Patient Pattern Management Terms Explained

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Patient Pattern Management Terms Explained

Note: Your Staff Manager configuration may not include this optional application. To add this application to your configuration, contact your Clinical Consultant or Client Advocate.

You will understand patient pattern management better if you become familiar with the following key terms.

Demand Manager Terms

The following terms are specific to Demand Manager.

Care Level Length of Stay: An interim length of stay based on the duration in a level of care group.
Care Phases: Segments of a pattern. Care phases have start and end times based on ADT transactions. A new phase begins when the patient’s location or level of care group changes.
Departure: The date and time the patient leaves the current nursing unit (for location-based patterns) or level of care group (for patterns defined by level of care).
Length of Stay (LOS): The duration of a patient's stay as measured by care level, care phase, total (admission to first inpatient unit through discharge), or a combination thereof.
Level of Care Groups: One or more nursing units, defined by your organization, as like units based on the relative intensity of service or nursing care provided. For example, an organization might put all critical care units in a level of care group called Critical Care. Each nursing unit may be associated with one level of care group. Levels of care are used to define library patterns by level of care duration.
Pattern: An outline of a patient’s entire hospital stay that, at a minimum, is defined by location and duration. Demand Manager uses several different pattern types.
- Library Pattern: Every pattern starts as a library pattern: an average length of stay defined for patients with similar characteristics. Library patterns are automatically assigned to patients based on data received by Staff Manager from a Registration import interface, or from data updated directly by users in Staff Manager, at which point they become the patient's expected pattern. Library patterns may be used for comparison purposes. You can see library patterns on the Pattern Library page. There are several types of library patterns.
  - Criteria Pattern: Any DRG or Non-DRG-based library pattern. Criteria patterns include:
    - Diagnosis Related Group (DRG)-based Pattern: A library pattern that aligns exactly to the current Standard Total LOS for a DRG. Examples of Standard DRG classifications include Medicare Severity DRG (M-S DRG) and All Patient Refined DRG (APR-DRG). Each facility may define up to two DRG-based patterns; for example, a facility may use a Standard DRG-based pattern based on Medicare and a Custom DRG-based pattern based on best practices (see Custom DRG-based Pattern following). DRG-based patterns are date dependent, meaning they have a start date and may have an end date, to support changes to the expected length of stay over time.
    - Custom DRG-based Pattern: A library pattern that aligns to the current LOS goals and best practices of the organization for a DRG. A modification to a Standard DRG pattern creates a Custom pattern; for example, adding a level of care group or altering the Standard TLOS creates a custom pattern.
    - Non-DRG-based Pattern: A library pattern that aligns to the current LOS goals and best practices for one or more ICD codes, Diagnoses, or Admit Reasons.
  - Location-Based Pattern: A library pattern defined by location. There are two types of location-based patterns: Location Patterns, which are library patterns that align to the average LOS for a location, and Location-Service Patterns, which are library patterns that align to average LOS goals for a location and new hospital service combination.
  - Actual Pattern: The patient-specific record that captures the location and duration of each patient's stay, regardless of the library pattern assigned. This record may be compared to the library pattern and to the expected pattern (see Expected Pattern following) to analyze variances in LOS by level of care, total length of stay, or both. Actual patterns include the patient's past up to the present moment or discharge.
  - Expected Pattern: The complete pattern associated with a patient at any point in time to which a patient's actual pattern is compared. It may be identical to a library pattern or may have been edited by a user. User edits to the departure and discharge dates for each patient create expected patterns. Edits update goals for departure from the current nursing unit or level or care and hospital discharge. For patients that have not yet been discharged, the future portion of the patient's pattern is the expected pattern.
Pattern anchor date: The date and time the patient arrives in the first inpatient nursing unit. This date and time marks the start of the patient's progress pattern.
Pattern Assignment Criteria: Data elements used to assign and manage library patterns for each patient. Assignment criteria are hierarchical for initial pattern assignment starting with DRG Code (admitting, working or final), primary ICD code (admitting, working, or final), diagnosis (admitting, working, or final), procedure, admit reason, and location (when no criteria are received or matched to a library pattern). Criteria may be received from a Registration import interface or users may update the data directly in Staff Manager.

Standard Terms

The following terms are used throughout the health care industry.

Case mix: The type or mix of patients treated by a hospital or unit.
Case Mix Index (CMI): The average diagnosis-related group weight for a hospital's entire Medicare volume. The CMI can be used to adjust the average cost per patient (or day) for a given hospital relative to the adjusted average cost for other hospitals by dividing the average cost per patient (or day) by the hospital's calculated CMI. The adjusted average cost per patient would reflect the charges reported for the types of cases treated in that year. If a hospital has a CMI greater than 1.00, their adjusted cost per patient or per day is lowered and, conversely, if a hospital has a CMI less than 1.00, their adjusted cost is higher.
Diagnosis-related group (DRG): A system to classify hospital cases into one of approximately 500 groups, also referred to as DRGs, expected to have similar hospital resource use. The application was developed for Medicare as part of the prospective payment application. DRGs are assigned by a grouper application based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the United States since 1983 to determine how much Medicare pays hospitals, since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). There are several different DRG applications, including
- Medicare Severity DRG (MS-DRG)
- All Patient DRGs (AP-DRG)
- All Patient Refined DRGs (APR-DRG)
ICD Codes: The International Statistical Classification of Diseases and Related Health Problems (ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this application, every health condition is assigned to a unique category and given a code. Each code is up to six characters long. These categories include similar diseases. ICD codes are used for morbidity and mortality statistics, reimbursement applications, and decision support.
Major Diagnostic Categories (MDC): Categories formed by dividing all possible principal ICD diagnoses into 25 mutually exclusive diagnosis areas; the first step in assigning a specific DRG to a pattern. The diagnoses in each MDC correspond to a single organ application or etiology and are, in general, associated with a particular medical specialty. MDCs provide high order categories to focus on entire body applications. Each non-location-based Library pattern is associated with an MDC. The MDC is used for reporting purposes.
Total Length of Stay (TLOS): The number of calendar days a patient stays in the hospital from arrival to the first inpatient unit to discharge.