Diagnosis Related Groups (DRG)
Used as indicator
- Monitoring (trend data)
- Evaluation
Health Expenses and Health Reimbursements
Data available on
Perpetrator
This statistical product does not collect information on Perpetrator
Incident
Incident
Victim data classified according to the codes already described; data for each category of aggression is gender disaggregated and can also grouped in several age groups; rural/urban division; basically these statistical products reflect the number of victims of certain forms of violence against women, including only those incidents involving physical force; the data reflects only the cases where the victim reached a hospital unit; Statistical products on the number of victims of forms of aggression perpetrated by spouses or domestic partners can be generated upon request ( based on law 544/2001 or upon inter-institutional protocols) but are not normally made available to the general public; Victim data- type of aggression- medical diagnosis, age, sex, rural/urban, relationship to the aggressor, number of hospital days.
Criminal statistics on sexual violence
Criminal statistical data included
Characteristics
Reference period
Usually data available at the end of April for January-December of the previous year;
Frequency of updating
Validation
The validation procedure is very accurate because the DRG system is actually an application upon which hospital care is reimbursed from the public health insurance fund; validation methodology is annually updated and issued together with the general contract for hospital services between the National Health Insurance Agency ( Casa National de Asigurari de Sanatate) and hospitals ( public and private); Each hospital sends in an electronic data set also known as Minium Data Set Per Patient in Continuous Hospital Care ( SMDPC in Romanian acronyms), this data is gathered from the standardized Clinical Patient Chart; the SMDPC or Minimum Data Set Per Patient in Continuous Hospital Care is sent for validation towards the National School for Public Health and Health Management; but also towards the Public Health Directions at county level; The Public Health Direction is the unit collecting info at a county level from all medical units including GPs, Specialized Private Practices, Hospitals and Private Clinics which do not operate with the National Health Insurance Fund; Going back to the validation procedure for DRG, mid month hospitals send out readjusted cases of those invalidated in the previous month as well as unreported cases for the past month; each trimester the data set received from hospital units is validated by the National School for Public Health ( the main administrator of the DRG data base); then annually all hospitals report to the School for Medical Management ( the validation unit) and to CNSIP ( with responsibilities in Public Health monitoring and policies) all the validated and non-validated cases - the CNSIP takes into account parts of the non-validated data sets ( for the invalidation on criterion B) the criteria for validation include complete data sets in the SMDPC ( the minimum data set per patient - it needs to have all fields with complete data); other validating conditions include compatibility between DRG code and medical treatment assigned; reported cases in medical specialities where the Clinical Patient's Chart is not used(ATI); date of birth and personal identification number ( Valid and coordinated);type of insurance each patient holds, citizenship status, etc. for more details here http://www.drg.ro/legislatie/ordin_cnas_25_30ian2012.pdf
Compilation
Data completed from the trimester reports from Hospitals to the National School of Public Health as well as the corrections and revalidation of cases added after each trimester; basically the information at CNSIP includes the validated cases for the past 12 months as well as the invalidates cases on error type B ( errors that can be subject to revalidation within the incoming trimester).
Quality assurance process
The validation process is very consistent and was described under validation; however this statistical product, which is only provided upon request is very much an by-product of a reimbursement validation procedure; because of that basically DRG validation procedures are not very much concerned with the actual diagnosis, the social problem certain diagnosis reflect or how accurate it reflects the state of health of patients rather the DRG validation procedures look at the status of the patient in relation to her/his health insurance; follows that medical procedures are not unnecessary but really connected to a diagnosis; basically it is more a system that monitors the efficiency of hospitals than the state of health of patients; DRG can only provide number of women/men provided with certain kinds of health care and medical procedures; for this The validation procedure is very accurate because the DRG system is actually an application upon which hospital care is reimbursed from the public health insurance fund; validation methodology is annually updated and issued together with the general contract for hospital services between the National Health Insurance Agency ( Casa National de Asigurari de Sanatate) and hospitals ( public and private); Each hospital sends in an electronic data set also known as Minium Data Set Per Patient in Continuous Hospital Care ( SMDPC in Romanian acronyms), this data is gathered from the standardized Clinical Patient Chart; the SMDPC or Minimum Data Set Per Patient in Continuous Hospital Care is sent for validation towards the National School for Public Health and Health Management; but also towards the Public Health Directions at county level; The Public Health Direction is the unit collecting info at a county level from all medical units including GPs, Specialized Private Practices, Hospitals and Private Clinics which do not operate with the National Health Insurance Fund; Going back to the validation procedure for DRG, mid month hospitals send out readjusted cases of those invalidated in the previous month as well as unreported cases for the past month; each trimester the data set received from hospital units is validated by the National School for Public Health ( the main administrator of the DRG data base); then annually all hospitals report to the School for Medical Management ( the validation unit) and to CNSIP ( with responsibilities in Public Health monitoring and policies) all the validated and non-validated cases - the CNSIP takes into account parts of the non-validated data sets ( for the invalidation on criterion B) the criteria for validation include complete data sets in the SMDPC ( the minimum data set per patient - it needs to have all fields with complete data); other validating conditions include compatibility between DRG code and medical treatment assigned; reported cases in medical specialities where the Clinical Patient's Chart is not used(ATI); date of birth and personal identification number ( Valid and coordinated);type of insurance each patient holds, citizenship status, etc. for more details here http://www.drg.ro/legislatie/ordin_cnas_25_30ian2012.pdf
Accuracy
Problems. Data available for VAW incidents is extracted from annual reports; basically the only statistical picture at national level is an annual one with no possibility of intermediary reports or regional breakdown; it only shows no of cases; in terms of accuracy - data is thoroughly validated, when it comes to matching condition to treatment as well as to the identification of patients yet the protocols for assigning patients' condition to certain codes remains unclear; for example for codes reflecting aggression injury by spouse or domestic/partner - there's no information on how the assignment is made; the statistical product only reflects hospital cases and does not include cases reported in other health system components such as GPs, etc.; errors are corrected upon a quarterly basis;
Reliability
Limitations. In terms of reliability the main problem is that the reporting of data is not done through a live data base but rather a monthly reported document is imported from each hospital unit database towards the validating commission; basically no estimates are made for this statistical product and reliability refers only to the medical data actually corresponding to a patient's condition; for the present study the main problem can be of mislabelling and under-reporting on certain codes; for example certain conditions or forms of aggression can labelled under different codes not capturing the relationship between victim and aggressor
Timeliness
Good. Sometimes data is reported late but revisions and corrections are made on a quarterly basis; the annual statistics includes non-validated cases ( if the reason for invalidation is clearly a mistake - such as age over 14, non correspondents between date of birth and injury sustained). This statistical product is annual so there is an important time lag in between the moment events happen and when they pop up in the statics.
Comparability
- Geographical
- Over time
- None
Current developments
No plans for improvement so far. Validation criteria are reviewed annually based on the most common errors or invalidation cases happening each year; however this data is mostly destined for economic evaluation of hospital treatment and even through important and significant very rarely used for policy; so far it has not been used for assessments of any VAW incidents.
