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Identifying and Definitional Attributes
QH 040013 v5
Data Element
Data Element
Current
01-Jul-2000
Superseded
28-Feb-2005
Standard
01-Jul-2000
28-Feb-2005
A care type defines the overall nature of a clinical service provided to an admitted patient during an episode of care, or the type of service provided by the hospital for boarders or posthumous organ procurement. The care type changes when the principal clinical intent changes.

Acute care: is care in which the principal clinical intent or treatment goal is one or more of the following:

- 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; and or
- perform diagnostic or therapeutic procedures.

Rehabilitation care: is care in which the clinical intent or treatment goal is to improve the functional status of a patient with an impairment, disability or handicap. It is usually evidenced by a multi-disciplinary rehabilitation plan comprising negotiated goals and indicative time frames which are evaluated by a periodic assessment using a recognised functional assessment measure. It includes care provided:

- in an designated rehabilitation unit , or
- in a designated rehabilitation program, or in a psychiatric rehabilitation program as designated by the State health authority for public patients in a recognised 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 in the opinion of the treating doctor when the principal clinical intent of care is rehabilitation.

(21) Rehabilitation - delivered in a designated unit ; is a dedicated ward or unit (and can be a stand-alone unit) that receives identified funding for rehabilitation care and/or primarily delivers rehabilitation care.

(22) Rehabilitation - according to a designated program; is where care is delivered by a specialised team of staff who provide rehabilitation care to patients in beds that may or may not be dedicated to rehabilitation care. The program may, or may not be funded through identified rehabilitation care funding. Code 21 should be used instead of code 22 if care is being delivered in a designated rehabilitation care program and a designated rehabilitation care unit.

(23) Rehabilitation - as a principal clinical intent, occurs when the patient is primarily managed by a medical practitioner who is a specialist in rehabilitation care or when, in the opinion of the treating medical practitioner, the care provided is rehabilitation care even if the doctor is not a rehabilitation care specialist. The exception to this is when the medical practitioner is providing care within a designated unit or a designated program, in which code 21 or 22 should be used, respectively.

Coding for rehabilitation categories should be carried out in strict numerical sequence, ie the first appropriate category code should be used.

Palliative care: is care in which the clinical intent or treatment goal is primarily quality of life for a patient with an active, progressive disease with little or no prospect of cure. It is usually evidenced by an interdisciplinary assessment and/or management of the physical, psychological, emotional and spiritual needs of the patient; and a grief and bereavement support service for the patient and their carers/family. It includes care provided:

- in a palliative care unit; or
- in a designated palliative care program; or
- under the principal clinical management of a palliative care physician or, in the
- opinion of the treating doctor, when the principal clinical intent of care is palliation.

(31) Palliative - delivered in a designated care unit is a dedicated ward or unit (and can be a stand-alone unit) that receives identified funding for palliative care and/or primarily delivers palliative care.

(32) Palliative - according to a designated program is where care is delivered by a specialised team of staff who provide palliative care to patients in beds that may or may not be dedicated to palliative care. The program may, or may not be funded through identified palliative care funding. Code 31 should be used instead of code 32 if care is being delivered in a designated palliative care program and a designated palliative care unit.

(33) Palliative principal client intent occurs when the patient is primarily managed by a medical practitioner who is a specialist in palliative care or when, in the opinion of the treating medical practitioner, the care provided is palliative care even if the doctor is not a palliative care specialist. The exception to this is when the medical practitioner is providing care within a designated unit or a designated program, in which case codes 31 or 32 should be used, respectively. For example, code 33 would apply to a patient dying of cancer who was being treated in a geriatric ward without specialist input by palliative care staff.

Coding for palliation categories should be carried out in strict numerical sequence ie the first appropriate category should be coded.

Geriatric evaluation and management: is care in which the clinical intent or treatment goal is to maximise health status and/or optimise the living arrangements for a patient with multi-dimensional medical conditions associated with disabilities and psychosocial problems, who is usually (but not always) an older patient. This may also include younger adults with clinical conditions generally associated with old age. This care is usually evidenced by multi-disciplinary management and regular assessments against a management plan that is working towards negotiated goals within indicative time frames.

Geriatric evaluation and management includes care provided:

- in a geriatric evaluation and management unit; or
- in a designated geriatric evaluation and management program; or
- under the principal clinical management of a geriatric evaluation and management physician or, in the opinion of the treating doctor, when the principal clinical intent of care is geriatric evaluation and management.

Psychogeriatric care: is care in which the clinical intent or treatment goal is improvement in health, modification of symptoms and enhancement in function, behaviour and/or quality of life for a patient with an age related organic brain impairment with significant behavioural or late onset psychiatric disturbance or a physical condition accompanied by severe psychiatric or behavioural disturbance. The care is usually evidenced by multi-disciplinary management and regular assessments against a management plan that is working towards negotiated goals within indicative time frames. It includes care provided:

- in a psychogeriatric care unit;
- in a designated psychogeriatric care program; or
- under the principal clinical management of a psychogeriatric physician or, in the opinion of the treating doctor, when the principal clinical intent of care is psychogeriatric care.

Maintenance care: is care in which the clinical intent or treatment goal is prevention of deterioration in the functional and current health status of a patient with a disability or severe level of functional impairment. Following assessment or treatment the patient does not require further complex assessment or stabilisation, and requires care over an indefinite period. This care includes that provided to a patient who would normally receive care in another setting eg at home, or in a nursing home, by a relative or carer, that is unavailable in the short term.

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 (eg transferred from another hospital ) are admitted with a newborn care type;
- patients aged greater than 9 days not previously admitted (eg 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 the newborn qualification status.

Within a newborn episode of care, each day after the baby turns 10 days of age is counted as acute (qualified) patient day.

Newborn qualified days are equivalent to acute days and may be denoted as such.
See section 4.5 for further information on newborns.

Other admitted patient care: is care where the principal clinical intent does not meet the criteria for any of the above.

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

Diagnosis 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.

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.
Institutional health care: the identification of different care types 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 of care.
Care type (QHAPDC)
Episode type
Representational Attributes
Numeric Character
Code
N(2)
2
2
Permissible Values

Permissible_values

CodeDescription
01Acute
05Newborn
06Other care
07Organ procurement
08Boarder
09Geriatric Evaluation and Management
10Psychogeriatric
11Maintenance
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
Supplementary Values

Supplemenary_values

-
Collection and Usage Attributes
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. There may be more than one care type within the one overnight stay period.
Relational Attributes
Related Metadata References

Related Metadata References_IR

  • 1 - 3
ViewRelationshipMetadata Item TypeMetadata Item SubtypeNameIdentifier & VersionApproval Status
SupersedesData ElementData ElementEpisode typeQH 040013 Version 4Superseded
Has been superseded byData ElementData ElementCare typeQH 040013 Version 6Superseded
Relates toData ElementData Element ConceptEpisode of care (admitted patient)QH 040019 Version 1Superseded
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-200028-Feb-2005
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 1MandatorySuperseded01-Jul-200028-Feb-2005
Source and Reference Attributes