[WWW - 2021.12.16]
Identifying and Definitional Attributes
Identifier
QH 040013
Version
8
Metadata Item Type
Data Element
Data Element Type
Data Element
Approval Status
Draft
26-Mar-2015  
Current
30-Jun-2015  
Superseded
15-Mar-2021  
Approval Type
Standard
Approving Authority
-
Effective From
01-Jul-2015
Effective To
30-Jun-2020
Definition
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).
Context
Admitted patient care and hospital activity:  For admitted patients, the type of care received will determine the appropriate casemix classification employed to classify the episode of care. Used for collection of national minimum data set admitted patient care type data represented in the state-wide Queensland Hospital Admitted Patient Data Collection (QHAPDC). 

Residential aged care patient care type, collected in the Hospital Based Corporate Information System (HBCIS), is not in scope for QHAPDC. Historically, QHAPDC care type codes have varied from those reported nationally as at times more specific data has been required to comply with Queensland Health business needs.
Short Name
Care type (QHAPDC)
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 care
05Newborn care
06Other admitted patient care
07Organ procurement-posthumous
08Hospital boarder
09Geriatric Evaluation and Management
10Psychogeriatric care
11Maintenance care
12Mental health care
20Rehabilitation care
30Palliative care
Supplementary Values
-
Collection and Usage Attributes
Guide for Use
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.

Acute care excludes care which meets the definition of mental health care.

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 above.

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.

Geriatric evaluation and management excludes care which meets the definition of mental health care.

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.

Psychogeriatric care excludes care which meets the definition of mental health care.

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.

Maintenance care excludes care which meets the definition of mental health care.

Code 12 Mental health care
Mental health care is care in which the primary clinical purpose or treatment goal is improvement in the symptoms and/or psychosocial, environmental and physical functioning related to a patient's mental disorder. Mental health care:
- is delivered under the management of, or regularly informed by, a clinician with specialised expertise in mental health;
- is evidenced by an individualised formal mental health assessment and the implementation of a documented mental health plan; and 
- may include significant psychosocial components, including family and carer support.

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.

Rehabilitation care excludes care which meets the definition of mental health care.

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.

Palliative care excludes care which meets the definition of mental health care.

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 mental health and subacute care types, the specialised expertise of the clinician who will be responsible for the management of the care. At the time of mental health or 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. 

While psychogeriatric care is a subspecialty of mental health, it is an established component of subacute care. Therefore, if a patient meets the definition of psychogeriatric care, then the psychogeriatric care type should be allocated.

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

Patients who receive acute same day intervention(s) (for example dialysis, chemotherapy or radiotherapy) 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.
Verification Rules
Queensland Hospital Admitted Patient Data Collection (QHAPDC):
Must not be null.
Validated against a list of care type codes.
Collection Methods
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 88 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 12 Mental health care is mapped to code 11 Mental health care.
Code 20 Rehabilitation care is mapped to code 2 Rehabilitation care.
Code 30 Palliative care is mapped to code 3 Palliative care.
Comment
-
Relational Attributes
Related Metadata References
Has been superseded by Hospital service-care type QH 040013 Version 9
Is mappable from Registered patient-care type (HBCIS) QH 041659 Version 2
Relates to Hospital service QH 041656 Version 1
Supersedes Hospital service-care type QH 040013 Version 7
Implementation in Metadata Sets

Otherrelational

  • 1 - 10
ViewMetadata Item TypeMetadata Set TypeNameAscendingIdentifier & VersionObligationEffective FromEffective To
Information AssetData CollectionMonthly Activity Collection (MAC)QH 020008 Version 101-Jul-201530-Jun-2019
Information AssetData CollectionMonthly Activity Collection (MAC)QH 020008 Version 201-Jul-201930-Jun-2020
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 1Mandatory01-Jul-201530-Jun-2019
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 2Mandatory01-Jul-201930-Jun-2020
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Private Facility Data Supply Requirement (DSR) 2016-2017QH 020315 Version 1Mandatory01-Jul-201630-Jun-2017
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Private Facility Data Supply Requirement (DSR) 2017-2018QH 020501 Version 1Mandatory01-Jul-201730-Jun-2018
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Private Facility Data Supply Requirement (DSR) 2018-2019QH 020503 Version 1Mandatory01-Jul-201830-Jun-2019
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Private Facility Data Supply Requirement (DSR) 2019-2020QH 020581 Version 1Mandatory01-Jul-201930-Jun-2020
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Public Hospital Services Data Supply Requirement (DSR) 2016-2017QH 020314 Version 1Mandatory01-Jul-201630-Jun-2017
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Public Hospital Services Data Supply Requirement (DSR) 2017-2018QH 020329 Version 1Mandatory01-Jul-201730-Jun-2018
Data Quality Declaration
-
Source and Reference Attributes
Source Organisation
Australian Institute of Health and Welfare
Source Document
METeOR data elements: Hospital service-care type, code N[N], identifier 584408, Health, Standard 13/11/2014 https://meteor.aihw.gov.au/content/index.phtml/itemId/584408/meteorItemView/long
Keywords

Care type