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The National Casemix Office Jargon Buster


A&E

Accident and Emergency; also known as Emergency and Urgent care or Emergency Medicine.

   

AC

Audit Commission.


CAP

PbR Clinical Advisory Panel.


CART

Classification and regression trees (CART) is a set of techniques for classification and prediction used in HRG design when developing initial data groupings.


Casemix

A system whereby the complexity of the care provided to a patient is reflected in an aggregate secondary healthcare classification.


CC

Complications and comorbidities.

These tend to be part of the initial patient presentation, whilst complications arise during a period of health care delivery. CCs are recorded in patient records using internationally-recognised diagnoses codes (currently ICD-10). Many Healthcare Resource Groups (HRGs) differentiate between care provided to a patient without any CCs, and those where CCs are present, in order to reflect the higher expected resource use of treating the latter. CCs may be deemed to be major, intermediate or insignificant in terms of requiring additional resource use to treat.


CCMDS

Critical Care Minimum Data Set


CDA

Casemix Design Authority.

This forms part of the Casemix governance structure within the NHS Information Centre for health and social care. It acts as the design authority for HRG development and has responsibility for assuring design consistency. Membership includes representation from Dh PbR, NHS CFH and other NHS personnel. The chair of the CDA is also the Clinical Leads Chair of Chairs.


CE

Consultant Episode.

"The time a PATIENT spends in the continuous care of one CONSULTANT using Hospital Site or Care Home bed(s) of one Health Care Provider or, in the case of shared care, in the care of two or more CONSULTANTS. Where care is provided by two or more CONSULTANTS within the same episode, one CONSULTANT will take overriding responsibility for the PATIENT and only one Consultant Episode (Hospital Provider) is recorded. Additional CONSULTANTS participating in the care of PATIENTS are defined as Shared Care Consultants. A Consultant Episode (Hospital Provider) includes those episodes for which a GENERAL MEDICAL PRACTITIONER is acting as a CONSULTANT." - definition from datadictionary.nhs.uk (external link)


NHS CfH

NHS Connecting for Health.


Cliff Edge

In the context of the Market Forces Factor (MFF) for PbR, the cliff edge problem refers to large differences in MFF values between neighbouring trusts.


Core HRG

The main HRG for a patient care event (Consultant Episode, Outpatient Attendance etc.). Unbundled HRGs may also be produced for the same patient care event.


Cost

"The expenditure of funds or use of property to acquire or produce a product or service. The opposite of revenue" - definition from the freedictionary.com (external link)


CQUIN

Commissioning for Quality and Innovation.

A DH framework produced as part of the Next Stage Review.

For more information please see the DH website (external link).


Currency

A unit of healthcare activity such as spell, episode, attendance. Under PbR, currency tends to mean that unit of measurement by which the national tariff is paid - e.g. admitted patient care HRGs


CV

Coefficient of Variation - A measure of the amount of variation within a group of values. Used to assess the performance of HRGs as part of the design iteration


DH

Department of Health


EAG

PbR External Advisory Group.


ERP

Expert Reference Panel.

These form part of the Casemix governance structure within The NHS Information Centre for health and social care. They have a wider remit than single HRG chapters, are populated by NHS and DH personnel and have clinical leads and chairs


EWG

Expert Working Group

These form part of the Casemix governance structure within The NHS Information Centre for health and social care. They are HRG chapter-specific, are populated by NHS personnel and have clinical leads and chairs.


FCE

A Consultant Episode that has finished. See also CE.


FT

Foundation Trust.


HES

Hospital Episode Statistics - a national source of patient non-identifiable data


HRG Root

This represents a stage in the grouping process whereby activity is mapped to a partially defined 4-character HRG prior to applying any split logic.


ICD

International Classification of Disease and Related Health Problems. An internationally defined classification of disease, managed by the World Health Organisation (WHO) - currently in its 10th Revision.


IS

Independent Sector.


MFF

Market Forces Factor.

The MMF is an index which is used to estimate the unavoidable cost differences of providing healthcare.


MIU

Minor Injury Unit.


MSC

Main Speciality Code.


NCS

NHS Classifications Service.

The definitive source of clinical coding guidance sets the national standards used by the NHS in coding clinical data.


NICE

National Institute for Health and Clinical Excellence.


OPCS

Office of Population Censuses and Surveys.


OPCS-4

The standard classification system used to record healthcare procedures and interventions in England. Originally named after the Office of Population Censuses and Surveys (now the Office for National Statistics).


PbR

Payment by Results.

The financial system providing a transparent, rules-based system for paying healthcare providers, where payment is linked to activity and adjusted for Casemix.


PCT

Primary Care Trust.


PFI

Private Finance Initiative.


PLICS

Patient Level Information and Costing Systems.


PSD

Planned Same Day (PbR).


Reference Costs

The national average unit cost of an HRG or similar unit of healthcare activity, as reported as part of the Reference Costs annual mandatory collection from all NHS organisations in England. These have been published in the National Schedule of Reference Costs by admission type and service, since 1998.


Resource

The total means available to an organisation for increasing activity or improving production, for instance, staff, theatre time, consumables, etc.


RIV

Reduction in Variance.

A measure of how much variation is explained by the HRGs. The aim is to maximise the RIV.


SHA

Strategic Health Authority


SLA

Service Level Agreement.


Spell

The period from patient admission to discharge within a single healthcare provider. A spell may comprise of more than one Finished Consultant Episode (FCE).


SUS

Secondary Uses Service.

"...The single source of comprehensive data to enable a range of reporting and analysis. It...is designed to provide anonymous patient-based data for purposes other than direct clinical care such as healthcare planning, commissioning, public health, clinical audit and governance, benchmarking, performance improvement, medical research and national policy development." services/the-secondary-uses-service-sus.

Details on SUS for PbR can be found on the NHS Connecting for Health website (external link).


Tariff

The calculated price for a unit of healthcare activity. Tariffs are calculated by the Department of Health Payment by results team, and are based on Reference Costs data. They may be mandatory or non-mandatory. Where no national tariff is mandated for a particular service or type of healthcare activity, NHS providers and commissioners are required to locally negotiate a price per unit of service activity.


TFC

Treatment Function Code.


TWG

PbR Technical Working Group.


Unbundling

An HRG design concept introduced as part of HRG4 that seeks to acknowledge high cost or specialist services activity that may or may not be provided as part of a patients' pathway of care.


Unify2

Corporate DH data collection tool used for the Reference Costs collection.


WHO

World Health Organisation.

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