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Identifying and Definitional Attributes
QH 040013 v7
Data Element
Data Element
Draft
23-Apr-2013
Current
09-Jul-2013
Superseded
29-Jun-2015
Standard
01-Jul-2013
30-Jun-2015
The overall nature of a clinical service provided to an admitted patient during an episode of care (admitted care), or the type of service provided by the hospital for boarders or posthumous organ procurement (care other than admitted care).
Admitted patient care and hospital activity:
For admitted patients, the type of care received will determine the appropriate casemix classification that shall be employed to classify the episode of care.
Care type (QHAPDC)
Representational Attributes
Numeric Character
Code
N(2)
2
2
Permissible Values

Permissible_values

CodeDescription
01Acute care
05Newborn care
06Other admitted patient care
07Organ procurement-posthumous
08Hospital boarder
09Geriatric Evaluation and Management
10Psychogeriatric care
11Maintenance care
20Rehabilitation care
30Palliative care
Supplementary Values

Supplemenary_values

-
Collection and Usage Attributes
Admitted care can be one of the following:

CODE 01 Acute care
Acute care is care in which the primary clinical purpose or treatment goal is to:
- manage labour (obstetric)
- cure illness or provide definitive treatment of injury
- perform surgery
- relieve symptoms of illness or injury (excluding palliative care)
- reduce severity of an illness or injury
- protect against exacerbation and/or complication of an illness and/or injury which could threaten life or normal function
- perform diagnostic or therapeutic procedures.

CODE 05 Newborn care
Newborn care is initiated when the patient is born in hospital or is nine days old or less at the time of admission. Newborn care continues until the care type changes or the patient is separated:
- patients who turn 10 days of age and do not require clinical care are separated and, if they remain in the hospital, are designated as boarders
- patients who turn 10 days of age and require clinical care continue in a newborn episode of care until separated
- patients aged less than 10 days and not admitted at birth (for example, transferred from another hospital) are admitted with a newborn care type
- patients aged greater than 9 days not previously admitted (for example, transferred from another hospital) are either boarders or admitted with an acute care type
- within a newborn episode of care, until the baby turns 10 days of age, each day is either a qualified or unqualified day
- a newborn is qualified when it meets at least one of the criteria detailed in Episode of admitted patient care (newborn)-qualification status.

Within a newborn episode of care, each day after the baby turns 10 days of age is counted as a qualified patient day. Newborn qualified days are equivalent to acute days and may be denoted as such.

CODE 06 Other admitted patient care
Other admitted patient care is care that does not meet the definitions for code 01, 05, 09, 10, 11, 20 or 30.

CODE 09 Geriatric Evaluation and Management
Geriatric Evaluation and Management is care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with multi-dimensional needs associated with medical conditions relating to ageing, such as tendency to fall, incontinence, reduced mobility and cognitive impairment. The patient may also have complex psychosocial problems.

Geriatric evaluation and management is always:
- delivered under the management of or informed by a clinician with specialised expertise in geriatric evaluation and management, and
- evidenced by an individualised multidisciplinary management plan, which is documented in the patient's medical record that covers the physical, psychological, emotional and social needs of the patient and includes negotiated goals within indicative time frames and formal assessment of functional ability.

CODE 10 Psychogeriatric care
Psychogeriatric care is care in which the primary clinical purpose or treatment goal is improvement in the functional status, behaviour and/or quality of life for an older patient with significant psychiatric or behavioural disturbance, caused by mental illness, an age-related organic brain impairment or a physical condition.

Psychogeriatric care is always:
- delivered under the management of or informed by a clinician with specialised expertise in psychogeriatric care, and
- evidenced by an individualised multidisciplinary management plan, which is documented in the patient's medical record, that covers the physical, psychological, emotional and social needs of the patient and includes negotiated goals within indicative time frames and formal assessment of functional ability.

Psychogeriatric care is not applicable if the primary focus of care is acute symptom control.

CODE 11 Maintenance care
Maintenance (or non-acute) care is care in which the primary clinical purpose or treatment goal is support for a patient with impairment, activity limitation or participation restriction due to a health condition. Following assessment or treatment the patient does not require further complex assessment or stabilisation. Patients with a care type of maintenance care often require care over an indefinite period.

CODE 20 Rehabilitation care
Rehabilitation care is care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with an impairment, activity limitation or participation restriction due to a health condition. The patient will be capable of actively participating.

Rehabilitation care is always:
- delivered under the management of or informed by a clinician with specialised expertise in rehabilitation, and
- evidenced by an individualised multidisciplinary management plan, which is documented in the patient's medical record, that includes negotiated goals within specified time frames and formal assessment of functional ability.

CODE 30 Palliative care
Palliative care is care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness. The patient will have complex physical, psychosocial and/or spiritual needs.

Palliative care is always:
- delivered under the management of or informed by a clinician with specialised expertise in palliative care, and
- evidenced by an individualised multidisciplinary assessment and management plan, which is documented in the patient's medical record, that covers the physical, psychological, emotional, social and spiritual needs of the patient and negotiated goals.

Care other than admitted care can be one of the following:

CODE 07 Organ procurement-posthumous Organ procurement-posthumous is the procurement of human tissue for the purpose of transplantation from a donor who has been declared brain dead.

Diagnoses and procedures undertaken during this activity, including mechanical ventilation and tissue procurement, should be recorded in accordance with the relevant ICD-10-AM Australian Coding Standards. These patients are not admitted to the hospital but are registered by the hospital.

CODE 08 Hospital boarder
A hospital boarder is a person who is receiving food and/or accommodation but for whom the hospital does not accept responsibility for treatment and/or care.

Hospital boarders are not admitted to the hospital. However, a hospital may register a boarder. Babies in hospital at age 9 days or less cannot be boarders. They are admitted patients with each day of stay deemed to be either qualified or unqualified.

Only one type of care can be assigned at a time. In cases when a patient is receiving multiple types of care, the care type that best describes the primary clinical purpose or treatment goal should be assigned.

The care type is assigned by the clinician responsible for the management of the care, based on clinical judgements as to the primary clinical purpose of the care to be provided and, for subacute care types, the specialised expertise of the clinician who will be responsible for the management of the care. At the time of subacute care type assignment, a multidisciplinary management plan may not be in place but the intention to prepare one should be known to the clinician assigning the care type.

Where the primary clinical purpose or treatment goal of the patient changes, the care type is assigned by the clinician who is taking over responsibility for the management of the care of the patient at the time of transfer. Note, in some circumstances the patient may continue to be under the management of the same clinician. Evidence of care type change (including the date of handover, if applicable) should be clearly documented in the patient's medical record.

The clinician responsible for the management of care may not necessarily be located in the same facility as the patient. In these circumstances, a clinician at the patient's location may also have a role in the care of the patient; the expertise of this clinician does not affect the assignment of care type.

The care type should not be retrospectively changed unless:
- it is for the correction of a data recording error, or
- the reason for change is clearly documented in the patient's medical record and it has been approved by the hospital's director of clinical services.

Subacute care is specialised multidisciplinary care in which the primary need for care is optimisation of the patient's functioning and quality of life. A person's functioning may relate to their whole body or a body part, the whole person, or the whole person in a social context, and to impairment of a body function or structure, activity limitation and/or participation restriction.

Subacute care comprises the defined care types of rehabilitation care, palliative care, geriatric evaluation and management and psychogeriatric care.

A multidisciplinary management plan comprises a series of documented and agreed initiatives or treatments (specifying program goals, actions and timeframes) which has been established through multidisciplinary consultation and consultation with the patient and/or carers.

It is highly unlikely that, for care type changes involving subacute care types, more than one change in care type will take place within a 24 hour period. Changes involving subacute care types are unlikely to occur on the date of formal separation.

Patients who receive acute same day intervention(s) during the course of a subacute episode of care do not change care type. Instead, procedure codes for the acute same day intervention(s) and an additional diagnosis (if relevant) should be added to the record of the subacute episode of care.

Palliative care episodes can include grief and bereavement support for the family and carers of the patient where it is documented in the patient's medical record.
For national reporting of the Hospital service-care type (NHDD) data element the following mapping occurs:
Code 01 Acute care is mapped to code 1 Acute care.
Code 05 Newborn care is mapped to code 7 Newborn care.
Code 06 Other admitted patient care is mapped to code 8 Other admitted patient care.
Code 07 Organ procurement-posthumous is mapped to code 9 Organ procurement-posthumous.
Code 08 Hospital boarder is mapped to code 10 Hospital boarder.
Code 09 Geriatric Evaluation and Management is mapped to code 4 Geriatric evaluation and management.
Code 10 Psychogeriatric care is mapped to code 5 Psychogeriatric care.
Code 11 Maintenance care is mapped to code 6 Maintenance care.
Code 20 Rehabilitation care is mapped to code 2 Rehabilitation care.
Code 30 Palliative care is mapped to code 3 Palliative care.
Relational Attributes
Related Metadata References

Related Metadata References_IR

  • 1 - 9
ViewRelationshipMetadata Item TypeMetadata Item SubtypeNameIdentifier & VersionApproval Status
SupersedesData ElementData ElementCare typeQH 040013 Version 6Superseded
Has been superseded byData ElementData ElementHospital service-care typeQH 040013 Version 8Superseded
Is mappable fromData ElementData ElementRegistered patient-care type (HBCIS)QH 041659 Version 1Superseded
Is used in conjunction withData ElementData ElementEpisode of admitted patient care-tobacco smoking status of patientQH 041751 Version 1Superseded
Is used in the derivation ofData ElementDerived Data ElementEpisode of admitted patient care-Australian national sub-acute and non-acute patient class (AN-SNAP v3)QH 040753 Version 2Superseded
Relates toData ElementData ElementEpisode of admitted patient care (newborn)-qualification statusQH 040376 Version 2Current
Relates toData ElementData ElementEpisode of admitted patient care-SNAP typeQH 040599 Version 3Superseded
Relates toData ElementData ElementEpisode of admitted patient care-SNAP typeQH 040599 Version 2Superseded
Relates toData ElementData Element ConceptHospital serviceQH 041656 Version 1Current
Implementation in Metadata Sets

Implemented

  • 1 - 2
ViewMetadata Item TypeMetadata Item SubtypeNameIdentifer & VersionObligationApproval StatusEffective FromEffective To
Information AssetData CollectionMonthly Activity Collection (MAC)QH 020008 Version 1Superseded01-Jul-201330-Jun-2015
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 1MandatorySuperseded01-Jul-201330-Jun-2015
Source and Reference Attributes
Australian Institute of Health and Welfare
METeOR data element: Hospital service-care type, code N[N], identifier 491557, Health, Standard 07/02/2013 https://meteor.aihw.gov.au/content/index.phtml/itemId/491557/meteorItemView/long