CAD data spec
30 June 2015
ITAP MANAGED CARE WORKING GROUP
TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL’s)
–CORONARY ARTERY DISEASE (CAD) and ISCHAEMIC HEART DISEASE (IHD) and HYPERLIPDAEMIA –
Explanatory note to the Managed Care minimum reporting data specification (excel spreadsheet)
The aim of the project is to report on the value added by managed care organisations, who by means of capturing, measuring and reporting on clinical
indicators that will demonstrate clinical outcome/s achieved. Hence this is by no means a representation of the full protocol, policy or guideline on
cardiovascular management.
Additionally, these indicators will be included within the Annual statutory return to be completed by the Scheme.
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CAD data spec
30 June 2015
1) Goal
The value of managing a disease is to determine goals that would enable the user to measure, record and report on an achieved outcome
(Diagnosis, treatment and care of all beneficiaries in line with evidence base medicine, cost effectiveness and affordability).

Prevent complications and or optimally manage the progression of disease.
2) Identification of CAD / IHD / Hyperlipidaemia beneficiaries by means of data mining (i.t.o. the contractual arrangement with the MCO)
Please ensure the relevant consent and confidentially has been addressed when obtaining personal health information.
Identification of beneficiaries with the relevant disease may include
 Registered on chronic / disease management programs
 ICD-10 Codes
 Anatomical Therapeutic Chemical Classification System (ATC Class)
 National stock numbers
3) Minimum data specification: Process indicators, clinical outcomes and data
The level of Active Disease Management services for CAD / IHD / Hyperlipidaemia will depend on the nature of the contract, the level of services covered and the fee
structure for those services, e.g. Screening, medicine management and hospital benefit management etc.
The minimum required fields for the effective collection of appropriate data to demonstrate the value of the managed care interventions for the
below mentioned categories are detailed by way of process indicators (see attached spreadsheet for details).
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
Screening
Pending the benefits and agreement in place, if screening will be managed and reported on and if so by which entity.

Diagnosis
The diagnosis to be made by the specified provider.

Baseline Investigations

Doctor Rooms
- Blood Pressure measurement
- ECG

Laboratory Tests
- Lipid profile
- Glucose
- Serum Electrolytes
- Prothrombin Index (PI)
*see condition specific spreadsheet for full details
 Procedures
- Percutaneous transluminal angioplasty
- Coronary artery bypass graft
 Discipline Type
The service provider to be adequately registered with their relevant statutory bodies and indicated as such by discipline coded list provided by
BHF.
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4) Treatment – Pending the condition
Coronary Artery Disease
Cardiomyopathy / Heart Failure
Organic nitrates
Beta blocking agents
Antihypertensive
Agents acting on the reninangiotensin system
Diuretics
Digoxin
Beta blocking agents
Organic nitrates
Calcium channel blockers
Hydrazinophthalazine derivatives
Agents acting on the renin-angiotensin
system
Diuretics
Hyperlipidaemia
Serum lipid reducing agents
Lipid Modifying Agents
Platelet aggregation inhibitors excl.
heparin

Vaccinations
o
o
Flu Vaccine
Pneumococcal vaccines
* Formulary Items per scheme and should include consumables.
* Please note these recommendations do not replace the published algorithms, PMB entitlements etc. It is a means of measuring the value provided by the managed
care process.
5) Clinical Outcomes
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




Number of cardiac related hospital admissions
Number of casualty visit/s
Number of
o Revascularisation procedures
o Invasive cardiology
o Open heart surgery / CABG / PCI
Number of comorbidities
o Cerebral vascular disease
o Heart Failure
o Diabetes
o Hypertension
Number of beneficiaries on
C09AA
C09BA
C09BB
C09BX
C09CA
C09DA
C09DB
C09DX
C09X

ACE inhibitors, plain
ACE inhibitors and diuretics
ACE inhibitors and calcium channel blockers
ACE inhibitors, other combinations
Angiotensin II antagonists, plain
Angiotensin II antagonists and diuretics
Angiotensin II antagonists and calcium channel blockers
Angiotensin II antagonists, other combinations
Other agents acting on the renin-angiotensin system
All-cause mortality
Clinical Measures
 % that reached goal - LDL (Initial scoring new patient vs current reading).
 Target / scoring documented Low / moderate / high risk
* Information in regards to ICD-10 coding may be found on the following site
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CAD data spec
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http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11
6) Reporting (MCO and Scheme)
*Definitions will be the same utilised within the Annual statutory returns – see circular 10 of 2015.
All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to the
service rendered.
6.1
By Managed Care Organisation: Management out of hospital
-
Time period: Benefit year (Reporting period – Start and end)
Per benefit option
Per Scheme
Member
Beneficiary
Service Date (Benefit Year)
Gender – Male / Female
6.1.1 Demographics
Year: Bi-Annual
Total Number of
Beneficiaries per option
(scheme)
Male
Female
Number of New
Registrations
Male
Female
Total Number of
Beneficiaries identified
with CAD / IHD /
Hyperlipidaemia
Male
Female
Total Number of
Beneficiaries identified with
2 or more co-morbidities
Male
Female
Under 1
1 to 4
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4 to 9
10 to 14
15 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
45 to 49
50 to 54
55 to 59
60 to 64
65 to 69
70 to 74
75 to 79
80 to 84
85 and above
Total
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Left the program – This may include a range of reason codes: left the scheme, death, suspensions etc.
Co-morbidities
o Cerebral vascular disease
o Heart Failure
o Diabetes
o Hypertension
6.1.2 Clinical Management – reported per disease registered
Percutaneous
coronary
intervention (PCI),
Open Heart
Surgery
Coronary artery
bypass graft
(CABG)
Total Number of Procedures
performed
PI
ECG
Electrolytes
Total Number of test
performed
Number of New Registrations
Glucose
Number of
on program
Lipogram
Year: BiAnnual
Per Age
group
B
Total
6.13 Medications
Year: BiAnnual
C09AA ACE
inhibitors,
C09BA ACE
inhibitors
C09BB
ACE
inhibitors
C09BX ACE
inhibitors,
C09CA Angiotensin II
antagonists,
C09DA Angiotensin
II antagonists
C09DB Angiotensin
II antagonists
C09DX Angiotensin II
antagonists,
C09X Other agents
acting on the
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CAD data spec
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plain
and
diuretics
and calcium
channel
blockers
other
combinations
plain
and diuretics
and calcium
channel
blockers
other
combinations
reninangiotensin
system
Per Age
group
Total
6.2 Management in Hospital
- Time period: 1 January to 31 December (financial year), define per quarter
- Per benefit option
- Per Scheme
- Hospital Admissions:
 All cause admissions
 Respiratory related Admissions
- Hospital Category
 Day Admission
 Long Stay
 Readmission
- Gender
- Age
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Admission definitions

Cardiac related admission - please refer to attached list of ICD10 Codes.

Mortality / Exit codes – Where a hospital notifies the schemes / MCO / Administrator that a member is deceased. See Attached

Emergency room – Definition is that member discharged from unit

Hospital admission

A day case is when admission day is same as discharge date

A long stay is when discharge date is after the admission day.

A Re-admission is when a patient from hospital is readmitted within 90 days of previous discharge date
6.2.1 Hospital Category: Day Case
Scheme
Total Number of
Admissions (All Cause)
Total Number of
Admissions (Cardiac
Related)
Admission Per Category
Surgical
Male
Female
Medical
Mortality (Exit
Codes = Expire)
Claimed
Amount
Risk Paid
Amount
Male Female
6.2.2 Hospital Category: Long Stay
Scheme
Total Number of
Admissions (All Cause)
Total Number of Admissions
(Cardiac) Related
Admission Per Category
Surgical
Medical
Mortality (Exit
Codes = Expire)
Claimed
Amount
Risk Paid
Amount
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CAD data spec
30 June 2015
Male Female Male Female
6.2.3 Hospital Category: Re-admission
Scheme
Total Number of
Admissions (All Cause)
Total Number of Admissions
(Cardiac) Related
Admission Per Category
Surgical
Medical
Mortality (Exit
Codes = Expire)
Claimed
Amount
Risk Paid
Amount
Male Female Male Female
7) References
- 2013 09 HeFSSA chronic Heart Failure Guideline Final SAMJ
- HeFSSA chronic Heart failure guideline poster
- SA Lipid Guidelines SAMJ March 2012
- South African Guidelines of Congestive Heart Failure
- State EDL
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