Project aims and objectives
- To develop a fully revised and contemporary version of the AN-SNAP classification suitable for implementing as a national sub-acute and non-acute ABF model
- To ensure that the revised classification is acceptable across the sub-acute sector including States and Territorie

Gordon, Robert

Green, Janette P

English

Research Online

University of WollongongResearch OnlineAustralian Health Services Research Institute Faculty of Business2014Development of AN-SNAP version 4: activitybased funding classification workshopJanette P. GreenUniversity of Wollongong, janette@uow.edu.auRobert GordonUniversity of Wollongong, robg@uow.edu.auResearch Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library:research-pubs@uow.edu.auPublication DetailsJ. Green & R. Gordon "Development of AN-SNAP version 4: activity based funding classification workshop", Activity Based FundingConference, Melbourne Convention and Exhibition Centre, 23-25 Jun 2014, (2014)Development of AN-SNAP version 4: activity based funding classificationworkshopAbstractProject aims and objectives- To develop a fully revised and contemporary version of the AN-SNAP classification suitable forimplementing as a national sub-acute and non-acute ABF model- To ensure that the revised classification is acceptable across the sub-acute sector including States andTerritoriesKeywordsactivity, 4, version, snap, classification, funding, workshop, developmentPublication DetailsJ. Green & R. Gordon "Development of AN-SNAP version 4: activity based funding classification workshop",Activity Based Funding Conference, Melbourne Convention and Exhibition Centre, 23-25 Jun 2014, (2014)This conference paper is available at Research Online: http://ro.uow.edu.au/ahsri/613Development of AN-SNAP Version 4: Activity Based Funding Classification WorkshopAssociate Professor Janette Green Associate Professor Rob Gordon Centre for Health Service Development  (CHSD)University of Wollongong 23 June 2014To develop a fully revised and contemporary version of the AN-SNAP classification suitable for implementing as a national sub-acute and non-acute ABF modelTo ensure that the revised classification is acceptable across the sub-acute sector including States and TerritoriesProject aims and objectivesConceptual frameworkWithin the context of:– the national health reform agenda, and – the changing clinical profile of sub-acute patients Three related sets of activities are being undertaken:– a review of previous and current work– an extensive stakeholder consultation process– application of recognised classification development and statistical analysis methods We know that cost drivers in the sub-acute sector are different from the acute sector and involve factors such as:– Rehabilitation: function, impairment, age, co-morbidities, complications, psychosocial environment, – Palliative care: stage of illness (phase of care), function, age, and acute complications;  – GEM: function, acute medical complications, co-morbidities, psychosocial environment – Psychogeriatrics: function, behaviour, risk factorsSub-acute cost driversDevelopment of AN-SNAP V4Project comprises the three major elementsA targeted review of previous work including AN-SNAP V3A multi-pronged stakeholder engagement strategyA series of statistical analyses using clinical, activity and financial data obtained from a range of sources, including projects recently undertaken on behalf of IHPA. To be completed in October  2014Core project activitiesMethodological and clinical issuesData from a range of sources are being synthesised including: – Jurisdictional sub-acute data collections– NHCDC sub-acute data– Admitted patient collection morbidity data for sub-acute episodes– Cost (and available clinical) data collected in 2013 by Ernst and Young study– Other available episode level costed sub-acute data (including data held by CHSD) – Non-admitted data collection, including service events for sub-acute type Tier 2 clinics– PCOC and AROC dataData availabilityChallenges with the dataIn general –– To measure the things that drive costs, – To have these measures available in a costed datasetFor this project …. a rigorous methodology to maximise the utility of all available data is being employedUnderstanding sub-acute cost drivers– reviewing variables in the current version– PLUS testing some new variables for inclusion– eg should diagnosis play a role?– what is it about cognition?Incorporating changing clinical practiceSome other key project issuesWe know that the following types of factors have influenced the delivery and cost of sub-acute services in recent years– Clinical characteristics of patients  – New models of care / treatment protocols – Structural / organisational issues – Length of stay related factors  – Patient / family / carer expectationsChanges in clinical practice and cost driversAdditional issues being given particular focus:– the interface between acute and sub-acute care– the interface between sub- and non-acute care types– reviewing ambulatory AN-SNAP classes  – developing paediatric AN-SNAP classesPlus…Solutions for these issuesMay be found in the new classificationMay be managed via business rulesMay be managed via a funding modelORMay be some years offOptions being considered in the statistical analysisTo improve the performance of the classificationPalliative CareModifying age and RUG/ADL splitsThe impact of incorporating weighted RUG-ADL scoresThe use  of diagnostic clusters as a splitting variableAdditional variables, eg palliative care problem severity scoreRehabilitationModifying FIM™ splits for several impairment categories Incorporating clusters of ICD 10 diagnosis codes in some impairments  Introducing a weighting for individual FIM itemsSpecial focus on the reconditioning impairmentGEMAn initial split based on FIM motor score and a second split based on diagnosis clustersAge and FIM cognition  - perhaps will not be included as splitting variablesAdditional measures that have been suggested –SNMSE, HoNOS 65+, other measure of  cognitive or behavioural issues for future versionsPsychogeriatricsLimited availability of data will preclude detailed analysis for this care typeLikely to remove two current AN-SNAP classes as are no longer relevant in clinical practiceOverlap with mental health classification Overlap with GEM care typeMaintenanceLikely to change the care type name to ‘non-acute’Reviewing current ‘maintenance care types’ to better reflect current  clinical practiceCheck for RUG-ADL and/or age splitsPaediatricsData!!!Rehabilitation: test the development of paediatric classes with an initial age split based on three age groups: 0-3, 3-12 and >12  followed by a secondary split based on impairment groupPalliative care: test the development of paediatric classes with an initial age split based on three age groups: 0-3, 3-12 and >12 followed by a secondary split based on cognitive impairment, medical complexity and function or impairment groupsAmbulatory AN-SNAP classesOverlap with classification based on Tier 2 ClinicsData availabilityFeedback from clinical panels– Mutlidisciplinary vs single discipline– Episode based?– What about same day admitted?– Ambulatory maintenance no longer happens

Development of AN-SNAP version 4: activity based funding classification workshop

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Development of AN-SNAP version 4: activity based funding classification workshop

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