A Clustering-Based Patient Grouper For Burn Care

Patient casemix is a system of defining groups of patients. For reimbursement purposes, these groups should be clinically meaningful and share similar resource usage during their hospital stay. In the UK National Health Service (NHS) these groups are known as health resource groups (HRGs), and are predominantly derived based on expert advice and checked for homogeneity afterwards, typically using length of stay (LOS) to assess similarity in resource consumption. LOS does not fully capture the actual resource usage of patients, and assurances on the accuracy of HRG as a basis of payment rate derivation are therefore difficult to give. Also, with complex patient groups such as those encountered in burn care, expert advice will often reflect average patients only, therefore not capturing the complexity and severity of many patients' injury profile. The data-driven development of a grouper may support the identification of features and segments that more accurately account for patient complexity and resource use. In this paper, we describe the development of such a grouper using established techniques for dimensionality reduction and cluster analysis. We argue that a data-driven approach minimises bias in feature selection. Using a registry of patients from 23 burn services in England and Wales, we demonstrate a reduction of within cluster cost-variation in the identified groups, when compared to the original casemix.