance), Acute Inpatients. Total Estimated Weighted Inpatient Activity therefore includes the remaining subgroups, and is reported in total. The subgroups are defined in this document for reference. Activity is counted at the funding hospital; therefore, activity conducted by a hospital that has been funded by another is not counted (i.e., contracted hospital separations are excluded). Activity being funded by Statewide Contracting Services is not included (e.g., renal and palliative care at Bunbury and Broome). Long Stay Admitted Mental Health (Graylands Selby Lemnos bedday based data) Graylands Selby-Lemnos is included here, despite its exclusion from {Total Estimated Unweighted Inpatient Activity}. This is because the bedday count can be converted to nWAUs using a per diem weight. Activity at Graylands Selby-Lemnos is reported using beddays from BedState, and includes Graylands Hospital, Selby Lodge and Frankland Centre. Therefore, while the unweighted bedday counts should not be summed with the unweighted separations counts, the weighted beddays equate to weighted separations and can be summed. Monthly Activity Targets The full year {Total Weighted Inpatient Activity Target} is set in the Service Level Agreements between the Department of Health and the Health Services. The default monthly {Total Weighted Inpatient Activity Target} is calculated by the Business and Financial Modelling Directorate,

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PAQ. The default target calculation looks at the proportion of activity attributed to each calendar month over the prior three financial years, and applies these proportions to the full year {Total Weighted Inpatient Activity Target}. For metro hospitals, this calculation is applied at the hospital x Ctyp12 level, and for Country hospitals, this calculation is applied at the region x Ctyp12 level. Note that the Health Services will have an opportunity to advise the Business and Financial Modelling Directorate of revised monthly targets that vary from the default monthly activity target; the Health Service monthly targets will override the default targets. The health service revision will only occur once, at the start of the financial year. It is expected that a standard methodology will be followed with an adjustment for area or hospital specific events that are known for the current year. All inclusions and exclusions applicable to the {Total Estimated Weighted Inpatient Activity} count apply to the {Total Weighted Inpatient Activity Target}. No routine updates are made to the targets. However, if the full year targets are revised in the Service Level Agreements (e.g., due to Minister for Health decision, additional funding available, budget transfer authorisations (BTAs) which impact activity), the monthly targets will be adjusted as required. Note regarding JHC and PHC targets The JHC and PHC targets are based on their respective contracts with WA Health, which are converted to nWAUs for the purposes of reporting against the WA ABF/M framework. This information is provided for comparative purposes only and is not the mechanism by which the activity values in the respective contract will be monitored against. The information is provided specifically to enable an overall view of the health system using a consistent counting approach. If you have any further questions on this process please contact the Business and Financial Modelling Directorate, PAQ. The full year target is seasonalised to monthly targets using the same default methodology used for public hospitals, which is described above. Limitations Total Estimated Unweighted Inpatient activity (separation based data) Figures reported for recent months have a higher proportion of uncoded information than earlier months, due to the delays in data coding and edit. Whilst an analysis across prior year information has been undertaken to understand any variability between the actual weights and the estimated weights across all patient episodes, the order of coding could potentially skew early results; simpler cases are likely to be coded before more complex cases, which may cause variability in estimates for weighted activity for recent months. The impact of order of coding diminishes as time goes on and more cases are coded. For final counts, complete HMDS data should be used. Reported Data Validation Items Format Numeric 6 NNNN.N% Data Values

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Inclusions For JHC and PHC records only Include only public patients HMDS [Payment Classification] = Australian Health Care Agreements 21 Correctional Facility 29 Reciprocal Health Care Agreement 30

Exclusions For Metropolitan and Country hospitals – separation based data (excluding Graylands Selby-Lemnos)

The following records are excluded from the HMDS extract: Cases with a record status: D (Deleted), E (Data Entry), I (In Progress), M (Modify), N (New), P (Pending), R (Replaced), V (Removed) or X (Error). The following records are excluded from the HCARe discharge extract: . [Flag] = C (these are reversed or cancelled cases). Exclude duplicate records from within each TOPAS, HCARe and HMDS extract: Duplicate records = [Establishment Code] and [Account Number] are identical within the HMDS, TOPAS and HCARe data sets.

For TOPAS and HCARe records: Exclude uncoded (TOPAS/HCARe) record where coded (HMDS) record has the same values for the following fields: . [Establishment Code] . [Account Number] Exclude uncoded (TOPAS/HCARe) record where the coded record in the HMDS Deleted, Replaced or Removed (DRV) extract* has the same values for the following fields: . [Establishment Code] . [Account Number] *The HMDS DRV extract is an extract of coded records with a [Record Status] of D (Deleted), R (Replaced) or V (Removed), where a matching record with a [Record Status] of C (Clean) does not exist in HMDS (records are matched using [Establishment Code] and [Account Number]).

For HMDS, TOPAS and HCARe records: Exclude contracted services TOPAS HCARe HMDS [Client Status] or [Patient type] =

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Contracted Service 5 C 5

The following patient subgroup exclusions are identified in the dataset sequentially, using an if-then-else criteria, then excluded based on the values attributed to each exclusion within {Ctyp12}: Source system value Group to {Ctyp12} Sub-group excluded: TOPAS HCARe HMDS as: 1. Boarders - Care Type/Episode of 10.0 O 28 Care = or BR - Client Status/Patient 3 B 3 Type = 2. Unqualified Newborns - Client Status/Patient 2 U 2 UnqNB Type = 3. Organ Procurement - Care Type/Episode of 9.0 OP 27 OP Care = 4. Flexible Care Residents - Care Type/Episode of N/A F 31 Care = H FCR C 5. Aged Care N/A AG 30 ACR 6. Cancelled Elective Surgery - first three characters of N/A N/A Z53 CES [Principal Diagnosis] =

For Graylands Selby-Lemnos – bedday based data (BedState)

Include activity at Graylands Selby-Lemnos and Frankland Centre Inclusions BedState [Hosp] = Graylands GH Exclusions Nil exclusions Scope This indicator can be calculated for all public hospitals (metropolitan and rural) and public activity at Joondalup and Peel Health Campuses, excluding:

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. Country Small Hospitals . Next Step Drug and Alcohol services, East Perth . Nursing posts and other non-hospital establishments For a particular report, please refer to that report’s scoping to determine which sites are included. Formula

{Total Estimated Weighted Inpatient Activity} For Metropolitan and Country hospitals – separation based data (excluding Graylands Selby-Lemnos and Country Small Hospitals) HMDS records Sum of (Count of the number of records where [Separation Date] has a value that is within/equal to the reference period (i.e., calendar month). Minus cases with a record status of D, E, I, M, N, P, R, V, X. Minus cases where [Establishment Code] and [Account Number] are identical

within the data set. Minus [Client Status] = 5. Minus {Ctyp12} = BR, UnqNB, OP, FCR, ACR or CES) multiplied by the corresponding nWAU. And for JHC and PHC only: And where [Payment Classification] = (21, 29, or 30). Further documentation explaining the calculation of an nWAU is available at http://activity. TOPAS, Sum of (Count of the number of records where [Separation Date] has a HCARe, JHC & value that is within/equal to the reference period (i.e., calendar month). PHC discharge Minus HCARe records where [Flag] = C.. Minus TOPAS & HCARe records records where [Establishment Code] and [Account Number] = records in HMDS or HMDS DRV extract. Minus records where [Establishment Code] and [Account Number] are identical within the data sets. Minus [Client Status] = 5. Minus {Ctyp12} = BR, UnqNB, OP, ACR or FCR) multiplied by the corresponding Specialty Weight.

And for JHC and PHC only: And where [Payment Classification] = (21, 29, or 30).

To calculate a ‘Specialty on Admission’ weight for an episode: Where, Ot is the one-time weight MTpd is the multi-time per diem weight NOS are equal to the nights of stay where a same day episode receives a score of 0 (NOS = [Separation Date] minus [Admission Date] minus [Leave days]) Ind is the indigenous status loading Rem is the remoteness loading ‘Specialty on Admission’ weight = (Ot + (NOS × MTpd)) × (1 + Ind + Rem) Refer to the ‘Specialty on Admission’ cost weight schedule, produced by the Business and Financial Modelling Directorate, PAQ.

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For Graylands Selby-Lemnos – bedday based data

BedState Sum of [Occ] where [Date] has a value that is within/equal to the start and end date of the reference period (i.e., Calendar Month) multiplied by the per diem nWAU. Calculation Sum of formula results for HMDS records and TOPAS & HCARe records and BedState = {Total Estimated Weighted Inpatient Activity}. Default Monthly {Total Weighted Inpatient Activity Target}

Terms 푚 = the {Total Estimated Weighted Inpatient Activity} for the calendar month, 푚푗푢푙, 푚푎푢푔, 푚푠푒푝 … 푚푗푢푛.

푓 = the {Total Estimated Weighted Inpatient Activity} for the financial

year, 푓1, 푓2, 푓3 … 푓푥 where 푓1 is the most recent full financial year, 푓2 is the year before the most recent full financial year, etc.

Therefore, 푚푗푢푙1 is July in the most recent full financial year, 푚푗푢푙2 is in the year before the most recent full financial year, etc.

푡푓 = full financial year target for that hospital (as set in the Service Level Agreements between the Health Services and the Department of Health)

푡푚 = monthly activity target for the calendar month, 푡푚푗푢푙 , 푡푚푎푢푔 … 푡푚푗푢푛

Calculation Metro hospitals: The following calculation steps 1 to 3 are completed at the {Ctyp12} level for each hospital except Graylands Selby-Lemnos, which is calculated at the hospital level only. In step 4, the percentages calculated at step 3 are

applied to the full year target (푡푓) for each {Ctyp12} category for each

hospital, as per the SLA. The monthly target results (푡푚) by {Ctyp12} can be summed to hospital, health service and statewide as required. {Ctyp12} groups are defined in this document.

Country hospitals: The following calculation steps 1 to 3 are completed at the {Ctyp12} level for each region. In step 4, the percentages calculated at step 3 are

applied to the full year target (푡푓) for each {Ctyp12} category for each

hospital, as per the SLA. The monthly target results (푡푚) by {Ctyp12} can be summed to hospital, health service and statewide as required. {Ctyp12} groups are defined in this document.

Note: Where the range of the monthly proportion percentages (푝푚) is greater than 10% (i.e., max 푝푚 − min 푝푚 > 10%) for a given {Ctyp12}, then replace the monthly percentages for that {Ctyp12} category for that hospital or region with the percentages for the {Ctyp12} category of Acute Inpatients (AC_IP). This is to avoid volatile monthly percentages where the amount of activity attributed to each month varies considerably and

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would not be considered reliable as an indication of monthly activity levels.

To calculate 푡푚 for each month (example given is for July):

1. Calculate ∑ 푚, the sum of {Total Estimated Weighted Inpatient Activity} for the relevant calendar month for the prior three full financial years

i.e., 푚푗푢푙1 + 푚푗푢푙2 + 푚푗푢푙3 = ∑ 푚푗푢푙

2. Calculate ∑ 푓, the sum of {Total Estimated Weighted Inpatient Activity} for the prior three full financial years

i.e., 푓1 + 푓2 + 푓3 = ∑ 푓

3. Using the month and year sums, calculate 푝푚 , the proportion of activity each calendar month contributes to the full financial year, as a percentage

∑ 푚 i.e., 푗푢푙 × 100 = 푝 ∑ 푓 푚푗푢푙

4. To calculate 푡푚 , the activity target for a given month, multiply the proportion for that calendar month with the full financial year target

i.e., 푝푚푗푢푙 × 푡푓 = 푡푚푗푢푙

The above default calculation applies unless the Health Services advise the Business and Financial Modelling Directorate, PAQ of revised targets. Percentage Variance from Target - Total Estimated Weighted Inpatient Activity Calculation ({Total Estimated Weighted Inpatient Activity inc. LSMH} for the reference period (e.g., calendar month) minus {Total Weighted Inpatient Activity Target (inc. LSMH)} for the reference period (e.g., calendar month)), divided by {Total Weighted Inpatient Activity Target (inc. LSMH)} for the reference period (e.g., calendar month), expressed as a percentage. Verification Where {Total Estimated Weighted Inpatient Activity (inc. LSMH)} > {Total Rules Weighted Inpatient Activity Target (inc. LSMH)}, the percentage variance is positive (+). Where {Total Estimated Weighted Inpatient Activity (inc. LSMH)} < {Total Weighted Inpatient Activity Target (inc. LSMH)}, the percentage variance is negative (-).

Additional information – How to calculate included inpatient subgroups for {Ctyp12} – separation based data Records need to be flagged as Area Mental Health Service within the created field {AMHS} as follows:

Hospital Establishment Number Wards {AMHS} & Name flag

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- 105 (Sir Charles Gairdner) D20, PYWD Y - 244 (Swan District) MHSW, MHLS, MHLW, Y MHWW, SVCO, SVCS - 239 (Osborne Park) OL Y - 104 (King Edward Memorial) MBU Y - 156 (Boronia Inpatient Unit) All wards Y - 255 (Bentley) W8, W7, W6, W5, JMC, 10A, 10B, 10C, FWP, CRU, W10A, W10B, Y W10C, 1309, ECTD, W6W7 - 102 (Fremantle) W41, W42, W51, W43, W4SW, MOSS, D5W, Y ECT - 203 (Armadale-Kelmscott LOPEN, LHDU, KARRI, Y District Memorial) BANKS, BANKSIA - 2239 (Armadale Mental Health BANKS, KARRI Y for Older People Authorised) - 101 (Royal Perth) 2K, PSYD, EDPP Y - 103 (Princess Margaret) 4H, STUBB Y - 277 (Rockingham General) MHAC, MHAO, MHEC, Y MHEO - 201 (Albany) MENTAL HEALTH Y UNIT, MHU - 208 (Bunbury) MEN, MENTAL Y HEALTH, PICU - 226 (Kalgoorlie) PSYCHIATRIC UNIT Y - 206 (Broome) ACUTE PSYCHIATRIC Y UNIT - All other records N

With records flagged as {AMHS}, the following patient subgroups are identified in the dataset sequentially using an if-then-else criteria, with the values attributed to {Ctyp12} as follows: Group to Field Values {Ctyp12} Sub-group: as: 1. Area Mental Health Service - {AMHS} flag = Y AMHS

2. Sub Acute TOPAS HCARe HMDS - Care Type/Episode of Care = SubAC Rehabilitation 2.0 R 22

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Palliation 3.0 P 23 Psychogeriatric† 5.0 PG 24 Geriatric Evaluation and 4.0 G 29 Management

3. Non-Acute TOPAS HCARe HMDS - Care Type/Episode of Care = NA Maintenance Care 6.0 N 25 4. Acute Inpatients - All other records that are not yet AC_IP grouped

†Note: Most psychogeriatric cases occur in designated mental health wards and will be grouped to the AMHS sub-group. Any cases that do not occur in a designated mental health ward will be grouped to sub-acute.

Data Collection Identification Items Source HMDS Weekly HMDS extracts HMDS Updated weekly, maintained by the Hospital Morbidity Data Collection Deleted, Branch Removed or The monthly file provided to Business & Financial Modelling, PAQ Replaced captures all activity to 2359 on last day of the calendar month extract Weekly file extracted at 0600 hours each Monday for data up to Sunday TOPAS 2359 hours (TOPAS Discharge Extract)

The monthly file provided to Business & Financial Modelling, PAQ captures all activity to 2359 on last day of the calendar month

HCARe Extracted every Monday for data up to Sunday 2359 hours (HCARe Discharge Extract) The monthly file provided to Business & Financial Modelling, PAQ captures all activity to 2359 on last day of the calendar month JHC Weekly discharge extract, provided by JHC (contains 7 days of data) The monthly file provided to Business & Financial Modelling, PAQ captures all activity to 2359 on last day of the calendar month PHC Weekly discharge extract, provided by PHC (contains 7 days of data) The monthly file provided to Business & Financial Modelling, PAQ captures all activity to 2359 on last day of the calendar month BedState Monthly BedState extract, updated first Wednesday of the month PAQ WA 2012/13 ABF/M Operating Model documentation and ‘Specialty on Admission’ cost weight schedule 2012/13. Independent nWAU schedule and methodology Hospitals Pricing Authority

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(IHPA) Service Level Full financial year {Total Weighted Inpatient Activity Target (inc. LSMH)} Agreements Health Services Revised Monthly {Total Weighted Inpatient Activity Target (inc. LSMH)}, as applicable Governance Items Purpose of the Percentage Variance from Target - Total Estimated Weighted Inpatient data Activity (including LSMH) allows a timely assessment of Health Service and hospital performance against the Service Level Agreements. This indicator is reported in the Activity Based Funding / Management Performance Management Report and the WA Health Dashboard Report. Source of the Business and Financial Modelling Directorate, Performance Activity and definition/ Quality Division, DoH WA additional Performance Directorate, Performance Activity and Quality Division, DoH information WA Local and National ABF/M Operating Model documentation, available on http://activity Hospital Morbidity Data System Reference Manual, July 2011 – Section 8: Operational Directives and Program Bulletins Version 1.0 number Approval date 20120813

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EI1.b: Volume of activity weighted year to date ED attendances (variance from target) Reported Data Element Definition Reported Data Description Items Identifier Percentage Variance from Target - Weighted Emergency Name Department (ED) Attendances Volume of ED Attendances Aliases Percentage ED attendances to target Definition The percentage variance (difference) between the weighted ED attendances and the ED attendance target.

Related Metadata Weighted ED Attendances. MDG-04-001 WA Emergency Department Attendances. Guide for Use Percentage Variance from Target - Weighted Emergency Department (ED) Attendances is the ({Weighted ED Attendances} less the {Weighted ED Attendance Target}), divided by the {Weighted ED Attendance Target}, expressed as a percentage. Weighted ED Attendances are the product of the {WA Emergency Department Attendances} and the corresponding national Weighted Activity Unit (nWAU) cost weights. ED Attendances are counted from event records in the Emergency Department Data Collection (EDDC) using [Presentation date and time]. [Presentation date and time] is the earlier of [Arrival date and time] and [triage date and time]. [Presentation date and time] is used rather than [Arrival date and time] or [Triage date and time] to ensure that the attendance is within the desired reference period. Some patients may arrive before midnight and be triaged after midnight. Recording the earlier of the two fields ensures the correct date and time is referenced. An attendance at the emergency department is recorded when a patient is registered in any manner in one of the electronic data collection systems, i.e., includes those cases that may not have been completely clerically registered or triaged. [Presentation date and time] indicates the commencement of an ED attendance. This data element encompasses all ED events regardless of whether treatment was subsequently provided in the ED or the individual was registered for care. ‘Registered for care’ is determined by the allocation of a Unit Medical Record Number (UMRN) or client identifier. For all hospitals except Peel Health Campus (PHC), Urgency Related Groups (URGs) are used to group ED attendances. URGs group ED attendances according to episode end status, triage category and diagnosis. Each URG category has a corresponding nWAU. PHC ED attendances are weighted using Urgency Disposition Groups (UDG) because PHC’s ED patient administration system does not capture diagnosis. The UDG grouper groups attendances based on the patient’s triage category

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and whether or not they were admitted to the hospital they attended. Refer to the documentation on the http://activity intranet site for further details on the URG and UDG methodologies and nWAU schedule. URG and UDG grouper software is produced by the Independent Hospital Pricing Authority (IHPA), and is available for free download from their website http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/ABF- Price-Model-Reference-Classifications-for-2012-13. Please note, WA’s ED model allows for records to be grouped to UDG where insufficient information is available to group to URG (i.e., diagnosis information unavailable). As at publication, WA is awaiting confirmation from the Independent Hospitals Pricing Authority (IHPA) regarding the use of this method nationally, as well as detailed documentation of the final model (currently in draft); should any rules change, this definition may be updated accordingly. Monthly Activity Targets The full year {Weighted ED Attendance Target} is set in the Service Level Agreements between the Department of Health and the Health Services. The default monthly {Weighted ED Attendance Target} is calculated by the Business and Financial Modelling Directorate, PAQ. The default target calculation looks at the proportion of ED activity attributed to each calendar month over the prior three financial years, and applies these proportions to the full year {Weighted ED Attendance Target}. Note that the Health Services will have the opportunity to advise the Business and Financial Modelling Directorate of revised monthly targets that vary from the default monthly activity target; the Health Service monthly targets will override the default targets. The health service revision will occur once at the start of the financial year. It is expected that a standard methodology will be followed with an adjustment for area or hospital specific events that are known for the current year. All inclusions and exclusions applicable to the {Weighted ED Attendances} count apply to the {Weighted ED Attendance Target}. No routine updates are made to the targets. However, if the full year targets are revised in the Service Level Agreements (e.g., due to Minister for Health decision or additional funding available), the monthly targets will be adjusted as required. Limitations

Reported Data Validation Items

Format Numeric 6 NNNN.N% Data Values

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Inclusions Cases are included if the triage has or has not been recorded. Cases are included if the clerical registration is incomplete, i.e., no UMRN allocated. As there are no cases excluded from the attendance count, those who are DOA, DNW, are inpatients, are referred to after hours GP, and who may be direct admissions will be included in the attendance count.

Exclusions Exclude duplicate records within the EDDC extract: Duplicate records = [Establishment Code], [Account Number], [UMRN], [Date of Birth], [Arrival Date] and [Arrival Time] are identical within the EDDC extract. Scope This indicator can be calculated for all public hospitals (metropolitan and rural) with an Emergency Department/Service and public activity at Joondalup and Peel Health Campuses, excluding: . Country Small Hospitals . Nursing posts and other non-hospital establishments For a particular report, please refer to that report’s scoping to determine which sites are included. Formula {Weighted ED Attendances} Count of the number of records where [Presentation date and time] has a value that is within/equal to the start and end date for the reference period (i.e., calendar month) minus records where [Establishment Code], [Account Number], [UMRN], [Date of Birth], [Arrival Date] and [Arrival Time] are identical within the EDDC extract. Multiplied by the corresponding nWAU for each record. Both the URG and UDG grouper group attendances by Episode End Status (also known as disposal code or disposition code) and Triage Category. Group [Episode end status/Disposal Code] for the URG and UDG groupers to new field [EpiEndStat]:

[Episode End Status/Disposal EDDC Group to Code] = Value [EpiEndStat] 1  Admitted to ward/other admitted patient unit 10  Admitted to ED OBS 1 11  Admitted to Hospital in the Home (Admitted) 12  Admit from HATH 14  Returned to HITH 15  Returned to RITH

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2  ED service event completed; departed under own care 13  Nursing Home 2 16  Returned to HATH (Discharged) 17  Transferred from HITH 18  Transferred from RITH 3 3  Transferred to another hospital for admission (Transferred) 4 4  Did not wait to be attended by medical officer (Did not wait) 5 5  Left at own risk (Left at own risk) 6 6  Died in ED (Died in ED) 7 7  Dead on arrival; not treated in ED (DOA) 8 9  Referred A/H GP 9 (Other)  Unknown

Group [Triage Category] for URG and UDG grouper to new field [Triage]:

[Triage Category] EDDC code Group to [Triage] = 1 1  Resuscitation 2 2  Emergency 3 3  Urgent 4 4  Semi-urgent 5 5  Non-urgent All other codes: 6  Dead on arrival 7 9  Direct Admission 8 (other)  Inpatient 9  Not stated

URG nWAUs For records from all hospitals with valid [Triage], [EpiEndStat] and [Diagnosis] (metro) or [Major Diagnostic Category] (country),

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(Urgency Related except PHC: Groups) Apply URG grouper using [Triage], [EpiEndStat] and [Diagnosis] (metro) or [Major Diagnostic Category] (country). URG grouper and documentation is available from http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/ABF- Price-Model-Reference-Classifications-for-2012-13 . The nWAU schedule is available from http://activity. UDG nWAUs For records from PHC and all public hospitals (inc JHC) with a missing or invalid [Diagnosis] (metro) or [Major Diagnostic

Category] (country): Apply UDG grouper using [Triage] and [EpiEndStat]. UDG grouper and documentation is available from http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/ABF- Price-Model-Reference-Classifications-for-2012-13 . The nWAU schedule is available from http://activity.

Default Monthly {Weighted ED Attendance Target}

Terms 푚 = the {Weighted ED Attendances} for the calendar month, 푚푗푢푙, 푚푎푢푔, 푚푠푒푝 … 푚푗푢푛.

푓 = the {Weighted ED Attendances} for the financial year,

푓1, 푓2, 푓3 … 푓푥 where 푓1 is the most recent full financial year, 푓2 is the year before the most recent full financial year, etc.

Therefore, 푚푗푢푙1 is July in the most recent full financial year, 푚푗푢푙2 is in the year before the most recent full financial year, etc.

푡푓 = full financial year target (as set in the Service Level Agreements between the Health Services and the Department of Health)

푡푚 = monthly activity target for the calendar month,

푡푚푗푢푙 , 푡푚푎푢푔 … 푡푚푗푢푛

Calculation Metro hospitals: The following calculation steps 1 to 3 are completed at the hospital level. In step 4, the percentages calculated at step 3 are applied to

the full year target (푡푓) for each hospital, as per the SLA. The

monthly target results (푡푚) can be summed to health service and statewide as required.

Country hospitals: The following calculation steps 1 to 3 are completed at the region (e.g., Goldfields) level. In step 4, the percentages calculated at step

3 are applied to the full year target (푡푓) for each hospital, as per the

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SLA. The monthly target results (푡푚) can be summed to health service and statewide as required.

To calculate 푡푚 for each month (example given is for July):

1. Calculate ∑ 푚, the sum of {Weighted Emergency Department Attendances} for the relevant calendar month for the prior three full financial years

i.e., 푚푗푢푙1 + 푚푗푢푙2 + 푚푗푢푙3 = ∑ 푚푗푢푙

2. Calculate ∑ 푓, the sum of {Weighted Emergency Department Attendances} for the prior three full financial years

i.e., 푓1 + 푓2 + 푓3 = ∑ 푓

3. Using the month and year sums, calculate 푝푚 , the proportion of activity each calendar month contributes to the full financial year

∑ 푚 i.e., 푗푢푙 = 푝 ∑ 푓 푚푗푢푙

4. To calculate 푡푚 , the activity target for a given month, multiply the proportion for that calendar month with the full financial year target

i.e., 푝푚푗푢푙 × 푡푓 = 푡푚푗푢푙

The above default calculation applies unless the Health Services advise the Business and Financial Modelling Directorate, PAQ of revised targets. Percentage Variance from Target - Weighted Emergency Department (ED) Attendances Calculation ({Weighted ED Attendances} for the reference period (e.g., calendar month) minus {Weighted ED Attendance Target}) for the reference period (e.g., calendar month), divided by {Weighted ED Attendance Target} for the reference period (e.g., calendar month), expressed as a percentage. Verification Rules Where {Weighted ED Attendances} > {Weighed ED Attendance Target}, the percentage variance is positive (+). Where {Weighted ED Attendances} < {Weighted ED Attendance Target}, the percentage variance is negative (-). Data Collection Identification Items Source EDDC Emergency Department Data Collection (EDDC) extract, updated every Wednesday at 0600.

PAQ WA 2012/13 ABF/M Operating Model documentation; nWAU schedule. Independent UDG and URG grouper software Hospitals Pricing Authority (IHPA)

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Service Level Full financial year {Weighted ED Attendance Target} Agreements

Health Services Revised Monthly {Weighted ED Attendance Target}, as applicable Governance Items Purpose of the data Percentage Variance from Target - Weighted Emergency Department (ED) Attendances is used to assess performance against the Service Level Agreements. This indicator is reported in the Activity Based Funding / Management Performance Management Report and the WA Health Dashboard Report. Source of the Business and Financial Modelling Directorate, Performance Activity definition and Quality Division, DoH WA Performance Directorate, Performance Activity and Quality Division, DoH WA Data Integrity, Performance Activity and Quality Division, DoH WA Local and National ABF/M Operating Model documentation, available on http://activity Emergency Department Data Collection Dictionary v1.0 Version number 1.0 Approval date 20120813

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EI1.c: Volume of activity weighted year to date: outpatients (variance from target)

Reported Data Description Items

Identifier

Name Percentage Variance from Target - Weighted Outpatient Service Events

Aliases . Episode of care . Outpatient Department Activity

Definitions Percentage Variance from Target – Weighted Outpatient Service Events is the ({Weighted Outpatient Service Events} less the {Weighted Outpatient Service Events Target}), divided by the {Weighted Outpatient Service Events Target}, expressed as a percentage. Weighted Outpatient Service Events are the product of the {Unweighted Outpatient Service Events} and the corresponding national Weighted Activity Unit (nWAU) cost weights. The count of {Unweighted Outpatient Service Events} is slightly different to the count derived from the Total Outpatient Service Events definition (MDG-10-003) – see heading ‘Clinic Type Exclusions’ on page 2. {Unweighted Outpatient Service Events} is the count of outpatient clinic services delivered to non admitted outpatients where the following definitions are met.

Non Admitted Patient:

Non admitted patients are those who receive care from a health service but who do not undergo a formal admission process.

Outpatient Clinic Services:

The term ‘clinic’ describes various arrangements under which a Hospital delivers specialist outpatient services to non-admitted non-emergency department patients. These services are provided through specific organisational units staffed to administer and provide a certain range of outpatient care in defined locations, at regular or irregular times and where one or more specialist providers deliver care to booked patients. Generally, in such clinics, a booking system is administered and patient care records are maintained to document patient attendances and care provided. Service Event: A service event is an interaction between one or more healthcare provider(s) with one non admitted patient, which must contain

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therapeutic/clinical content and result in a dated entry in the patient's medical record. Clinic Type Exclusions: This definition excludes activity from several NHCDC clinic types that have been determined as out-of-scope from ABF and national funding. The exclusion of these clinic types are the point of difference compared with the Total Outpatient Service Events definition (MDG-10-003). The result from the Total Outpatient Service Events definition (MDG-10-003) will be higher than the {unweighted outpatient service events} result using this definition.

Note:

This service event definition applies to non-admitted outpatients and is not intended to apply to community health based services.

Related . MDG-10-001 Total Outpatient Occasions of Service Metadata . MDG-10-002 Total Outpatient Group Sessions . MDG-10-003 Total Outpatient Service Events definition

This definition describes the method for calculating weighted outpatient Guide for Use service events for reporting against the WA Activity Based Funding/Management 2012/13 Operating Model target. The basis for this definition is the Total Outpatient Service Events definition (MDG-10-003); however, additional exclusions are applied in this definition to align with the ABF funding scope. This definition can also be referenced for the unweighted service event count which corresponds with the weighted result. Note that due to the slightly different exclusions applied in this definition, the unweighted outpatient service event count derived from this definition will be slightly lower than the count derived from Total Outpatient Service Events definition (MDG-10-003).

Non-Admitted Patient Activity and Wait list Data Collection (NAPAAWL DC):

The NAPAAWL DC is intended to capture instances of service provision from the point of view of the patient. This may be for assessment, examination, consultation, treatment and/or education.

Total service events are counted from records in the NAPAAWL DC using the following indicators:

. [Appointment_date], . [Attendance_flag], . [Patient_indicator],

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. [Individual_or_group], . [Pay_class], . [Mental_Health_Flag], and . [OCS_index].

For further information, refer to ‘Inclusions’ and ‘Formula’.

Service Event:

Please refer to the Meteor Service Event definition (identifier 400604) for the guide for use. The count in this definition is for patient level service events and not occasions of service (individual or group sessions). For reporting information on occasions of service, refer to: . MDG-10-001 (individual), and . MDG-10-002 (group).

Outpatient services provided to admitted patients:

An outpatient Service Event delivered to an admitted patient is still to be recorded however will be excluded from Service Event reporting, even where the outpatient activity is not related to the reason for admission.

This outpatient Service Event delivered to an admitted patient is funded as part of the admitted patient episode.

Please note that as at publication, this exclusion is to be confirmed by the Independent Hospitals Pricing Authority (IHPA). Should this criterion change, this definition will be updated accordingly.

Weighting Methodology

To calculate {Weighted Outpatient Service Events}, unweighted service events are multiplied by their corresponding nWAUs. nWAUs are applied based on the NHCDC Tier 2 clinic type for each service event. A mapping/reference table has been developed by Data Integrity, PAQ and the health services, which maps each hospital clinic to a National Hospital Cost Data Collection (NHCDC) Tier 2 clinic type. The Tier 2 clinic types have been allocated to each clinic based on the hospital, source system (i.e., TOPAS, Allied Health System, HCARe), clinic code, clinic category code, clinic descriptor and feedback from the hospitals/health services. The mapping of the clinics to the NHCDC Tier 2 clinic types is reviewed and updated regularly. In addition, the Tier 2 clinic types are currently being implemented in the source data collection systems and in future will

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be directly collected from the source system rather than primarily retrospectively allocated. However, although these updates will occur throughout 2012/13, the version of the mapping table that was used to develop the outpatient service event targets will continue to be used for reporting weighted outpatient service event activity during 2012/13. This is to ensure consistency in reporting actual against the target. Using this mapping/reference table, service events are grouped into the National Hospital Cost Data Collection (NHCDC) Tier 2 clinics, using [Establishment Code], [Source System] and [Clinic Code] (where available) or [Clinic Category Code] (where [Clinic Code] is missing). The definitions of the Tier 2 clinic categories are available from http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/ABF-Price- Model-Reference-Classifications-for-2012-13. As at publication, WA is awaiting detailed documentation of the final national model (currently in draft) from the Independent Hospitals Pricing Authority (IHPA); should any national rules change, this definition may be updated accordingly. Clinic Type Exclusions This definition excludes activity from NHCDC clinic types that have been determined by the Independent Hospitals Pricing Authority to not be eligible for Commonwealth funding under the National Health Reform Agreement. These clinics are excluded:  General Practice and Primary care  Aged Care Assessment  Primary health Care  Family Planning  Alcohol and Other Drugs  General Counselling

In addition the NHCDC Clinic Classification Definitions (V1.2) states that, “For ABF purposes, stand-alone diagnostic (ancillary) clinics do not report service events; these are an integral part of the ‘requesting’ Tier 2 clinic service event,” (p. 11). These clinics are excluded:  General Imaging  Medical Resonance Imaging (MRI)  Computerised Tomography (CT)  Nuclear Medicine  Pathology (Microbiology, Haematology, Biochemistry)  Positron Emission Tomography (PET)  Mammography Screening  Clinical Measurement

The exclusion of these clinic types are the point of difference compared with the Total Outpatient Service Events definition (MDG-10-003). The result from the Total Outpatient Service Events definition (MDG-10-003) will be higher than the {unweighted outpatient service events} result using this definition.

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Monthly Activity Targets The full year {Outpatient Service Events Target} is set in the Service Level Agreements between the Department of Health and the Health Services. The default monthly {Weighted Outpatient Service Events Target} is calculated by the Business and Financial Modelling Directorate, PAQ. The default target calculation determines the proportion of activity attributed to each calendar month for the most recent full financial year for which data are available, and applies these proportions to the full year {Weighted Outpatient Service Events Target}. Note that the Health Services will have the opportunity to advise the Business and Financial Modelling Directorate of revised monthly targets that vary from the default monthly activity target; the Health Service monthly targets will override the default targets. The health service revision will occur once, at the start of the financial year. It is expected that a standard methodology will be followed with an adjustment for area or hospital specific events that are known for the current year. All inclusions and exclusions applicable to the {Weighted Outpatient Service Events} count apply to the {Weighted Outpatient Service Events Target}. No routine updates are made to the targets. However, if the full year targets are revised in the Service Level Agreements (e.g., due to Minister for Health decision or additional funding available), the monthly targets will be adjusted as required. Coverage: Limitations This count currently does not include all data from all sites (refer to Scope). TOPAS: Group session activity is not identified within TOPAS data; therefore, the service events records are given a value of 1 (individual) in the [Individual_or_Group] field.

Reported Data Validation Items

Format . Numeric . 8 . [N(8)]

Data Values . The fields listed under inclusions/exclusions that are derived fields within the NAPAAWL DC are indicated by an asterix. . That is, the fields marked with an asterix are mapped and/or calculated from the source system data (e.g. TOPAS, HCARe, Allied Health System), and are not available directly from the source systems.

Inclusions Field and value names NAPAAWL DC

[Appointment_date] =

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 Not missing, not invalid DDMMYYYY

[Mental_Health_Flag]* =

 Not Mental Health OOS 0 (zero)

[Attendance_Flag]* =

 Attended 1

[Patient_Indicator] =

 Outpatient 1

[Individual_or_Group]* =

 Individual 1

 Group session 2

[Pay_Class] =

 Australian Health Care Agreements 21

 Worker’s Compensation 24

 Motor Vehicle Third Party Personal Claim 25

 Other Compensation 26

 Department of Veterans’ Affairs 27

 Department of Defence 28

 Correctional Facility 29

 Reciprocal Health Care Agreements 30

 Ineligible 31

 Other 32

 Detainee 34

[OCS_Index] =

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 HS Count of components of an episode <= 1

Exclusions Field and value names NAPAAWL DC

[Appointment_date] =

 Missing, invalid

[Mental_Health_Flag]* =

 Mental Health OOS 1

[Attendance_Flag]* =

 Did not attend OOS 2

 Did not wait 3

 Chart only not OOS 4

 Not reported / Unknown 9

[Patient_Indicator] =

 Inpatient 2

 Continuing Care 3

 Primary Health 4

 External/Community 5

 Emergency 6

 Unknown 9

[Individual_or_Group]* =

 Non client event / unknown 9

[Pay_Class] =

 Private Health Insurance 22

 Self Funded 23

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 Ambulatory Surgery Initiative 33

[OCS_Index] =

 HS Count of components of an episode > 1

 Other

[NHCDC Tier 2 Clinic Type] (based on mapping table used in target setting) =

 General Practice and Primary care 20.06

 Aged Care Assessment 40.02

 Primary health Care 40.08

 Family Planning 40.27

 Alcohol and Other Drugs 40.30

 General Counselling 40.33

 General Imaging 30.01

 Medical Resonance Imaging (MRI) 30.02

 Computerised Tomography (CT) 30.03

 Nuclear Medicine 30.04

 Pathology (Microbiology, Haematology, 30.05 Biochemistry)

 Positron Emission Tomography (PET) 30.06

 Mammography Screening 30.07

 Clinical Measurement 30.08

Patients not present:

Patients, who did not attend the appointment or did not wait to be seen, are excluded from the count. Chart reviews where the health professional reviews the patient’s record,

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but the patient is not in attendance are also excluded from the count. Mental Health activity: Mental health activity captured in the NAPAAWL DC from TOPAS, HCARe or the Allied Health System (AHS) are excluded from the count. This activity is to be reported to Mental Health Data Collections through PSOLIS.

Scope This definition applies to non-admitted outpatients and is not intended to apply to community health based services. . Development work is underway to include electronic patient level outpatient activity from:  Joondalup Health Campus,  Peel Health Campus,  Radiation Oncology, and  individual clinics at various sites where activity is not currently reported to the NAPAAWL DC. In the 2012/13 operating model, the included sites are public hospitals (metropolitan and rural), excluding:  WACHS Small Hospitals (no activity targets)  Joondalup and Peel Health Campuses (due to unavailability of data)  Nursing posts and other non-hospital establishments

Map service events to the [NHCDC Tier 2 clinic type] with the Formula mapping/reference table used to determine the targets, using the fields [Establishment Code], [Source System] and [Clinic Code] (where available) or [Clinic Category Code] (where [Clinic Code] is missing).

{Unweighted NAPAAWL DC: Outpatient Count for {unweighted outpatient service events} is the number of records Service events} where:

. [Appointment date] has a value that is within/equal to the start and end date for the reference period (e.g., calendar month), and . [Mental_Health_Flag] = 0, and

. [Attendance flag] = 1, and

. [Patient Indicator] =1, and

. [Individual_or_Group] = (1, 2), and

. [Pay Class] = (21, 24, 25, 26, 27, 28, 29, 30, 31, 32, or 34), and

. [OCS_Index] <= 1. Minus records where [NHCDC Tier 2 clinic type] = 20.06, 40.02, 40.08, 40.27, 40.30, 40.33, 30.01, 30.02, 30.03, 30.04, 30.05, 30.06, 30.07 or

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30.08.

{Weighted Outpatient Apply the applicable nWAU using the [NHCDC Tier 2 clinic type]. Refer to Service Events} the documentation available on http://activity and http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/Content/ABF-Price- Model-Reference-Classifications-for-2012-13

Default Monthly {Weighted Outpatient Service Events Target}

Terms 푚 = the {Weighted Outpatient Service Events} for the calendar month, . 푚푗푢푙, 푚푎푢푔, 푚푠푒푝 … 푚푗푢푛 푓 = the {Weighted Outpatient Service Events} for the financial year, 푓1, 푓2, 푓3 … 푓푥 where 푓1 is the most recent full financial year

푡푓 = full financial year target (as set in the Service Level Agreements between the Health Services and the Department of Health)

푡푚 = monthly activity target for the calendar month, 푡푚푗푢푙 , 푡푚푎푢푔 … 푡푚푗푢푛

Calculation Metro hospitals: Calculation step 1 is completed at the hospital level. In step 2, the percentages calculated at step 1 are applied to the full year target (푡푓) for each hospital, as per the SLA. The monthly target results (푡푚) can be summed to health service and statewide as required. Country hospitals: Calculation step 1 is completed at the region level. In step 2, the percentages calculated at step 1 are applied to the full year target (푡푓) for each hospital, as per the SLA. The monthly target results (푡푚) can be summed to health service and statewide as required.

To calculate 푡푚 for each month (example given is for July): 1. Using the {Weighted Outpatient Occasions of Service} data for 2010/11, calculate 푝푚 , the proportion of activity each calendar month of 2010/11 contributed to the full 2010/11 financial year ∑ 푚푗푢푙 i.e., = 푝푚푗푢푙 ∑ 푓2010/11 2. To calculate 푡푚 , the activity target for a given month, multiply the proportion for that calendar month with the full financial year target

i.e., 푝푚푗푢푙 × 푡푓 = 푡푚푗푢푙 The above default calculation applies unless the Health Services advise the Business and Financial Modelling Directorate, PAQ of revised targets. Percentage Variance from Target – Weighted Outpatient Service Events Calculation ({Weighted Outpatient Service Events} for the reference period (e.g., calendar month) minus {Weighted Outpatient Service Events Target} for the reference period (e.g., calendar month)), divided by {Weighted Outpatient Service Events Target} for the reference period (e.g., calendar month), expressed as a percentage. Verification Where {Weighted Outpatient Service Events} > {Weighted Outpatient Rules Service Events Target}, the percentage variance is positive (+).

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Where {Weighted Outpatient Service Events} < {Weighted Outpatient Service Events Target}, the percentage variance is negative (-).

Data Collection Identification Items Source Data are collected from non admitted data applications and incorporated into the Non Admitted Patient Activity and Wait list Data Collection

(NAPAAWL DC). A monthly extract is produced by the second week of the month from the NAPAAWL DC.

PAQ WA 2012/13 ABF/M Operating Model documentation; nWAU schedule and methodology.

Commonwealth/ Tier 2 Outpatient Clinic Definitions link to site IHPA/NHCDC

Service Level Full financial year {Weighted Outpatient Service Events Target} Agreements

Health Services Revised Monthly {Weighted Outpatient Service Events Target}, as applicable

Governance Items

Purpose of the Percentage Variance from Target – Weighted Outpatient Service Events data assesses Health Service and hospital performance against the Service Level Agreements. This indicator is reported in the Activity Based Funding / Management Performance Management Report and the WA Health Dashboard Report.

Source of the . METeOR definition/ additional . Operational Directives information . Health Services . Performance Activity and Quality Division . Local and National ABF/M Operating Model documentation, available on http://activity

Version Number 1.0

Approval date 20120813

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EI3: Average cost per test panel for PathWest

Reported Data Description Items Identifier Name Average cost per occasion of service for PathWest Aliases N/A Definition The average PathWest cost for performing a laboratory test or panel Related Metadata PathWest “test” is a robust measure of PathWest activity obtained from the Ultra and AP Laboratory Information Systems which has been in use for a number of years. A test can be an individual analyte or procedure or a group of common analytes performed at the same time as an aggregate eg LFT (liver function test which has up to 7 analytes). A test or an aggregate of tests is referred to in the Ultra LIS as a panel. Limitations Not all PathWest activity is recorded as a test or panel e.g. specimen collection, specimen reception, specimen transport, clinical activities, teaching and research. Reported Data Validation Items Format Numeric 4 $NN.NN Data Values Inclusions Includes all pathology department activities providing pathology services. Exclusions Forensic expenditure and activities (funded by WA Police) Food and Waters expenditure and activities (funded from external sources) Scope All public hospital pathology, private collections from collection centres and referrals from external laboratories Verification Rules Data Collection Identification Items Source Ultra and AP LIS – monthly extracts Oracle GL – monthly reports Governance Items Purpose of the data To measure the cost of performing pathology activities as a measure of efficiency.To monitor changes to efficiency to use a management tool Source of the definition PathWest Version number 1.0 Approval date 20120813

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EI6: YTD Distance of Net Cost of Service to Budget

Reported Data Description Items Identifier (office use only)

Name YTD Distance of Net Cost of Service to Budget

Aliases Net Cost of Service to Date – Distance to Budget

Definition The distance of year to date (YTD) actual net cost of service (total expenditure less total own sourced revenue) to the YTD budget.

Related Metadata n/a

Guide for Use Actual expenditure is operating/recurrent expenditure, excluding asset investment program (capital works) expenditure.

Actual own source revenue (OSR) is operating/recurrent revenue, excluding asset investment program (capital works) revenue.

Actual expenditure and OSR are extracted from the Year to Date Actual measure, of the Discoverer Report HCN_FIN.FR(SUM) – Income Statement – Budget Holder, generated from the General Ledger.

YTD budget is extracted from the YTD Budget measure of the Discoverer report.

The distance of YTD actual net cost of service to YTD budget is to be expressed as a percentage.

Discoverer Report Period Name = relevant period (month) of report Parameter Values: Budget Name = Budget 2012 (representing the 2011-12 financial

year). Budget Holders(s) = NMH0000 – NORTH METROPOLITAN HEALTH SERVICE SMH0000 – SOUTH METROPOLITAN HEALTH SERVICE * WCH0000 – CHILD & ADOLESCENT HEALTH SERVICE WACHS00 – WA COUNTRY HEALTH SERVICE *: Includes Peel Health Service

Limitations Internal transactions (purchase of services and recoups, and shared services transactions) are not eliminated at individual entity or health services level, but on consolidation for whole of Health.

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Budget figures for a particular month are subject to updates in subsequent months.

Reported Data Validation Items Format Percentage

NNN.NN%

Data Values Leave blank.

Inclusions Include Operating/Recurrent Entities from Oracle Financials 11i:

Entity Posting + Name = 040 (NMHS) Entity Posting + Name = 020 (SMHS) Entity Posting + Name = 075 (Peel HS) Entity Posting + Name = 030 (CAHS) Entity Posting + Name = 080 (WACHS)

Exclusions Exclude Capital Entities from Oracle Financials 11i: Entity Posting + Name = 140 (NMHS) Entity Posting + Name = 120 and 121 (SMHS) Entity Posting + Name = 175 (Peel HS) Entity Posting + Name = 130 (CAHS) Entity Posting + Name = 180 (WACHS)

Scope The four major WA area health services.

Formula Run the report to display only the Operating/Recurrent Entities, as indicated in the above inclusions and exclusions.

NOTE: Based on accounting convention, Oracle Financials and Discoverer present revenue (actual and budget) as negative values and expenditure as positive values. Therefore, to calculate net cost of service, sum expenditure and revenue values.

Budget = YTD Budget total expenditure + total OSR

Actual = YTD Actual total expenditure + total OSR

Calculation = (Budget - Actual) / Budget x 100, expressed as a percentage.

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If the denominator is zero, the calculated result should be reported / displayed as "N/A".

Verification Rules Value is likely to be between -100% and 100%, however, it is mathematically possible to be >100%.

Data Collection Identification Items Source Oracle Financials 11i – General Ledger.

Note: The GL is generally closed and ready for reporting on the 4th working day each month, with June being the exception when the GL will remain open for a longer period due to the processing of end of year adjustments.

Governance Items Purpose of the data Net cost of service is used for monitoring and accountability of budget management.

Source of the definition Health Finance.

Version number 1.0

Approval date 20120813

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EI8: Ratio of actual cost of specified public hospital services compared with the state efficient price Reported Data Element Definition Reported Data Description Items Identifier Ratio of actual cost of specified public hospital services compared with the state Name efficient price (cost per unit) Aliases Ratio of cost per weighted unit of activity compared with the state price Definition The ratio of the actual cost of specified public hospital services compared with the state price for those services is the cost of 1 weighted activity unit divided by the state price for 1 weighted activity unit. It shows the relative unit cost of public hospital services compared to the unit price allocated to those services in each year of the WA ABF Operating Model. Related Total Estimated Weighted Inpatient Activity Metadata Weighted ED Activity Weighted Outpatient Activity Guide for This indicator is a measure of the relative cost of services provided by in-scope Use ABF/M hospitals compared with the state price set in each year of the WA Activity Based Funding Operating Model. The ratio will reflect the how close the actual cost per unit of activity was in relation to the state price, in a given financial year, where a ratio of 1.0 indicates that cost = price. The ratio for each financial year is calculated based on the parameters of each year’s model. That is, the calculation for each year in terms of inclusions and exclusions is based on that year’s scope and definitions for activity. For 2010/11 and 2011/12 the cost:price ratio includes inpatient and emergency department (ED) activity, as these areas were in scope for 2010/11. Although outpatient activity was in scope for the 2011/12 WA ABF Operating Model, the costing is not available at an adequate level of granularity, and will therefore be excluded from the 2011/12 ratio. In 2012/13, the cost:price ratio will include outpatient activity as well as inpatient and ED. The 2012/13 methodology is not included in this definition; however, the methodology will be included in subsequent updates of this definition. The costing information is sourced from WA’s NHCDC costing submission for each year. The metropolitan hospitals’ costing is record level. The country hospitals’ costing is provided in aggregate for each facility. The difference in the level of costing requires different formulas for calculating the ratio of cost:price between metro and country hospitals. The activity inclusions and exclusions are as per the definitions for each activity type in each financial year. However, in order to align with the prices set in each financial year, the following additional inpatient exclusions are applied for all years: Ambulatory Surgery Initiative and Contracted Dialysis. Non-acute nursing

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home type patient activity is excluded from the 2011/12 figures. These activity types have their own prices separate to the peer group pricing and are therefore excluded from this indicator. The ABF models and prices are different in each financial year; however, the ratios can be compared between financial years provided an understanding of the prices is taken into consideration. In any given year, there is an expectation that costs will align to prices, but the ease with which this can be achieved will vary depending on how the prices have been set (e.g., if an efficiency dividend has been taken into account in the price, aligning costs to price may be more difficult to achieve compared with other years). Costs are compared with the state price at the health service level. In 2010/11 and 2011/12, there were different peer group prices for inpatient and ED activity, and different weighting schedules (iWAUs – inpatient weighted activity units; and eWAUs – emergency weighted activity units). A notional state price has been derived from these prices in order to calculate a ratio of cost to state price for these financial years. The way these prices and separate weights have been converted is explained in this document. Therefore, the ‘state price’ for these years is not an actual price that was modelled in those years, but a ‘composite’ price calculated for the purpose of this indicator.

Limitations There is up to a 12 month data lag following the end of the financial year. I.e., Data for 2010/11 will be available in June/July 2012. This lag may decrease as improvements are made in the timeliness of costing.

Reported Data Validation Items Format Numeric 4 (display only; do not truncate) N.NN Data Values The data values are described separately for each financial year. 2010/11 Costs

{Inpatient costs} - NHCDC Costing Submission for Round 15 (2010/11) Inclusions Metro (patient level costed records):  Include patient level costed records according to definition for Total Estimated Weighted Inpatient Activity 2010/11 Operating Model. Country:  Include total facility inpatient costs for each in scope facility. Exclusions Metro (patient level costed records):  Exclude patient level costed records as per definition for Total Estimated Weighted Inpatient Activity 2010/11 Operating Model.  Exclude ASI

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Ambulatory Surgery Initiative HMDS - Funding source for hospital patient = 33 Country:  Exclude ASI Remove modelled cost funding for ASI (as stipulated in the 2010/11 Service Level Agreement (SLA)) from total facility cost for applicable in scope facilities (Note: actual ASI costs cannot be removed as these cannot be identified in the country facility costings; therefore, in this instance, the funding for ASI patients is assumed to equal costs for the purpose of excluding ASI). {ED costs} - NHCDC Costing Submission for Round 15 (2010/11) Metro: Include total facility emergency department costs for each in scope facility. WACHS: Include total facility emergency department costs for each in scope facility.

Total Weighted Activity Units

{Total Estimated Weighted Inpatient Activity} Follow the Total Estimated Unweighted Inpatient Activity 2010/11 Operating Model definition. There are no additional inclusions to be applied; however, the following additional exclusions need to be applied: Exclusions Metro and Country:  Exclude ASI

Ambulatory Surgery Initiative HMDS - Funding source for hospital patient = 33

{Weighted ED Attendances} Follow the Weighted ED Attendances 2010/11 Operating Model definition. No additional inclusions or exclusions to be applied. Price per weighted activity unit

Inclusions Specific peer group base rates apply to the weighted activity determined for each hospital for both inpatient and ED services. Refer to the 2010/11 Technical Documentation, available at http://activity/file.axd?file=2010%2f8%2fABF_ABM+AHS+Service+Agreement+Te chnical+Support+Document.pdf {Inpatient Activity Prices} Inclusions  Peer group prices Peer group Abbreviation Metro non-tertiary MNT

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Tertiary TH Paediatric Paed Country Regional Resource Centre CNTr Country Integrated District Health Service CNTi

Exclusions  Peer group prices Peer group Abbreviation Country Small Hospitals CNTo Ambulatory Surgery Initiative ASI Contracted Dialysis CNT Dial

{ED Activity Prices} Inclusions  Peer group prices Peer group Abbreviation Metro non-tertiary MNT Tertiary TH King Edward Memorial Hospital KEMH Country Regional Resource Centre CNTr Country Integrated District Health Service CNTi

Exclusions  Peer group prices Peer group Abbreviation Country Small Hospitals CNTo

2011/12 Costs

{Inpatient costs} - NHCDC Costing Submission for Round 16 (2011/12) Inclusions Metro (patient level costed records):  Include patient level costed records according to definition for Total Estimated Weighted Inpatient Activity 2011/12 Operating Model. Country:  Include total facility inpatient costs for each in scope facility. Exclusions Metro (patient level costed records):  Exclude patient level costed records as per definition for Total Estimated Weighted Inpatient Activity 2011/12 Operating Model.  Exclude ASI

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Ambulatory Surgery Initiative HMDS - Funding source for hospital patient = 33  Exclude Contracted Dialysis For HMDS records: HMDS 1. Contracted dialysis - DRG v6.0 = L61Z and - Client Status/Patient Type = 0  Exclude Non-Acute Nursing Home Type Patient

HMDS - Care Type = 25 30 and - Client Status = 4

Country:  Exclude ASI Remove modelled cost funding for ASI (as stipulated in the 2011/12 Service Level Agreement (SLA)) from total facility cost for applicable in scope facilities (Note: actual ASI costs cannot be removed as these cannot be identified in the country facility costings; therefore, in this instance, the funding for ASI patients is assumed to equal costs for the purpose of excluding ASI). {ED costs} - NHCDC Costing Submission for Round 16 (2011/12) Inclusions Metro: Include total facility emergency department costs for each in scope facility. WACHS: Include total facility emergency department costs for each in scope facility.

Total Weighted Activity Units

{Total Estimated Weighted Inpatient Activity} Follow the Total Estimated Weighted Inpatient Activity 2011/12 Operating Model definition. There are no additional inclusions to be applied; however, the following additional exclusions need to be applied:

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Exclusions Metro and Country:  Exclude ASI

Ambulatory Surgery Initiative HMDS - Funding source for hospital patient = 33  Exclude Non-Acute Nursing Home Type Patient

HMDS - Care Type = 25 30 and - Client Status = 4

Metro:  Exclude Contracted Dialysis For HMDS records: HMDS 1. Contracted dialysis - DRG v6.0 = L61Z and - Client Status = 0

{Weighted ED Attendances} Follow the Weighted ED Attendances 2011/12 Operating Model definition. No additional inclusions or exclusions to be applied. Price per weighted activity unit

Specific peer group base rates apply to the weighted activity determined for each hospital for both inpatient and ED services. See http://activity/file.axd?file=2011%2f8%2fABF+2011-12+Budget+- +Technical+Documentation+updated.pdf. For the calculation of this indicator, only the inpatient prices are required. {Inpatient Activity Prices} Inclusions  Peer group prices Peer group Abbreviation Metro non-tertiary MNT Tertiary TH Paediatric Paed Country Regional Resource Centre CNTr Country Integrated District Health Service CNTi

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Exclusions  Peer group prices Peer group Abbreviation Non Acute NA Country Small Hospitals CNTo Ambulatory Surgery Initiative ASI Contracted Dialysis CNT Dial

Exclusions  Peer group prices Peer group Abbreviation Country Small Hospitals CNTo

Scope This indicator includes all public hospitals (metropolitan and rural), excluding . Joondalup and Peel Health Campuses . Country Small Hospitals . Nursing posts and other non-hospital establishments For a particular report, please refer to that report’s scoping to determine which sites are included. Formula There are several steps in the calculation of the ratio. The simplified formulae describe the concept of the overall calculation, and are used in the calculation of the ratio.

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Simplified Formulae

(1) For year 푥,

퐶표푠푡 푝푒푟 1 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 (푇표푡푎푙 푎푐푡𝑖푣𝑖푡푦 푐표푠푡푠) = 퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 (푇표푡푎푙 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡푠)퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒

(2) Then, for year 푥,

푅푎푡𝑖표 표푓 푐표푠푡 푡표 푝푟𝑖푐푒퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 (퐶표푠푡 푝푒푟 1 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡) = 퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 푃푟𝑖푐푒 푝푒푟 1 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡푆푡푎푡푒 푃푟푖푐푒 Where year 푥 is 2010/11 or 2011/12.

The following sections explain how the individual values/components used in the detailed calculation steps are calculated. {Inpatient Costs} 2010/11 Metro: Sum of [costs] for inpatient coded and costed records where [Separation date] is within or equal to the start and end date of the reference period (i.e., financial year) and meet the criteria for [Total Estimated Weighted Inpatient Activity} minus records where [Funding source] = 33. Country: Sum of total in scope facility inpatient costs minus [SLA modelled cost for ASI]. 2011/12 Metro: Sum of costs for inpatient coded and costed records where [Separation date] is within or equal to the start and end date of the reference period (i.e., financial year) and meet the criteria for [Total Estimated Weighted Inpatient Activity} minus records where [Funding source] = 33, minus records where ([DRG] = L61Z, and [Client Status] = 0), minus records where ([Care Type] = 20 or 30, and [Client Status] = 4). Country: Sum of total in scope facility inpatient costs minus [SLA modelled cost for ASI]. {ED costs} 2010/11 Metro and Country: and Sum of total in scope facility emergency department costs. 2011/12

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{Total Estimated Weighted Inpatient Activity} 2010/11 Metro and Country: Sum of {Total Estimated Weighted Inpatient Activity} (as per 2010/11 Operating Model definition) minus records where [Funding source] = 33. 2011/12 Metro and Country: Sum of {Total Estimated Weighted Inpatient Activity} (as per 2011/12 Operating Model definition) minus records where [Funding source] = 33, minus records where ([DRG] = L61Z, and [Client Status] = 0), minus records where ([Care Type] = 20 or 30, and [Client Status] = 4).

{Weighted ED Activity} 2010/11 Metro and Country: As per the 2010/11 weighted ED activity definition. 2011/12 Metro and Country: As per the 2011/12 weighted ED activity definition.

Detailed calculation steps

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2010/11 and The following steps describe the calculations required in order to compute the 2011/12 cost:price ratio. The steps achieve the calculation of the simplified formulae described earlier in this definition (page 7).

Initially, the {total weighted activity units} value needs to be calculated. The {total weighted activity units} is the sum of weighted inpatient and ED activity. In 2010/11 and 2011/12, the inpatient and ED weight schedules were separate. To validly sum the weighted inpatient and ED activity, the ED activity is re-weighted to the inpatient weighting scale. The following calculation should be done separately for 2010/11 and 2011/12, according to each year’s methodology.

To equate the ED weights to the inpatient weights and derive {total weighted activity units}: 1. Calculate the total value of the inpatient activity from the SLA, according to the {total estimated weighted inpatient activity} inclusions and exclusions. Perform the following calculation separately for each included peer group (see pages 3 and 6 for the included peer groups). {푃푒푒푟 퐺푟표푢푝 퐼푛푝푎푡𝑖푒푛푡 퐴푛푛푢푎푙 퐴푐푡𝑖푣𝑖푡푦 푇푎푟푔푒푡} × {퐼푛푝푎푡𝑖푒푛푡 푃푒푒푟 퐺푟표푢푝 푃푟𝑖푐푒} = 푃푒푒푟 퐺푟표푢푝 퐼푛푝푎푡𝑖푒푛푡 퐴푐푡𝑖푣𝑖푡푦 푉푎푙푢푒 Then, sum the inpatient peer group results.

∑ 푃푒푒푟 퐺푟표푢푝 퐼푛푝푎푡𝑖푒푛푡 퐴푐푡𝑖푣𝑖푡푦 푉푎푙푢푒푎,푏..푒 = 푇표푡푎푙 𝑖푛푝푎푡𝑖푒푛푡 푎푐푡𝑖푣𝑖푡푦 푣푎푙푢푒

Where a, b, … e are the different peer groups. 2. Sum the inpatient peer group activity targets to get the total inpatient activity target.

∑ 푃푒푒푟 퐺푟표푢푝 퐼푛푝푎푡𝑖푒푛푡 퐴푛푛푢푎푙 퐴푐푡𝑖푣𝑖푡푦 푇푎푟푔푒푡푎,푏..푒 = 푇표푡푎푙 𝑖푛푝푎푡𝑖푒푛푡 푎푐푡𝑖푣𝑖푡푦 푡푎푟푔푒푡

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3. Calculate the total value of the ED activity from the SLA. Perform the following calculation separately for each included peer group (see pages 4 and 7 for the included peer groups). {푃푒푒푟 퐺푟표푢푝 퐸퐷 퐴푛푛푢푎푙 퐴푐푡𝑖푣𝑖푡푦 푇푎푟푔푒푡} × {퐸퐷 푃푒푒푟 퐺푟표푢푝 푃푟𝑖푐푒} = 푃푒푒푟 퐺푟표푢푝 퐸퐷 퐴푐푡𝑖푣𝑖푡푦 푉푎푙푢푒 Then, sum the ED peer group results.

∑ 푃푒푒푟 퐺푟표푢푝 퐸퐷 퐴푐푡𝑖푣𝑖푡푦 푉푎푙푢푒푎,푏..푒 = 푇표푡푎푙 퐸퐷 푎푐푡𝑖푣𝑖푡푦 푉푎푙푢푒

Where a, b, … e are the different peer groups. 4. Sum the ED peer group activity targets to get the total ED activity target.

∑ 푃푒푒푟 퐺푟표푢푝 퐸퐷 퐴푛푛푢푎푙 퐴푐푡𝑖푣𝑖푡푦 푇푎푟푔푒푡푎,푏..푒 = 푇표푡푎푙 퐸퐷 푎푐푡𝑖푣𝑖푡푦 푡푎푟푔푒푡

5. Determine the price per unit of inpatient activity across all peer groups. Use the values calculated at steps 1 and 2 as the numerator and denominator, respectively. 푇표푡푎푙 𝑖푛푝푎푡𝑖푒푛푡 푎푐푡𝑖푣𝑖푡푦 푣푎푙푢푒 = "퐼푛푝푎푡𝑖푒푛푡 푃푟𝑖푐푒" 푇표푡푎푙 𝑖푛푝푎푡𝑖푒푛푡 푡푎푟푔푒푡 푎푐푡𝑖푣𝑖푡푦 Note: This “Inpatient Price” is also the ‘state price’ or {price per 1

weighted activity unit}State Price used in the final ratio calculation. 6. Determine the price per unit of ED activity across all peer groups. Use the values calculated at steps 3 and 4 as your numerator and denominator, respectively. 푇표푡푎푙 퐸퐷 푎푐푡𝑖푣𝑖푡푦 푣푎푙푢푒 = "퐸퐷 푃푟𝑖푐푒" 푇표푡푎푙 퐸퐷 푡푎푟푔푒푡 푎푐푡𝑖푣𝑖푡푦 7. Determine the ratio between the value of inpatient and ED activity. You will use this ratio as a scaling factor to ‘re-weight’ the weighted ED activity. 퐸퐷 푃푟𝑖푐푒 = 퐸퐷 푠푐푎푙𝑖푛푔 푓푎푐푡표푟 퐼푛푝푎푡𝑖푒푛푡 푃푟𝑖푐푒 8. Multiply each eWAU on the eWAU schedule by the ED scaling factor. This will now bring the eWAUs onto the same scale as the iWAUs. 푒푊퐴푈 × 퐸퐷 푠푐푎푙𝑖푛푔 푓푎푐푡표푟 = 𝑖푊퐴푈 9. For each financial year, re-weight the {weighted ED attendances} using the revised weights, or iWAUs (this is done at attendance record level).

∑(퐸퐷 푎푡푡푒푛푑푎푛푐푒 × 𝑖푊퐴푈)퐹푖푛푎푛푐푖푎푙 푦푒푎푟 = {푇표푡푎푙 푟푒 − 푤푒𝑖푔ℎ푡푒푑 퐸퐷 푎푐푡𝑖푣𝑖푡푦}

10. For each health service, sum the {total estimated weighted inpatient activity} and the {total re-weighted ED activity}, to get the {total weighted activity units}.

{푡표푡푎푙 푒푠푡𝑖푚푎푡푒푑 푤푒𝑖푔ℎ푡푒푑 𝑖푛푝푎푡𝑖푒푛푡 푎푐푡𝑖푣𝑖푡푦}퐹푎푐푖푙푖푡푦

+ {푡표푡푎푙 푟푒 − 푤푒𝑖푔ℎ푡푒푑 퐸퐷 푎푐푡𝑖푣𝑖푡푦}퐹푎푐푖푙푖푡푦

= {푡표푡푎푙 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡푠}퐹푎푐푖푙푖푡푦

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To determine the {total activity costs} for each health service: 11. Sum the total inpatient and ED costs:

{inpatient costs}퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 + {ED costs}퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 = {total activity costs}퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒

The values are now available to calculate the Simplified Formula (1) from page 7 to determine the cost per 1 weighted activity unit for each health service. 12. For each health service, divide the total activity costs (calculated at step 11) by the total weighted activity units (calculated at step 10). (푇표푡푎푙 푎푐푡𝑖푣𝑖푡푦 푐표푠푡푠) 퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 (푇표푡푎푙 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡푠)퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒

= 퐶표푠푡 푝푒푟 1 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 The values are now available to calculate the Simplified Formula (2) from page 7 to determine the ratio of health service cost to state price. 13. For each health service, divide the cost per 1 weighted activity unit (calculated at step 12) by the ‘state price’. The ‘state price’ is the result from calculation step 5 (also referred to as the ‘Inpatient Price’).

푅푎푡𝑖표 표푓 푐표푠푡 푡표 푝푟𝑖푐푒퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 (퐶표푠푡 푝푒푟 1 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡) = 퐻푒푎푙푡ℎ 푆푒푟푣푖푐푒 푃푟𝑖푐푒 푝푒푟 1 푤푒𝑖푔ℎ푡푒푑 푎푐푡𝑖푣𝑖푡푦 푢푛𝑖푡푆푡푎푡푒 푃푟푖푐푒

Verification Where cost is more than price, ratio > 1 Rules Where cost is less than price, ratio < 1 Value > 0

Data Collection Identification Items Source

NHCDC Costing data annual submission HMDS; Weighted Inpatient activity (see Weighted inpatient activity definition) TOPAS; HCARe; EDDC Weighted ED activity (see Weighted ED attendances definition)

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NAPAAWL DC Weighted Outpatient activity (see Weighted Outpatient Attendances definition) ABF/M Activity Prices - refer to each year’s documentation available from http://activity Operating Model

Governance Items Purpose of the For reporting in the 2012/13 ABF/M Performance Management Report. data Source of the Business and Financial Modelling Directorate, Performance Activity and Quality definition Division, DoH WA Performance Directorate, Performance Activity and Quality Division, DoH WA Local and National ABF/M Operating Model documentation, available on http://activity Version 1.0 number Approval date 20120813

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2.5 Equity Access (EQA) KPIs

There are 5 EQA PIs proposed in the 2014-15 PMF, including 2 outcome measures.

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EQA1: Standardised Mortality Ratio (SMR) of deaths among Aboriginal children (0-4 years) and non-Aboriginal children (0-4 years)

Reported Data Description Items Identifier ABF/M-KPI-EQA1

Name Standardised Mortality Ratio (SMR) of deaths among Aboriginal children (0-4 years) and non-Aboriginal children (0-4 years)

Aliases Standardised Mortality Ratio (SMR) of deaths among Indigenous children (0-4 years) and non-Indigenous children (0-4 years) Standardised Mortality Ratio (SMR) of deaths among ATSI children (0-4 years) and non-ATSI children (0-4 years)

Definition Standardised mortality ratios are used to compare the mortality rates in different subgroups within a population.

The standardised mortality ratio among Aboriginal children (0-4 years) and non-Aboriginal children (0-4 years) compares the rate of deaths in the Aboriginal population to the non-Aboriginal population. The rate ratio shows the difference between the two populations, and is presented with a 95% confidence interval.

Related Metadata Mortality rate by Indigenous status for children 0-4 years in the National Indigenous Reform Agreement: Baseline Performance for 2008-2009.

Guide for Use Infant and child mortality rates are used internationally as key measures of population and child health. They reflect the effect of structural factors on population health and are strongly associated with social and economic disadvantage.

The standardised mortality ratio of deaths of children aged 0-4 comparing Aboriginal children to non-Aboriginal children shows the gap in mortality rates in these two populations in early childhood.

Limitations Due to the time lag in the receipt of data, reported deaths are likely to be from at least 6 months previous. (ABS coded data not required for this indicator).

Due to small numbers, three years of data will be presented each

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year.

The identification of Aboriginal status will be improved through measures the Epidemiology Branch uses routinely with data linkage. However, the identification of Aboriginal status will be a limitation.

Reported Data Validation Items Format Numeric

NN.N

Data Values

Inclusions Deaths occurring in WA residents for children aged 0-4 years and with known Aboriginal status.

Population figures: All WA residents assigned to a Health Service (North Metro, South Metro and WACHS according to SA2 based on boundaries outlined by the Epidemiology Branch.

Exclusions Deaths with unknown Aboriginal status or age at death.

Deaths of non-WA residents (overseas and other Australian states and territories), as well as WA residents with no postcode or locality information recorded.

Excludes foetal deaths.

Scope All death registrations for WA residents with at least postcode or locality, age at death and Aboriginal status recorded.

Formula Standardised rate ratios are calculated using the indirect method. 95% confidence intervals are calculated using the exact method for Poisson distribution. Rate ratios are calculated annually (calendar year) and represent 3 years of data including the most current and previous 2 years.

The numerator is the observed number of deaths in children aged Numerator: 0-4 in the Aboriginal population.

The denominator is the expected number of deaths in children Denominator: aged 0-4 in the Aboriginal population based on the rate of deaths in children aged 0-4 in the non-Aboriginal population. To enable the comparison of the indicator over time, the rate of deaths in the non-Aboriginal population will be based on the rate in 2007-2009.

Verification Rules > 0

For statistical validity the SRR will not be reported if the number of deaths is less than 5.

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When data are extracted for the calculation of the rate ratios for the new year, data from the same extract are also used for the re- calculation of all previously reported years to ensure that those rate ratios are based on the most up-to-date available data. Data Collection Identification Items Source Death data: WA Death Registrations and Australian Bureau of Statistics (ABS) Death Data Population: Australian Bureau of Statistics, Department of Planning Governance Items Purpose of the data For ABF/M KPI reporting.

Source of the definition Epidemiology Branch, Public Health and Clinical Services Division

Version number 1.2

Approval date 20140423 (Noted by PRGC)

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EQA4: Proportion of eligible population receiving dental services from subsidised dental programs by group (aged 16 years and over, aged 65 years and over, and total Aboriginal population)

Reported Data Description Items Identifier Name Proportion of eligible population receiving dental services from subsidised dental programs by group: a) Aged 16 years and over, b) Aged 65 years and over, c) Total Aboriginal population Aliases Access to dental treatment services for eligible people Definition Dental Health Service (DHS) provides financially disadvantaged people with access to non-specialist dental treatment service, including both emergency care and non-emergency care. WA Dental services are provided by DHS dental clinics and the Oral Health Centre of WA (OHCWA) through a contracted service arrangement. This indicator measures the proportion of eligible concession card holders who receive at least one dental treatment of any kind (either general or specialist services) per reporting period. Related Metadata Guide for Use The Numerator and Denominator data are grouped and reported by Health Service level such as North Metropolitan Health Service (NMHS), South Metropolitan Health Service (SMHS) and WA Country Health Service (WACHS) as indicated by the LGA (Local Government Area) address of the concession card holders. Denominator data is obtained from Centrelink on a quarterly basis. This data contains the number of eligible concession card holders in WA by LGA, age group and Aboriginality status. As per the Department of Health Operational Directive 0329/11, the use of the term “Aboriginal” within this document refers to Australians of both Aboriginal and/or Torres Strait Islander people. Data linkage (via Data Linkage Unit, DoH) will be required to match individual patients in the DHS data with those in the OHCWA data to ensure individual patients are not double counted in the combined Numerator data. Limitations It is optional for customers to identify as Aboriginal so this limitation should be considered in any application or use of the concession card holders Aboriginal status information. The Aboriginal status data may represent an undercount.

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Data is grouped to Health Service level based on customers’ residential postcodes and LGA address. In a small number of cases the residential postcode is reported incorrectly or blank. These unknown LGA cases will be excluded. The data linkage process uses a probabilistic matching methodology. Service events that are likely to belong to the same person are matched based on a series of patient identifying information. Reported Data Validation Items Format Percentage 7 NNN.NN% Data Values Inclusions All target WA population (eligible Concession Card Holders) accessing dental care by group: a) Aged 16 years and over; b) Aged 65 years and over; and c) Total Aboriginal population including concession card holders of all ages, identified with Aboriginality status.

The concession cards include:  Health Care Card;  Pensioner Concession Card Exclusions  For part a) Eligible Concession Card Holders aged less than 16 years old are excluded.  The eligible Concession Card Holders with unknown Aboriginality status are excluded for examination for the group c (total Aboriginal population).  Commonwealth Senior Health Care Card holders.  The eligible Concession Card Holders with postcode address of ‘unknown’ within the Centrelink data file.  Residents with postcodes not within WA. Scope  Dental Health Service (DHS)  DoH contract provider: Oral Health Centre of WA (OHCWA) Formula Numerator Count of the number of eligible concession card holders who receive at least one dental treatment of any kind (either general or specialist service) from either Dental Health Service (DHS) or Oral Health Centre

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of WA (OHCWA) per reporting period from subsidised dental programs. Exclude Commonwealth Senior Health Care Card holders. Exclude eligible Concession Card Holders with postcode address of ‘unknown’ within the Centrelink data file. Exclude clients with postcodes not within WA. Then, for each sub-category: a) aged 16 years and over Exclude clients less than 16 years of age. b) aged 65 years and over Exclude clients less than 65 years of age. c) total Aboriginal population Exclude eligible Concession Card Holders with not Aboriginal or unknown Aboriginal status.

Denominator Count of the number of eligible concession card holders. Exclude Commonwealth Senior Health Care Card holders. Exclude eligible Concession Card Holders with postcode address of ‘unknown’ within the Centrelink data file. Exclude clients with postcodes not within WA. Then, for each sub-category: a) aged 16 years and over Exclude clients less than 16 years of age. b) aged 65 years and over Exclude clients less than 65 years of age. c) total Aboriginal population Exclude eligible Concession Card Holders with not Aboriginal or unknown Aboriginal status. Calculation Numerator for each group [by a) aged 16 years and over; b) aged 65 years and over; and c) total Aboriginal population)] divided by Denominator for each group [by a) aged 16 years and over; b) aged 65 years and over; and c) total Aboriginal population)] respectively, expressed as a percentage by each group. Verification Rules Value is between zero and one hundred (100) percent inclusive. Data Collection Identification Items Source  Dental Health Services Patient Management System;  Oral Health Centre of WA Patient Management System;  Centrelink - Number of Concession Card Holders.

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Governance Items Purpose of the Used to measure of the proportion of WA eligible concession card data holders accessing dental care. Source of the Performance Activity and Quality Division, Department of Health; and Definition Dental Health Service

Version number 1.1 Approval date 20130719

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2.6 Sustainability Workforce (SW) KPIs

There are 6 SW PIs proposed in the 2014-15 PMF, including 1 outcome measure.

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SW3: Staff turnover Reported Data Description Items

Identifier MDG-06-009 Name Monthly Staff Turnover

Aliases . Resignations

. Employee-initiated turnover Definition The total number of permanent employee-initiated resignations during the month as a proportion of the total number of permanent employees (head count) as of the last day of that month. Related Metadata

Guide for Use Relates to permanent employees only. Resignations are determined by the employee status reason in the employee detail table. The date of the resignation is determined from the employee termination date. Employees can be employed in multiple jobs across multiple account codes and locations. Limitations There will be some instances where employees resign from one position and commence a new job within WA Health. Figures provided will therefore include the movement of staff across hospitals and entities within the Department. As the information is extracted from the employee detail table the information (e.g. account code and location) will refer to as at the time of extraction. For this reason, historical information will not be updated. See also Guide for Use.

Reported Data Validation Items

Format Numeric 4 NNN.N Data Values Inclusions Numerator Employee Status Reason Description is “RESIGNED” Valid termination date Permanently employed staff

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JobTypeInd Job Type Description P Permanent

Denominator Permanently employed staff JobTypeInd Job Type Description P Permanent

Exclusions Office of Health Review Peel Health Campus Joondalup Health Campus Mental Health Commission WA Drug and Alcohol Office

All job types other than permanent JobTypeInd Job Type Description B Board member C Casual E Trainee NULL Not specified O Other S Sessional T Fixed term

Scope All permanent employees within WA Health Staff turnover is reported by WA Health major locations. For a particular report, please refer to that report’s scoping to determine which major locations are included. Formula Count of employee-initiated resignations during the calendar month divided by the total number of employees (head count) as at the

end of that month expressed as a percentage.

Verification Rules Values >= 0% and <=100% Data Collection Identification Items

Source Human Resource Data Warehouse (Employee Detail Table).

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Extract is taken on the second week of the month following the end of the report period. Governance Items

Purpose of the data To report the staff turnover of the WA Health workforce. Source of the Workforce Modelling and Data, Workforce Directorate, Department definition of Health. Version number 2.1 Approval date 20130605

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2.7 Processes Coding (PC) KPIs

There are 3 PC PIs proposed in the 2014-15 PMF, including 1 outcome measure.

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PC2a&b: Percentage of cases coded and available for reporting within: (a) 2 weeks and (b) 4 weeks

Reported Data Description Items Identifier MDG-01-019 Name Percentage of cases coded and available for reporting within boundary Aliases Cases coded within boundary Definition The percentage of all inpatient discharge records which have been clinically coded, transmitted to the Hospital Morbidity Data Collection (HMDC), and cleared from a range of quality edit processes within boundary. Related Metadata . Total Separations . Submitted Cases . Coded Cases Guide for Use This indicator reports the percentage of cases coded within the boundary days from the date of separation, in accordance with the required performance stated in Operational Directive 0137/08 ‘Hospital Morbidity Data Reporting Cycle’ for WA public hospitals (excluding Joondalup and Peel Health Campuses). Numerator A count of coded inpatient records from the Hospital Morbidity Data Collection (HMDC) that have been cleared from a range of quality edit processes, and were coded within the boundary period. A case is determined as being coded when the coded record is extracted from the feeder system (i.e., TOPAS, HCARe, and webPAS) for the morbidity extract, submitted to the HMDC, and has passed HMDC quality edit checks - that is, the record has a status of ‘Complete’ in HMDC, and is therefore available for reporting. Cases with a status other than ‘Complete’ (e.g., ‘Pending’, ‘Error’) have not passed the HMDC quality edit checks and are subject to the protocol described in Operational Directive 0136/08 ‘Edit Protocol for Hospital Morbidity Data System’). Records can be coded at any time; however, the ‘coded date’ attributed to a coded case is the date that it is extracted from the feeder system for the morbidity extract sent to the HMDC (i.e., [extract date]). The number of days taken to code a case ({days to code}) is therefore the number of days between the [separation date] and the [extract date]. The {days to code} is assessed against the {boundary period} + {days since the previous extract} to determine timeliness of coding. The {boundary period} is the number of days required for coding to be

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completed according to the Operational Directive 0137/08 (i.e., 2 weeks/4 weeks or 8 weeks in the case of small/remote hospitals). The {days since the previous extract} is the number of days between the latest morbidity extract, and the immediate prior morbidity extract generated from the feeder system. This is to take into account the cases that were coded in the time since the last extract was taken from the source system. This is further explained under “Limitations.” Denominator A count of records from inpatient discharge extracts. This extract contains details of all inpatient discharges, irrespective of status of clinical coding. Cases are matched between numerator and denominator using Hospital Number (Establishment Code) and Account Number. Some contract cases (e.g., Renal Dialysis funded by public hospitals) may not have been entered into TOPAS, HCARe, or webPAS when the discharge extracts were generated. These cases are entered by hospitals at a later date and would eventually be submitted to HMDC. At times, as a result of different extract timing between discharge extracts and morbidity extracts, there would be some discrepancies between the discharge extract and morbidity extract. In order to accommodate these discrepancies, the denominator is supplemented with the cases in the numerator that are absent from the denominator by linking with Establishment Code and Account Number. Reporting using this definition cannot be performed until the {boundary period} and {days since the previous extract} has elapsed, i.e., the date the report is generated needs to be greater than [Separation Date] + {Boundary Period} + {days since the previous extract}. Limitations Replacement cases Replacement cases: A small proportion of cases can be replaced or updated after acceptance into the HMDC. The most recent case with a status of ‘Complete’ is counted in the numerator, and therefore the extract date for the most recent case is used to calculate {days to code}. This means that when a case is resubmitted for an already ‘Complete’ case in the HMDC, the {days to code} will become longer for that case. To the extent that sites resubmit completed cases, this will impact on the percent coded-in-time result. For this reason, when this indicator is reported, the date the data is extracted from the HMDS and the date(s) that the discharge extracts are generated should be stated in the report for reference. Private hospitals This indicator excludes private establishments (e.g., Joondalup and Peel Health Campuses, Next Step Drug and Alcohol Services) because morbidity extracts from private hospitals are received on a monthly basis containing 100% of cases from the previous month.

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The data from Next Step Inpatient Withdrawal Unit are not included because the inpatient discharge extracts are not available and the morbidity extracts are received on a monthly basis. Separation date Cases in the numerator have passed quality control checks and may have required modification by the Health Services prior to acceptance into the HMDC. Based on current processes it is possible for these changes to be reflected in the numerator prior to the denominator. Therefore, if alterations are made to the separation date it is possible to have differing dates between the numerator and denominator. In these circumstances, the date in the numerator is considered correct and used when available. [Extract date] and {days since the previous extract} Records can be coded at any time; however, the ‘coded date’ attributed to a coded case is the date that it is extracted from the feeder system for the morbidity extract sent to the HMDC (i.e., [extract date]). Before 01 April 2010, morbidity extracts were sent from TOPAS and HCARe on a weekly basis. From 01 April 2010, morbidity extracts for the HMDC are generated from the feeder systems (TOPAS, webPAS, and HCARe) on different schedules. TOPAS and webPAS morbidity extracts are currently generated daily, while HCARe extracts are currently generated twice a week, on Sunday and Thursday. {Days to code} is the number of days between the [separation date] and the [extract date]. The {days to code} is assessed against the {boundary period} + {days since the previous extract} to determine timeliness of coding. The {boundary period} is the number of days required for coding to be completed according to the Operational Directive 0137/08 (i.e., 2 weeks/4 weeks). The {days since the previous extract} is the number of days between the latest morbidity extract, and the prior morbidity extract generated from the feeder system. Because the ‘actual’ coded date for each record is not available in the extract, and the [extract date] from the source system is used as the coded date, the {days since the previous extract] must be taken into account to ensure that cases that were ‘actually’ coded between the last extract and the extract prior are assessed fairly against the {boundary period}. Before 01 April 2010, morbidity extracts from all source systems were received weekly; therefore, if this indicator is calculated for separations prior to 01 April 2010, {days since the previous extract} = 7. From 01 April 2010, for TOPAS and webPAS, the {days since the previous extract} is always 1 day, as the extracts are taken daily. For

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HCARe, if the most recent morbidity extract was taken on Sunday then the {days since the previous extract} (taken on Thursday) is 3 days; if the most recent morbidity extract was taken on Thursday then the {days since the previous extract} (taken on Sunday) is 4 days. The [extract date] for each record is obtained from the date in the file name of the source system extract in which the record was extracted (0105IS620140128.0100 is an example of a file name – the underlined component is the extract date in YYYMMDD format). The [extract date] given in the file name corresponds with the actual date of extraction, except for the HCARe morbidity extract taken on Sunday. Due to the steps required between extraction from the source system and loading into HMDC, the HCARe extract taken on Sunday is given an [extract date] of the next day (Monday). Therefore, the calculation for {days to code} for records from the Sunday HCARe morbidity extracts needs to subtract an additional 1 day to reflect the actual [extract date]. Current Morbidity Extract Schedule (from 01 April 2010 onwards)

[Extract date] used as ‘coded date’ TOPAS & Weekday HCARe webPAS Sunday   (refer to ‘limitations’) Monday  Tuesday  Wednesday  Thursday   Friday  Saturday  To determine which boundary period rules to apply to which record the [Feeder System] field is used. This field contains a two character code identifying which feeder system the record came from. TOPAS sites will have a code starting with ‘T’, ‘S’, or ‘R’; HCARe sites will have a code starting with ‘H’ or ‘J’; webPAS sites will have a code starting with ‘W’. The time period that has elapsed between separation dates and the submission of a coded case does not include an additional 1 day period required for the assignment of DRG.

Reported Data Validation Items Format Percentage 7 NNN.NN%

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Data Values Inclusions Numerator HMDC records: Record Status HMDC Complete C

Before 01 April 2010, for records from all feeder systems: Include cases where, {days to code} <= {boundary period} + {days since the previous extract} Where: {days to code} = [extract date] – [separation date] {boundary period} = 14 / 28 / 56 days {days since the previous extract} = 7 days From 01 April 2010: HMDC records from TOPAS and webPAS sites Where the first character of [Feeder System] = ‘T’, ‘S’, ‘R’, or ‘W’, include cases where {days to code} <= {boundary period} + {days since the previous extract} Where: {days to code} = [extract date] – [separation date] {boundary period} = 14 / 28 / 56 days {days since the previous extract} = 1 day HMDC records from HCARe sites Where the first character of [Feeder System] = ‘H’ or ‘J’, include cases where {days to code} <= {boundary period} + {days since the previous extract} If [extract date] is Sunday (i.e., extract file has a Monday date) then apply the following calculations: {days to code} = [extract date] – [separation date] – 1 day {boundary period} = 14 / 28 / 56 days {days since the previous extract} = 3 days If [extract date] is Thursday then apply the following calculations: {days to code} = [extract date] – [separation date] {boundary period} = 14 / 28 / 56 days {days since the previous extract} = 4 days

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Denominator All records from TOPAS, HCARe, and webPAS inpatient discharge extracts and coded records which do not have a corresponding discharge record when matching on [Establishment Code] and [Account Number]. HMDC records where there is no corresponding discharge record when matching on [Establishment Code] and [Account Number].

Exclusions Numerator/Denominator . Next Step Inpatient Withdrawal Unit cases o Establishment Code = 0459 Numerator HMDC records: Record Status HMDC Deleted D Data Entry E In Progress I Modify M New N Pending P Replaced R Removed V Error X

. Duplicate records: Cases with identical [Establishment Code] and [Account Number] combinations. In the event of cases with identical [Establishment Code] and [Account Number] combinations, the case with the latest batch and case number is kept. Denominator . HCARe discharge extract only. Flag HCARe discharge extract Reversed/Cancelled C

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. Duplicate records: Cases with identical [Establishment Code] and [Account Number] combinations. In the event of cases with identical [Establishement Code] and [Account Number] combinations, the case with the latest Separation Date is kept. Scope . Public hospitals (metropolitan and rural), excluding Next Step Inpatient Withdrawal Unit. . Excludes Joondalup and Peel Health Campuses. Formula Numerator Count of the number of HMDC records with a [separation date] within/equal to the start and end date of the reference period and ([separation date] + {boundary period} + {days since the previous extract} <= date the report is run) and where [record status] = ‘C’ and {days to code} <= {boundary period} + {days since the previous extract}.

Denominator Count of the number of TOPAS, HCARe, and webPAS inpatient discharge records with a [separation date] that is within/equal to the start and end date of the reference period and ([separation date] + {boundary period} + {days since the previous extract} <= date the report is run)

For HCARe inpatient discharge records only: and where [Flag] is not equal to ‘C’.

Plus count of the number of HMDC records with a [separation date] that is within/equal to the start and end date of the reference period and ([separation date] + {boundary period} + {days since the previous extract} =< date the report is run) and where [Record Status] = ‘C’ and there is no corresponding discharge record when matching on [Establishment Code] and [Account Number].

Calculation Numerator divided by denominator, expressed as a percentage. Verification Rules 0 -100% inclusive.

Data Collection Identification Items Source Discharge extracts TOPAS Extracted Monday/ Tuesday. webPAS Extracted Monday. HCARe Extracted Monday / Tuesday.

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HMDC Extracts Extracted as required. (HSECS ‘Dirty Side’)

Governance Items Purpose of the data This information is used in hospital statistics, resource utilisation, budgetary allocation, clinical auditing and research, and reporting to external organisations. This information is used to measure the performance of clinical coding at public hospitals. Source of the . Inpatient Data Collections definition . Operational Directive 0137/08 ‘Hospital Morbidity Data Reporting Cycle’ Version number V1.1 Approval date 20141021

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2.8 Processes Finance (PF) KPIs

There are 5 PF PIs proposed in the 2014-15 PMF, including 2 outcome measures.

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PF2: Manually corrected payroll errors (Underpayments)

Reported Data Description Items Identifier (office use only) Name Manually Corrected Payroll Errors Aliases Definition The number of underpayments registered that are a result of an EFT being processed in the system Related Metadata

Guide for Use: The bench mark for acceptable number of manually corrected payroll errors is 1.0% of the total payroll. The report distinguishes between where the causes of the errors have originated ie Employee Benefits, Site and Employment Services. Limitations The report is based on data recorded of urgent out of cycle payments processed for employees via Electronic Funds Transfer (EFT), in accordance with a register. The data does not take into account any of the payments processed in the normal pay cycle where an underpayment was identified and processed in the following pay.

This same register records Overpayments Data. Health Corporate Network normally report Overpayments separately. Again they are manually recorded errors that go through the formal overpayments process and not adjustments to pay that are processed as part of the usual Payroll Cycle.

Reported Data Validation Items Format Numeric values as a percentage of the Payroll, in Microsoft Excel format. 5 NNN.NN% Data Values >=0% or <=100% Inclusions Different payroll teams – NMHS, WACHS, SMHS, CAHS and Alesco. Exclusions Number of underpayments as they do not require an EFT. Scope Public WA Health Sites and Hospitals (metro and rural) Underpayments that require a manual EFT Formula: Numerator Total number of manually corrected pays Denominator Total number of electronic funds Verification Rules >=0% or <=100%

Data Collection Identification Items Source Lattice and Alesco Human Resource Information Systems - where the transactions trigger a reason for raising an Electronic Funds Transfer (EFT).

Data collected is manually entered into a Register which is in Microsoft Excel format and extracted for reporting.

Governance Items Purpose of the data Used to measure the number of EFT’s created due to an underpayment in the normal pay cycle, we can determine which

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pay team is processing the most EFT’s and the underlying reason for the underpayment. Source of the definition Health Corporate Network – Employee Benefits Version number 1.1 Approval date 20130605

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PF3: Availability of information communication technology (ICT) services: percentage of Service calls resolved at first point of contact

Reported Data Description Items

Identifier (office use only)

Name Percentage of information communication technology (ICT) service calls resolved at first point of contact. Aliases First point of contact (FPOC) Definition The scope of this KPI is defined by the users who contact the HIN Service Desk who are primarily from the metropolitan area and is defined by the number of service calls resolved at first point of contact divided by total number of service calls logged by a member of the HIN Service Desk. Related Metadata HIN (completed in Properties) ICT service calls

Guide for Use: The Service Desk is the first and single point of contact for customers to engage the IT Services offered by HIN (Health Information Network).

ICT service calls logged by the HIN Service Desk are initiated by (phone or email) contact with the HIN Service Desk.

ICT service calls are comprised of IT service faults and difficulties reported by WA Health users.

Service calls can also include:  Incident (fault) - these are breaks or degradation detected by a Caller in a managed IT service.  Request for change - this is a request to change the state of a Configuration Item (CI) for reasons such as enhancement, etc.  Request for information - this type of request is a “how to” type question.  Request for service - this is a request for a particular service (e.g., account creation, password reset, desktop installation etc).  Feedback - this can be a complaint, compliment, suggestion or comment about the service provided by WA Health IT groups or their suppliers.

Web logged service calls via the on-line form are not included in this KPI.

Limitations  Incomplete information provided by caller/requestor  Reliance on HIN Service Desk officer to tick the resolved at 1st contact tick box.  Program error/bug

Reported Data Validation Items

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Format Percentage KPI Value Numeric Numerator Numeric Denominator Data Values Inclusions Exclusions Scope Initiated by users who contact the HIN Service Desk. Excludes DAO / Path West / Dental Health / WACHS country sites

Formula: Numerator Number of ICT service calls resolved at first contact. Denominator Number of ICT service calls logged in HP Openview by a member of the HIN Service Desk. Verification Rules

Data Collection Identification Items Source HP Openview – IT Service Management system where ICT Service Calls are logged and managed.

Governance Items Purpose of the data A measure of the ICT service calls resolved at first point of contact for ABF/ABM Performance Management Reports. Source of the definition Version number 1.2 Approval date 20140423 (Noted by PRGC)

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