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Identifying and Definitional Attributes
Identifier
QH 040013
Version
3
Metadata Item Type
Data Element
Data Element Type
Data Element
Approval Status
Current
01-Jul-1998  
Superseded
30-Jun-1999  
Approval Type
Standard
Approving Authority
-
Effective From
01-Jul-1998
Effective To
30-Jun-1999
Definition
An episode type describes the phase of treatment.  The episode type changes when the principal clinical intent changes.

Acute (Episode of Care)
An acute episode of care is a phase of treatment where the principal clinical intent is one or more of the following.
To:
- manage labour (obstetric);
- cure illness or provide definitive treatment for injury;
- perform surgery;
- relieve symptoms of illness or injury (excluding palliative care);
- reduce severity of illness or injury;
- protect against exacerbation and/or complication of an illness and/or injury which could threaten life or normal function; or
- perform diagnostic or therapeutic procedures.

Rehabilitation (Episode of Care)
A phase of treatment where a patient with a disability is participating in a multi-disciplinary program aimed at improving functional capacity, retraining lost skills, and/or a change in psychosocial adaptation.

Palliative (Episode of Care)
A phase of treatment where the patient's condition has progressed beyond the stage where curative treatment is effective or attainable, or where the patient chooses not to pursue curative treatment. Palliative care provides relief of suffering and enhancement of quality of life for such a patient.  Interventions such as radiotherapy, chemotherapy, and surgery are considered part of the palliative episode if they are undertaken specifically to provide symptomatic relief.

Non-acute Nursing Home Type (Episode of Care)
An episode of care which applies to patients who have been classified as Nursing Home Type patients (NHTPs). Patients are classified as NHTPs after 35 days consecutive hospitalisation, unless the treating doctor has:
- completed an Acute Care Certificate under section 3B of the Health Insurance Act 1973 (Commonwealth); or
- made an order under section 3A of that Act;
which determines that the patient is in need of acute care for a specified period.

The 35 day qualifying period may accrue in more than one hospital (public, private or both), excluding extended treatment wards in public psychiatric hospitals.

Patients who go on leave or are separated from hospital, but return within seven days, may continue accruing their 35 days.  Patients who leave hospital and do not enter another hospital for at least seven days will begin at day one on their next admission to hospital.

Leave days and days out of hospital do not count in accruing the 35 days.

If a patient is reclassified from nursing home type to another episode of care (eg, the patient broke their arm and requires acute care), the 35 day qualifying period begins again.

Non-acute -  Respite (Episode of Care)
A phase of treatment where the patient:
- has not qualified as nursing home type but is in receipt of respite care and the sole reason for admitting the patient to a hospital is that the care that is usually provided in another environment (eg, at home or in a nursing home) is unavailable in the short term; or

Non-acute - Other (Episode of care)
A phase of treatment where the patient:
- has not qualified as nursing home type, or would normally not require hospital treatment, but there are factors in the home environment (physical, social, psychological) which make it inappropriate for the patient to be discharged in the short term; or
- is being treated in a psychiatric unit and has a stable but severe level of functional impairment, an inability to function independently without extensive care and support, and for whom the principal function is provision of care over an indefinite period.

Newborn (Episode of care)
An episode of newborn care is initiated when the patient is nine days old or less at the time of admission and continues until the care type changes or the patient is separated.  Those newborns who:

- turn 10 days of age and require clinical care, remain as newborn until separated;
- turn 10 days of age, and do not require clinical care, are separated and become boarders;
- are not admitted at birth (e.g. transferred from another hospital) and are aged less than 10 days, will be admitted as a newborn; or
- are not currently admitted (e.g. transferred from another hospital) and are aged greater than 9 days old are either boarders or admitted with an acute care type.

Within a newborn episode, each day is deemed to be either an acute (qualified) or unqualified day.  A newborn is qualified when it meets at least one of the following:
 
- The newborn is the second or subsequent live born infant of a multiple birth, whose mother is currently an admitted patient;
- The newborn is admitted to an intensive care facility in a hospital, being a facility approved by the Commonwealth Minister for the purpose of the provision of special care; or
- The newborn is admitted to, or remains in hospital without its mother.

Other Care (Episode of Care)
A phase of treatment where the principal clinical intent does not meet the criteria for acute, rehabilitation, palliative, nursing home type, other non-acute, or unqualified neonate episodes of care.

It would be rare that a patient needs to be reported under other care.
Context
Institutional health care: the identification of different episodes of care is required in order to appropriately classify and count the care a person received whilst in hospital. The type of care received will determine the appropriate casemix classification that shall be employed to classify the episode.
Short Name
Episode type
Name in Other Contexts
-
Representational Attributes
Datatype
Numeric character
Representation Class
Code
Format
N(2)
Minimum Character Length
2
Maximum Character Length
2
Permissible Values
CodeDescription
01Acute
05Newborn
06Other care
21Rehabilitation - delivered in a designated unit
22Rehabilitation - according to a designated program
23Rehabilitation - principal clinical intent
31Palliative - delivered in a designated unit
32Palliative - according to a designated program
33Palliative - principal clinical intent
41Non-acute care - Nursing Home Type patient
42Non-acute care - Respite
43Non-acute care - Other
44Non-acute care - Nursing Home patient
Supplementary Values
-
Collection and Usage Attributes
Guide for Use
An episode of care refers to the phase of treatment rather than to each individual patient day. There may be more than one episode of care within the one overnight stay period.

An episode of care begins on the date the person meets the criteria defined above for a particular type of care; this may be the same as the date the person was admitted to hospital or a date during the hospital stay. An episode of care ends when the principal intent of the care changes or when the patient is formally separated from the hospital.

A rehabilitation episode of care includes care provided:
- in a designated rehabilitation unit;
- in a designated rehabilitation or psychiatric rehabilitation program, as designated by the State health authority for Medicare patients in a recognised public hospital, for private patients in a public or private hospital, as approved by a registered health benefits organisation; or
- under the principal clinical management of a rehabilitation physician;  or which    in the opinion of the treating doctor the principal clinical intent of the care is rehabilitation.

A palliative episode of care includes care provided:
- in a designated palliative care unit;
- in a designated palliative care program; or
- under the principal clinical management of a palliative care physician; or
- which, in the opinion of the treating doctor, the principal clinical intent of the care is palliation.

Coding for rehabilitation/palliative care should be carried out in strict numerical sequence and only the first appropriate category should be coded; i.e. when a patient under the clinical management of a rehabilitation/palliative care physician is receiving care in a designated program, the episode should be coded to the option that is highest in the hierarchy (designated program).

The Nursing Home Type Patient criteria applies to all admitted patients regardless of the type of episode of care the patient is receiving. Once a patient meets this criteria they should be classified as a Nursing Home Type Patient.
Verification Rules
-
Collection Methods
QHAPDC
Code 44 (Non-acute care - Nursing Home patient) is used in HBCIS only, and not provided to DSU, as nursing homes are not part of the scope of QHAPDC.
Comment
-
Relational Attributes
Related Metadata References
Has been superseded by Episode type QH 040013 Version 4
Relates to Episode of care (admitted patient) QH 040019 Version 1
Supersedes Episode type QH 040013 Version 2
Implementation in Metadata Sets

Otherrelational

  • 1 - 2
ViewMetadata Item TypeMetadata Set TypeNameAscendingIdentifier & VersionObligationEffective FromEffective To
Information AssetData CollectionMonthly Activity Collection (MAC)QH 020008 Version 101-Jul-199830-Jun-1999
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 1Mandatory01-Jul-199830-Jun-1999
Data Quality Declaration
-
Source and Reference Attributes
Source Organisation
-
Source Document
-
Keywords

Care type