Actual Death Percentage: the actual number of deaths per 100 patients with a certain condition or procedure, excluding transfers to another hospital. Actual death percentage does not adjust for the hospital's case mix. Other name: observed death rate per 100 patients.
Agency for Health Care Research and Quality (AHRQ): a federal agency that develops indicators of patient safety and quality of care and engages in other related activities. Read more…
APR-DRG: stands for All Patient Refined Diagnosis Related Group, software widely used in health services research. The APR-DRG software organizes about 20,000 clinical diagnoses and procedures into about 300 groups. Each APR-DRG has four levels for severity of illness (minor, moderate, major and extreme). This report uses APR-DRG version 20.0 for expected deaths, because AHRQ uses this version to determine expected rate and risk-adjusted rate in the Inpatient Quality Indicators and Patient Safety Indicators. Some other Utah Department of Health reports based on hospital administrative data through 2004 published through 2004 that include average charges use APR-DRG version 15.0. Read more…
Average Hospital Charge: the average dollars for hospital services for which patients were billed at a particular hospital. The hospital charge does not include physicians' professional fees or patient personal costs. The charge may differ from actual payment that the hospital receives. For this report cases with a high outlier (unusually high) charge and cases with a high outlier were excluded from each hospital's average charge. A high outlier is over 2.5 standard deviations higher than the state mean for each of four levels of patient severity per APR-DRG.
Expected Death Percentage: the number of deaths expected per 100 patients with a certain condition or procedure if the hospital performed the same as other hospitals in the nation with similar patients in the Health Care Cost and Utilization Project (HCUP) State Inpatient Databases for 2003. Expected death percentage adjusts for the hospital's case mix (patients' age, gender and how ill the patients are). Read more in the Technical Document, p. 9.
Influenza: a contagious disease that is caused by a virus. When influenza attacks the lungs, the lining of the respiratory tract is damaged. The tissues temporarily become swollen and inflamed but usually heal within two or more weeks. Influenza is often complicated by pneumonia, especially in the elderly. Influenza, especially with pneumonia, can be life threatening. Other name: flu. Read more…
Inpatient Quality Indicators (IQIs): developed by the Agency for Health Care Research and Quality (AHRQ), a federal agency, to be used on inpatient hospital discharge data. AHRQ IQI definitions and methods were used to calculate the actual and expected deaths rates conditions and procedures in this report. AHRQ IQI limitations include possible differences in hospital coding practices and possible inadequacy of the risk adjustment method for expected death percentage. The AHRQ IQIs and APR-DRGs in Utah Hospital Comparison reports are similar but not identical. The IQIs and APR-DRGs include patients with do not resuscitate orders and other end of life conditions with pneumonia patients that are not expected to recover. Read more… Pneumonia Technical Document and http://www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf and http://www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml and http://www.3mpluggedin.com/promotions/aprdrgs/aprdrg2006.asp?URL_id=3maprdrgcom
Outlier Charge: a charge by a specified hospital that is more than 2.5 standard deviations higher than the state average by APR-DRG for each of the four severity of illness levels. This report excludes patients with outlier charges from its hospital average charge.
Pneumonia: an inflammation of the lung caused by infection with bacteria, viruses, and other organisms. Pneumonia is often a complication of a pre-existing condition/infection and triggered when a patient's defense system is weakened, most often by a simple viral upper respiratory tract infection or a case of influenza, especially in the elderly. This report includes some but not all kinds of pneumonia among adult hospital inpatients (age 18 years and older). The average hospital charge in this report is for patients in the All Patient Refined Diagnosis Related Group 139 (APR-DRG 139) Other Pneumonia. "Other Pneumonia" includes some of the more common kinds of bacterial, viral and mycoplasma pneumonia as well as influenza with pneumonia. It does not include respiratory syncylial viral (RSV) pneumonia, which is more common among children, or many of the rarer kinds of bacterial, viral and fungal pneumonia such as those associated with tuberculosis and cystic fibrosis. For a complete list of kinds of pneumonia included in APR-DRG 139, see the Pneumonia Technical Document, page 14. The indicator for in-hospital deaths among adult pneumonia patients is more inclusive. For a complete list of kinds of pneumonia included in this indicator, see the Pneumonia Technical Document, p. 15.
State Inpatient Databases (SID) 2003: a national sample that represents about 90% of all inpatients from 38 participating states in 2003. The Health Care Cost and Utilization Project (HCUP) collects these data every year. For this report, the percentage of expected deaths for the quality indicators is based on the SID 2003. Read more…
Statistical Rating System: Utah Hospital Comparison reports use statistical rating based on a test of statistical significance, the exact 95% confidence interval. For the Heart Surgeries and Conditions Report, the Hip and Knee Surgeries and Conditions Report, and the Pneumonia Report, this test shows whether the difference between a hospital's actual death percentage and expected death percentage is real (statistically significant, p < 0.05) or just due to chance. We calculated the upper and lower exact 95% confidence interval limits for each hospital's actual death rate for each indicator. If the expected death percentage is between the lower and higher limits for the actual death percentage, then we are 95% confident that the actual death rate and the expected death rate are essentially the same. If the higher limit for the actual death percentage is lower than the expected death percentage, then we are 95% confident that the actual death percentage is really lower than the expected death rate. If the lower limit for the actual death percentage is higher than the expected death percentage, then we are 95% confident that the actual death rate is really higher than the expected death rate. Read more… Pneumonia Technical Document, p. 10.
Statistically Significant Difference: the statistical ratings in the AHRQ IQI tables use exact 95% confidence intervals to show whether differences are statistically significant (p < 0.05). Read more… Pneumonia Technical Document, p. 10.
Utah Overall: for each specified condition or procedure and severity of illness group (Minor/Moderate or Major/Extreme), all adult cases treated at all Utah hospitals, except some specialty hospitals such as Primary Children's Medical Center. Utah overall average hospital charge is the sum of all reported hospital charges billed to all patients treated at Utah hospitals for a specified severity of illness group divided by the number of Utah overall patients for that severity of illness group except the Veterans Administration. The quality tables include only Utah residents. The hospital average charges (APR-DRGs) tables include Utah resident and non-resident patients.
Note: Medical terms for pneumonia are based on the American Lung Association, http://www.lungusa.org Indicator terms, such as expected death percentage, are based on Agency for Health Care Research and Quality and APR-DRG documents.