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Dr Foster's Case Notes

Counting hospital activity: spells or episodes?

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1207

The NHS is introducing a new “payment by results” system of financial flows. Crucial to the reforms are both the tariffs for each activity and how activity is measured at the trust level. Activity will be based on hospital episode statistics (HES), a complex dataset containing over 12 million records per year on NHS patient care in England. The basic record is a finished consultant episode of care (the time spent under the care of one consultant). An admission, or spell, is defined as a continuous period of time spent as a patient within a trust, and may include more than one episode. Using HES data, we contrasted spell based activity and episode based activity, using myocardial infarction as an example.

The bottom line

  • Trends in hospital activity for myocardial infarction differ depending on the unit of analysis

  • Many spells contain several episodes of care with a primary diagnosis of myocardial infarction, suggesting episode inflation

  • The interpretation of what constitutes …

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