92917 Using Health Care Data for Decision Making
Course area UTS: Health
Delivery Autumn 2015; block mode; City
Subject
Professional studies subject classification
Credit points 6 cp
Result type Grade and marks
Attendance: intensive mode
Subject coordinator
Michael Roche
Room: CB10.07.220
Tel: (02) 9514 4811
Email: Michael.Roche@uts.edu.au
Coordinator contact details
It is preferable that students contact the lecturer via email as he is often out of the office. Responses to emails will usually be sent within 48hrs (weekends and public holidays excepted). Please indicate on the priority listing of the email if an urgent response is required. As lecturing staff teach in multiple subjects, please indicate the subject code or subject name in the subject heading of the email. Please also be aware that only emails using your UTS Student email account will be read and answered.
Teaching staff
Assessor
Phillip Newton
Room: CB10.06.407
Tel: (02) 9514 2858
Email:Phillip.Newton@uts.edu.au
Subject description
This subject provides a supervised experiential opportunity for the graduate student with an interest in clinical or managerial decision-making in the health services sector to explore and manipulate 'real' patient data to both generate and answer questions. The focus may be managerial or clinical, or an integration of these. Theoretical input is limited to allow for more in-depth use of the database. The subject helps students to develop the ability to generate and answer research questions, and make decisions based on available health sector data.
Subject objectives
Upon successful completion of this subject students should be able to:
A. Access and manipulate supplied data in order to generate reports and make recommendations;
B. Consider the relationship between data, information, knowledge and wisdom and how these elements inform practice, management, and policy in the context of international trends;
C. Examine the relationship between datasets and information literacy;
D. Explain the data elements in contemporary health data terminologies;
E. Create a variety of ways in which complex issues can be effectively communicated for a variety of target audiences.
This subject also contributes specifically to the following graduate attributes:
Propose relevant problem solving and human factors theories to the analysis of common issues inherent in the management and evaluation of healthcare services . (1.2)
Determine and recommend modes of communication necessary to optimise outcomes across differing audiences, purposes and contexts within healthcare practice. (4.2)
Content
The content of this subject includes:
Basic data analysis and presentation in Microsoft Excel
Minimum data sets, classifications and terminologies
Information literacy
Data linkage
Standardisation of data
Health Level 7 (HL7)
Health informatics
Unintended errors in technology
Privacy, security and confidentiality
Project management software & GANTT charts
Program

Grp C - Week 10 Fri 8 May 2015Health informatics
Electronic health record
Unintended errors in technology
Application and reporting of routinely collected data
Assessment
Attendance
The University requires that students attend all 4 study days in this subject and be present for the whole period (9.00a.m. – 5.00pm). Students must inform the subject coordinator if they are unable to attend a study day. If a student is absent he/she will be required to submit makeup material to the lecturer. This material will address the content provided in the lectures and readings of the day, and consist of a series of questions to be addressed. The completed makeup material must be sent to the subject coordinator via email by Friday 5th June 2014. This material will be checked by the subject coordinator as ‘satisfactory’ or ‘not satisfactory’ but will not be marked and no additional feedback will be provided. This work is not counted towards the subject assessment, however makeup material not received by the due date or not meeting a ‘satisfactory’ standard will result in the student’s grade for the subject being withheld. Absence of more than 25% of the study days (1 day) will require the student to withdraw from the subject. NB: Poor attendance may result in failure of the subject.
Referencing style
The Faculty of Health uses the ‘Harvard (UTS)’ style for in text referencing and production of a reference list. Please refer to www.lib.uts.edu.au/help/referencing/harvard-uts-referencing-guide for guidance on this referencing style.
Cover sheets
Assignments 2 is to be completed using the HSM Individual Assignment Template, located in the Assessment Resources portal on UTSOnline. Assignments not using this template will not be marked. Assignment 3 IS NOT to be be completed using this template. Do not include an additional cover sheet.
Labelling assignments
Please label the electronic assignments using the following format for the file name: Student’s last name, first name initial, subject code, assignment no, e.g. Sorensen_R_92917_Ass 1.
Submitting assignments and keeping copies
Assignments must be submitted in MS Word format via the designated assignment portal in UTSOnline.
It is essential that students keep a copy of every piece of work submitted to the Faculty of Health. In the unlikely event of the assignment being misplaced or corrupted, the copy can be provided for marking.
Completion of assignments
All three assessment items must be completed in order to pass this subject.
For online assessments, it is strongly recommended that students print the summary/feedback sheet that is provided at the completion of the assessment.
Academic Integrity & Student Misconduct
Academic integrity is central to the work of the University and is an essential part of the professional identity of graduates from the Faculty of Health. The University Academic Board advises students that academic integrity:
involves a good measure of trust between students, and between students and academic staff…Cheating, whether in the form of plagiarism, bringing unauthorised material into exams, submitting false requests for alternative exams or special consideration, or any other form, is a breach of this trust. Cheating also subverts the aims and value of students' studies. In certain courses, this may have serious consequences for public health and safety. [1]
Plagiarism is defined in the UTS Student Rules as “taking and using someone else's ideas or manner of expressing them and passing them off as his or her own by failing to give appropriate acknowledgement of the source to seek to gain an advantage by unfair means.” [2] It is a serious form of Student Misconduct and can result in harsh penalties.
Plagiarism includes, but is not limited to:
copying words, or ideas, from websites, reference books, journals, newspapers or other sources without acknowledging the source;
paraphrasing material taken from other sources, to change the words but keep the ideas, without acknowledging the source;
downloading material from the internet and including it as part of your own work without acknowledging the source; copying work, such as all or part of an assignment, from other persons and submitting it as your own work;
Cheating includes, but is not limited to:
copying work, such as all or part of an assignment, from other students and submitting it as your own work; purchasing an assignment from an online site and submitting it as your own work;
requesting or paying someone else to write original work for you, such as an assignment, essay or computer program, and submitting it as your own work; unauthorised collusion with students or others and submitting it as your own.
Plagiarism and cheating is completely unacceptable behaviour.
You will need to read and understand the following to assist in understanding your responsibilities for academic integrity and plagiarism at the University:
Avoiding Plagiarism Tutorial: http://avoidingplagiarism.uts.edu.au/index.html
Student Misconduct Definition (Rule 16.2) and Appeals www.gsu.uts.edu.au/rules/student/section-16.html#r16.2
[1] Advice to Students on Good Academic Practice, UTS Academic Board 98/5, Resolution AB98/86, www.gsu.uts.edu.au/policies/academicpractice.html
[2] UTS Student Rules, Rule 16.2 Definition of Student Misconduct,
www.gsu.uts.edu.au/rules/student/section-16.html#r16.2
Assessment task 1: Workbook Exercise
Intent: This assessment item focuses on the elements of administrative data and related key concepts and how to analyse health data.
Objective(s): This assessment task addresses subject learning objective(s):
A, B and D
This assessment task contributes to the development of graduate attribute(s): 1.2 and 4.2
Weight: 20 %
Due: Group A: Opens 16:00 5th March 2015 / Closes 22:00 19th March 2015
Group B: Opens 16:00 6th March 2015 / Closes 22:00 20th March 2015 Group C: Opens 16:00 7th March 2015 / Closes 22:00 21st March 2015
Length: Online assessment using the supplied spreadsheet and other resources
Task: 1. Students are to answer a series of questions via UTSOnline. A selection of multiple choice,
multiple answer, true/false, matching statements, short text response, and ordering questions may be included. Questions may:
require manipulation of the supplied UTS Hospital data using Microsoft Excel;
require access to sources on the International Classification of Diseases and the list of Australian Refined Diagnosis Related Groups, available through the UTS library and/or UTSOnline; relate to casemix, including, but not limited to, AR-DRGs; relate to basic statistical concepts; relate to important concepts and definitions.
Students will receive feedback and grades via UTSOnline.
Criteria: 10 % Accesses data in a supplied dataset to address questions and generate information
25 % Determines relevant elements in contemporary health data terminologies to guide data analysis
25 % Selects the most appropriate technique to analyse data
40 % Justifies conclusions from data analysis to inform practice and guide management decisions
Assessment task 2: Short Statements
Intent: This assessment item focuses on the ability to concisely respond to specific questions and to demonstrate an understanding of the management and application of health data.
Objective(s): This assessment task addresses subject learning objective(s):
B, C, D and E
This assessment task contributes to the development of graduate attribute(s):
1.2 and 4.2
Weight: 30 %
Due: 10.00 pm Friday 17 April 2015
Length: Maximum 1500 words
Task: 1. Read the following case scenario.
2. Provide a response to each of the five sections that demonstrates an understanding of the application and management of health data and refers to literature related to the identified issues and associated tasks.
3. In each response, apply your findings to the hospital so as to assist the executive group in decision making and planning.
Case Scenario – UTS Hospital
UTS hospital is a well-established charitable hospital operated on a not for profit basis. It has 250 beds in an inner-city location. The population of the local community, from which it draws the majority of its patients, is ageing: 40% are over the age of 65 years. UTS hospital has an excellent reputation for innovative care, rapid uptake of new technologies, teaching and research. It gets very little support from the government for running costs, although previous governments have been generous in meeting the cost of new buildings and refurbishing old buildings.
The hospital is in financial difficulty. Over 90% of the funding to the hospital for acute inpatients comes from private health insurers. The remainder is from the Department of Veterans Affairs, patients who pay for their own admissions, compensable patients from motor vehicle and workplace insurance and patients whose stay is paid from a research grant. The rate of reimbursement from private insurers is based on a negotiated rate for each AR-DRG. Each insurance fund negotiates the rate it pays for each AR-DRG individually each year with the hospital. The fees are based on the average length of stay for each AR-DRG using the Australian cost weights.
The Chief Executive Office (CEO) has called a special meeting of the executive to discuss the issues facing the hospital and to plan the action they need to take. Present at the meeting are the Director of Nursing (DON), the Chief Financial Officer (CFO) and the Chief Information Officer (CIO).
1. The DON suggested that the problem is that casemix funding using AR-DRGs are not the best method to record performance because they do not suit the type of patients treated by UTS Hospital. She said that the majority of patients are older and more complex, and need to stay longer than the average length of stay for each AR-DRG. She suggested that DRGs are useless for measuring the hospital’s performance when the length of stay of the patients was different to that of the average hospital. She was of the view that the hospital should go back to the
insurance funds and negotiate a return to the funding of patients on a per diem basis (based on the national average bed day cost).
Provide a short statement (~ 300 words) for the executive that identifies the pros and cons of funding on a flat per diem rate compared to funding on a DRG basis. Provide the executive with a recommendation.
2. The CIO disagreed that the age and complexity of the patient made the DRG system useless. He noted that there were many examples where older patients or those with more complex care, that needed a longer length of stay, had been classified into a different AR-DRG. UTS hospital is using AR-DRG version 5, and he was not sure if this was the most recent version.
Provide a short statement (~300 words) with two or three examples of where the DRG had been split to allow for patients of different age or complexity in the most recent version of AR-DRGs in use in Australia. Given the nature of UTS Hospital’s patients, outline to the executive the implications of changing AR-DRG versions.
3. The CIO was also sceptical of the practices of the coding staff: that the AR-DRGs assigned to episodes of care may not be the appropriate one. He suggested that clinical coders might not always select the correct diagnostic and procedure information from the notes, leading to incorrect classification.

Provide a short statement (~300 words) that identifies potential issues with coding practices, including the potential rate of incorrect codes, suggested causes, and ramifications. Identify potential solutions for the executive to implement to address the issues identified.
4.
The CFO expressed the view that it was not incorrectly classified AR-DRG, age or complexity of the patients that was the problem. She noted that the average length of stay was exactly that – an average – and because UTS hospital patients were old and complicated they were likely to stay longer than average and be on the expensive side of the average cost for a given AR-DRG.

Provide a short statement (~300 words) that identifies one or more potential issues with using the average for a measure of central tendency. Describe for the executive how this issue (or issues) may be addressed in casemix (AR-DRG) funding approaches.
5.
The CEO said that there was no reason to believe that UTS hospital patients in a given AR-DRG classification were older or more complex than the patients in the same AR-DRG at a different hospital. He noted that there were established methods in use to compare the performance of similar hospitals.

Provide a short statement (~300 words) on the way peer hospitals are compared within Australia. Identify, for the executive, the areas of the hospital or type of patients where there could be a particular issue with falling outside the benchmarks, and the implications for the hospital.
Criteria: 20 % Defends the advantages and disadvantages of casemix and per-diem funding and their potential impact on a hospital
10 % Explains the different approaches to resource splits in AR-DRGs
20 % Considers data quality and accuracy challenges inherent in health communication such as medical coding, medical notes and discharge summaries
20 % Compares contemporary measures of central tendency and selects appropriate techniques to address issues in health service provision
20 % Judges the current use of peer group hospital comparisons
10 % Produces correct grammar, spelling, formatting, style and referencing
Assessment task 3: Analysis of supplied patient data
Intent: This assessment item focuses on the development of data analysis and presentation skills in order to make recommendations that are congruent with contemporary literature.
Objective(s): This assessment task addresses subject learning objective(s):
A, B, D and E
This assessment task contributes to the development of graduate attribute(s):
1.2 and 4.2
Weight: 50 %
Due: 10.00 pm Wednesday 20 May 2015
Length: Maximum 2500 words
Task: You have been engaged as a consultant to the Local Health District (LHD). The LHD governing
council requires you to develop a report based on the ‘UTS Hospital’ data to address issues related to Outlier Admissions (patients with a length of stay over 30 days) . The governing council is primarily interested in the analysis, and expects clear recommendations that apply to, and are implementable by, ‘UTS Hospital’.
1. Locate the UTS Hospital data file from the Data Files folder in UTSOnline.
2. Produce a written report no longer than 2500 words for the LHD council based on the supplied data (UTS Hospital data file) and the following topic items that includes tables or graphs as appropriate (for example, to show comparisons). NB The word limit excludes tables and appendices.
3. The report must contain a data analysis strategy, the analysis, and appropriate reference to the literature.
Topic Items
1. With reference to Australian and overseas literature, briefly describe:
the current percentage of patients who stay longer than expected for their AR-DRG, including those identified as outlier admissions
factors (internal and external) likely to influence length of stay
approaches used to prevent outliers and reduce length of stay for these admissions
2. Analyse the UTS Hospital dataset as follows:
i. Create a profile of outlier patients (those who stay more than 30 days)
a. include both individual and episode characteristics (e.g. age and others you identify in the literature)
b. include the proportion of the dataset that these patients comprise
c. compare this to a profile of all patients in this dataset
ii. For outlier patients:
describe the most common individual and episode variables that occur in these long stay cases
identify the most common principal and secondary diagnoses identify the most common principal and secondary procedures
compare the length of stay of outlier patients to non-outlier patients in the same (or related) AR-DRG and/or the same MDCs
3. Based primarily on your analyses, but with reference to the literature:
identify important points that might suggest interventions to reduce the length of stay for outlier
patients
make specific recommendations to reduce the number of outliers and reduce their length of stay
Requirements / Notes
1. Investigate the issues by:
researching the issue in the literature designing a data analysis strategy conducting the analysis making recommendations
2. Appropriately reference all material, however you do not need to reference the supplied dataset.
3. Ensure you read the marking criteria.
4. Develop an understanding of each of the data elements in the dataset. Do not limit your analysis to the most obvious variables.
5. The supplied dataset is relatively small so it is not expected that the analyses here would be definitive. You are expected to treat the dataset as if there were more cases than there actually are, so that the solutions you may suggest should be considered to be more valid than they will actually be with this selection of data. You do not need to note this in the report.
6. Secondary diagnoses are defined as any diagnosis after the principal.
7. Appendices may be included but will not contribute to the grade for this assessment
8. Report formats vary, but usually contain:
Introduction
Background / Literature
Method / Data Analysis Strategy
Results / Findings
Discussion & Recommendations Conclusion.
Criteria: 10 % Constructs a review of the literature to identify and discuss issues relevant to the topic
20 % Designs a clear and logical data analysis strategy that is logically sequenced and structured and addresses the points raised in the topic
20 % Performs an analysis of the supplied data in a manner consistent with the data analysis strategy to provide appropriate answers to the points raised in the topic
30 % Recommends contemporary and achievable approaches to address the points raised in the topic
10 % Validates perspectives through correct interpretation of relevant and current literature ( year 2003)
10 % Produces correct grammar, spelling, formatting, style (report) and referencing
Use of plagiarism detection software
Students are reminded that all written work must be their own original work. Please refer to http://web.uts.edu.au/teachlearn/avoidingplagiarism/ for information on avoiding plagiarism. Students should
familiarise themselves with the Turnitin report to ensure that their assignment conforms to academic referencing standards.
As a quality check for written assessment items, students are required to utilise the plagiarism detection software Turnitin, which compares submitted assignments with documents located on the Internet and a database of published material; and all assignments previously submitted to Turnitin. The results are compiled into an 'originality report' that generates an index of similarity with other documents. For example, a similarity index of 10% indicates that 10% of an assignment matches material that Turnitin has located electronically. Students should check the report carefully prior to submission of their assessment item for marking to ensure that material that is not original is appropriately referenced.
Students should ensure enough time is left for the software to generate an originality report before the assessment item due date. A late Turnitin report is not grounds for extension of an assessment item.
Moderation of marks
As assignments in this subject will be marked by more than one marker, the Faculty may need to modify marks to ensure consistency in marking across all assignments. Should moderation of marks be necessary, it will be completed prior to marks being released to students.
Assessment feedback
The assessment for this subject is criterion referenced. This means each student’s performance is measured against a set of criteria, not against the performance of other students. The criterion allows students to gauge how well he or she is able to meet the objectives of the subject. Marking criteria is provided with each assessment item in the Subject Outline.
Resubmission of assignments is not permitted as this subject has three assessment items, and remarking of assignments is not permitted as all assessment items marked as a ‘fail’ or ‘high distinction’ are cross marked by the assessor of the subject prior to release to the student.
Returned marked assignments
The marked assignments can be accessed via the Turnitin portal on UTSOnline after the Post Date assigned in UTSOnline. The Post Date is three weeks from the submission day, however lecturing staff always attempt to complete marking prior to the three week time period so that students receive feedback as soon as possible. This three week timeframe may need to be extended if lecturing staff are marking assignments in multiple subjects at the same time.
Late Assignments
Extensions for assignments will only be provided where there are extenuating and unforeseen circumstances. Students having more than one assignment due in the same week does not meet the definition of extenuating or unforeseen circumstances. Students seeking an extension must apply to the subject coordinator by email prior to the day on which the assignment, to which the extension refers, is due. Extensions cannot be granted on the day the assignment is due. Late and extension assignments may need to be submitted via the Late and Extension Assignment portal in UTSOnline.
Penalties will be applied for late submission of assessment items without written approval from the subject coordinator.
Assignments submitted late (with no extension granted) may incur a penalty of 5% per day, to be deducted from the final mark for the assessed work. For example, if an assignment is worth 30 marks and is two days late, the penalty incurred = 3 marks (30 x .05 x 2). If the work was evaluated at 25 out of 30, then the final mark would be = 22 marks (25-3) after the penalty was subtracted from the mark awarded.
Unless approval has been given for an extension, assignments will not be accepted or marked if received two weeks after the due date.
Special Consideration
Special consideration consists of the exercise of academic discretion to provide equitable treatment to students whose performance in an assessment item or items is affected by illness, misadventure or work-related circumstances. Students should only apply for special consideration during a teaching period, where performance in an assessment item or items, including examinations, has been affected by extenuating or special circumstances beyond their control.
Special consideration is only required for extensions of more than one week. Students requesting an extension of one week or less should contact their subject coordinator.
The online special consideration tool is now available for all special consideration applications, assessments and exams (centrally conducted and Faculty based) at www.uts.edu.au/current-students/managing-your-course/classes-and-assessment/special-circumstances/special. The application form must be lodged before the due date of the assessment item.
Late applications may be lodged in exceptional circumstances.
Subject grades
No marks are awarded for individual assignments. A final mark will be awarded for the subject. Each assignment completed is awarded a grade as specified on UTSOnline.
Required texts
There is no prescribed text for this subject. Links to references and electronic resources will be made available on UTSOnline.
References
Links to references and additional resources are provided on UTSOnline.
Other resources
UTS Student Centres
Building 10
Monday to Friday: 9am - 5pm
Tel: 1300 ASK UTS (1300 275 887)
Kuring-gai
Monday to Friday: 9am - 5pm
Tel: 1300 ASK UTS (1300 275 887)
Details for student centres: www.uts.edu.au/current-students/contacts/general-contacts
For other resources/information refer to the Faculty of Health website (www.uts.edu.au/about/faculty-health) , the Health Student Guide (www.uts.edu.au/sites/default/files/uts-health-student-guide.pdf) and UTSOnline at: https://online.uts.edu.au/webapps/login/
Improve your academic and English language skills
Marks for all assessment tasks such as assignments and examinations are given not only for what you write but also for how you write. If you would like the opportunity to improve your academic and English language skills, make an appointment with the HELPS (Higher Education Language & Presentation Support) Service in Student Services.
HELPS (Higher Education Language & Presentation Support)
HELPS provides assistance with English language proficiency and academic language. Students who need to develop their written and/or spoken English should make use of the free services offered by HELPS, including academic language workshops, vacation intensive courses, drop-in consultations, individual appointments and Conversations@UTS (www.ssu.uts.edu.au/helps) . HELPS staff are also available for drop-in consultations at both City and Kuring-gai Libraries. Phone (02) 9514 9733
Please see www.uts.edu.au for additional information on other resources provided to students by UTS.
Statement on UTS email account
Email from the University to a student will only be sent to the student's UTS email address. Email sent from a student to the University must be sent from the student's UTS email address. University staff will not respond to email from any other email accounts for currently enrolled students.