A. RESPIRATORY DISEASE

Transcription

1 RESPIRATORY DISEASE IV. A. RESPIRATORY DISEASE Rates of respiratory disease are higher in relative to national rates. - has an eight percent to 21 percent higher trachea, bronchus, and lung cancer death rate than all benchmark communities 1. - s lung and bronchus cancer incidence rate of 77.3 per 100,000 persons is 43 percent higher than the national rate. The rate of infectious diseases affecting the respiratory system in has decreased, but is still higher than some benchmark communities. - There were 31.0 deaths per 100,000 persons due to pneumonia and influenza in 1997, which is higher than the rates in Maryland, New Jersey and Washington State, but fifteen percent lower than Pennsylvania s rate and four percent below the nation s rate. - tuberculosis cases per 100,000 persons declined from 7.8 per 100,000 persons in 1995 to 5.3 per 100,000 persons in The rate of new cases of tuberculosis in (5.3 per 100,000 persons in 1997) is lower than most benchmarks, but remains above the Healthy People 2000 objective of 3.5 per 100,000 persons. residents receive the vast majority of their physician and inpatient care for respiratory conditions from providers. - Ninety-three percent of all inpatient admissions for respiratory conditions are in-area admissions, the majority of which occur in New Castle County. When residents leave the state for respiratory care, they generally seek treatment in Maryland. - had 16 physicians specializing in treating pulmonary conditions in 1997 (0.85 percent of all physicians), which is comparable to the national distribution. residents utilize inpatient services at higher rates for respiratory diseases than most benchmark communities. - Respiratory system diagnoses account for a substantial portion of s inpatient utilization, representing 10.3 percent of total inpatient days (the second highest of all Major Disease Categories [MDCs]) and 9.4 percent of total admissions (the fourth highest of all MDCs). 1 The five-year average mortality rate for trachea, lung, and bronchus cancer in was

2 RESPIRATORY DISEASE residents were admitted more often in 1997 to inpatient facilities for respiratory diseases relative to most benchmark communities. The admission rate for is between one percent and 57 percent higher in four benchmark communities, but lower than the national rate. - residents inpatient admission rate for pneumonia/pleurisy is slightly higher than that of benchmark communities. - residents are admitted for tracheostomy procedures at a rate 14 percent to 242 percent higher than all benchmark communities. residents experience higher than average asthma rates. ISSUE FOR FUTURE STUDY To better understand the significance of s higher rate of hospital admissions for tracheostomy procedures, research and data analysis is needed in a number of areas, including the underlying diagnosis, precipitating cause of the procedure, age distribution and clinical practice patterns. - Estimated prevalence rates for asthma based on self-reported survey information for residents are higher than the national estimate of prevalence rates for this disease. The difference in prevalence rates is greatest for residents under age The pediatric asthma hospital admission rate (5.47 per 1,000 persons) is 12 percent to 75 percent higher than comparison community rates, but comparable to the national rate. - The majority of asthma patients in may need additional counseling and resources to manage their asthma. The Health Assessment Survey found that 58 percent of asthma patients are counseled on what to do if they have a severe flare up, 50 percent are taught how to adjust their medication when their asthma gets worse and 55 percent are educated on common allergens and irritants and how to avoid them. ISSUE FOR FUTURE STUDY The NAEP guidelines specify that health care providers should educate all asthmatic patients about what to do if a severe episode of asthma occurs, how to adjust medications when asthma worsens and what environmental precipitants or exposures can make asthma worse and how to avoid them. residents are experiencing higher than average rates of asthma and admissions for the disease, but only slightly more than half are receiving education consistent with NAEP guidelines. Admission rates for two high volume respiratory system diagnoses pose particular concern for residents. - Chronic Obstructive Pulmonary Disease (COPD) accounts for 1.7 percent of total inpatient days in. The admission rate per 1,000 persons for COPD is between four percent and 83 percent higher than most benchmark communities, yet slightly lower than the national rate. - The COPD mortality rate of 21.2 deaths per 100,000 persons is six percent to 29 percent higher than Maryland, New Jersey and Pennsylvania, comparable to the national rate but below the Healthy People 2000 objective 2. The Kent County COPD 2 The five-year average mortality rate for COPD in was

3 RESPIRATORY DISEASE mortality rate of 29.7 per 100,000 persons is twice that of Sussex County and slightly higher than New Castle County. - Simple pneumonia and pleurisy with complicating conditions account for 1.9 percent of total admissions and 2.2 percent of total inpatient days in. residents experience a high admission rate for simple pneumonia compared to Seattle, WA and Washington State but a comparable admission rate to all other benchmark communities. Average charges for respiratory system disorder admissions and tracheostomy are within the range of benchmark communities. - Average charges for respiratory system disorders per admission in is 22 percent to 28 percent higher than Maryland, Washington State and Seattle, WA but lower than the rates of Pennsylvania and San Joaquin, CA. - Tracheostomy charges per admission are 24 percent to 59 percent higher than Washington State, Maryland and Seattle, WA but lower than the rates for Pennsylvania and San Joaquin, CA. 552

4 Exhibit IV-A-1: experienced a higher trachea, bronchus, and lung cancer death rate compared to benchmarks. Trachea, Bronchus, and Lung Cancer Deaths per 100,000 Persons (a) 1997 % Over/(Under) Benchmark 57.3 Norms U.S % Maryland % New Jersey % Comparison Communities Pennsylvania % Washington State % Consensusbased Standard Healthy People % Sources: 1-6) 1997 data, U.S. National Center for Health Statistics; CDC, CDC Wonder Data Extraction Software; 7) Healthy People 2000 Objectives. (a) Death rates are age-adjusted to the 1970 U.S. national population. (b) Although uses five-year averages to compensate for small sample size, one-year rates are used here so that can be compared to benchmarks. The five-year average mortality rate for trachea, bronchus, and lung cancer in was

5 Exhibit IV-A-2: The new case rate for lung and bronchus cancer experienced by residents was 43 percent higher than the national rate. Trachea, Bronchus, and Lung Cancer Incidence Rates per 100,000 Persons Pooled Data % Over/(Under) Benchmark 77.3 U.S.(a) Norms % Sources: (1) data, Division of Public Health, Epidemiology Branch; 2) 1995 data, National Cancer Institute, SEER Cancer Statistics Review (a) Incidence rates are age-adjusted to the 1970 U.S. national population. 554

6 Exhibit IV-A-3: s pneumonia and influenza death rate was comparable to most benchmarks. Pneumonia and Influenza Deaths per 100,000 Persons (a) % Over/(Under) Benchmark Norms U.S (4%) Maryland % New Jersey % Comparison Communities Pennsylvania 36.4 (15%) Washington State % Sources: 1997 data, U.S. National Center for Health Statistics, CDC Wonder Data Extraction Software. (a) Death rates are age-adjusted (except for U.S. rates which are age-sex adjusted) to the 1940 U.S.national population. 555

7 Exhibit IV-A-4: From 1995 to 1997, experienced a decrease in tuberculosis cases that paralleled the decrease in the U.S. tuberculosis case rate. Tuberculosis Cases per 100,000 Persons 1995 to U.S. Sources: data, Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 1996; 1997 data Centers for Disease Control and Prevention, Tuberculosis Morbidity 1997, MMWR; 47(13)

8 Exhibit IV-A-5: The incidence of tuberculosis in was lower than most benchmarks but above the Healthy People 2000 objective. New Tuberculosis Cases per 100,000 Persons % Over/(Under) Benchmark Norms U.S. 7.4 (28%) Maryland 6.7 (21%) New Jersey 8.9 (40%) Comparison Communities Pennsylvania % Washington State 5.4 (2%) Consensusbased Standard Healthy People % Sources: 1-6) 1997 data, U.S. National Centers for Disease Control and Prevention. Tuberculosis Morbidity - United States, 1997, MMWR; 47(13) 1998; 7) Healthy People 2000 Objective. 557

9 Exhibit IV-A-6: Ninety-three percent of all inpatient admissions for respiratory conditions are in-area admissions, the majority of which occur in New Castle County. Percent of Admissions to Selected Counties Respiratory System Disorders 1997 In-area Admissions Out-of-area Admissions Sussex County 25.2% Worcester County, MD 9.2% Other MD Counties 6.6% Philadelphia County, PA 13.9% Kent County 13.6% Cecil County, MD 9.2% County, PA 15.1% New Castle County 61.2% Wicomico County, MD 32.5% Other PA Counties 7.0% Baltimore City, MD 6.5% Total = 7,926 93% of All Respiratory System Disorders Total = 610 7% of All Respiratory System Disorders Source: 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc. 558

10 Exhibit IV-A-7: The proportion of the physicians specializing in pulmonary care in is comparable to the national norm. Percent of Pulmonary Specialists and U.S % Norms U.S. 0.88% Source: American Medical Association, Physician Characteristics and Distribution in the U.S.,

11 Exhibit IV-A-8: Respiratory system diagnoses represent 10.3 percent of total inpatient days and 9.4 percent of total admissions. Top MDCs by Percent of Total Admissions and Days 1997 Rank (Admissions) Rank (Days) MDC Description Percent of Admissions Percent of Days 1 1 5: Circulatory System 17.3% 16.3% : Pregnancy and Childbirth 11.8% 5.8% : Newborns and Neonates 10.0% 6.8% 4 2 4: Respiratory System 9.4% 10.3% 5 3 6: Digestive System 8.0% 8.9% 6 6 8: Musculoskeletal System 7.5% 6.3% 7 7 1: Nervous System 5.7% 6.2% : Mental Diseases and Disorders 5.3% 8.8% All Other MDCs 25.0% 30.6% Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc. 560

12 Exhibit IV-A-9: Utilization of inpatient days for residents for respiratory system disorders was within the range of benchmarks. Days per 1,000 Person MDC 4: Respiratory System 1997 Data Not Severity Adjusted % Over/(Under) Benchmark 64.5 Norms U.S (21%) Maryland % Pennsylvania 72.9 (12%) Comparison Communities Washington State San Joaquin, CA % 4% Seattle, WA % Consensusbased Standard Wichita, KS M&R Moderate % 72% Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data; 9) 1997 data, Milliman & Robertson Healthcare Management Guidelines (Volume I: Inpatient and Surgical Care, updated December 1997). (a) Days per 1,000 persons is calculated from the admissions per 1,000 persons and the average length of stay. Benchmark community rates are age/sex-adjusted to the population and case-mix adjusted to control for differences in types of hospital admissions. However, M&R rates are age-adjusted only (gender-specific utilization data were not available). M&R rates are adjusted to control for differences in the inpatient experience of residents. 561

13 Exhibit IV-A-10: Over one-tenth of inpatient days provided to residents are for respiratory system diagnoses. Hospital Days by Top MDCs 1997 Data Not Severity Adjusted Circulatory System 16.3% Other MDCs 36.4% Respiratory System 10.3% Digestive System 8.9% Neurological System 6.2% Mental Diseases and Disorders 8.8% Musculoskeletal System 6.3% Newborns/Neonates 6.8% Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc. 562

14 Exhibit IV-A-11: residents experienced an admission rate for respiratory system disorders slightly lower than the national rate, but slightly higher than most other benchmarks. Admissions per 1,000 Persons MDC 4: Respiratory System 1997 % Over/(Under) Benchmark 11.6 Norms U.S (12%) Maryland % Pennsylvania 12.3 (6%)* Comparison Communities Washington State San Joaquin, CA %* 5%* Seattle, WA %* Consensusbased Standard Wichita, KS M&R Moderate %* 57% Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data; 9) 1997 data, Milliman & Robertson Healthcare Management Guidelines (Volume I: Inpatient and Surgical Care, updated December 1997). (a) Benchmark community rates are age/sex-adjusted to the population. However, M&R rates are age-adjusted only (gender-specific utilization data were not available). * = statistically significant at the 0.05 level. Statistical significance is not calculated for M&R Moderate. 563

15 Exhibit IV-A-12: The three counties had similar utilization rates of inpatient days for respiratory system disorders. Days per 1,000 Persons MDC 4: Respiratory System 1997 Data Not Severity Adjusted New Castle 62.5 Days/1,000 Kent 69.9 Days/1,000 N Sussex 67.0 Days/1,000 W E S Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc. (a) Days per 1,000 persons is calculated from the admissions per 1,000 persons and the average length of stay. County rates are age/sex-adjusted to the population. County-specific rates are also case-mix adjusted to to control for differences in types of hospital admissions. 564

16 Exhibit IV-A-13: New Castle County residents experienced a lower admission rate for respiratory system disorders than residents of other counties. Admissions per 1,000 Persons MDC 4: Respiratory System 1997 New Castle 10.8 Admissions/1,000 Kent 12.4 Admissions/1,000 Sussex 13.2 Admissions/1,000 W N E S Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc. (a) County-specific rates are age/sex-adjusted to the population. 565

17 Exhibit IV-A-14: s inpatient admission rate for pneumonia/pleurisy was slightly higher than those of benchmarks. Pneumonia/Pleurisy Inpatient Admission Rate per 1,000 Persons % Over/(Under) Benchmark Norms U.S. (a) 3.93 (12%)* Maryland (a) % Pennsylvania (a) %* Comparison Communities Washington State (a) San Joaquin, CA (a) %* 9%* Seattle, WA (a) %* Wichita, KS (a) 3.58 (4%) Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association. (a) Benchmarks were age-adjusted to the population. * = statistically significant at the 0.05 level. 566

18 Exhibit IV-A-15: residents were admitted for tracheostomy procedures at a rate 14 percent to 242 percent higher than benchmarks. Admissions per 1,000 Persons DRG 483: Tracheostomy Except for Face, Mouth and Neck Diagnoses % Over/(Under) Benchmark Norms U.S %* Maryland %* Pennsylvania %* Washington State %* Comparison Communities San Joaquin, CA %* Seattle, WA %* Wichita, KS %* Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1996 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data. (a) Benchmark community rates are age/sex adjusted to the population. * = statistically significant at the 0.05 level. 567

19 Exhibit IV-A-16: Estimated asthma rates in are above the national prevalence estimates. Prevalence of Asthma and U.S. Condition (2000) U.S. (1996) Percent Above U.S. Benchmark Asthma < 45 Years of Age 13.2% 5.9% 124% Years of Age 9.9% 4.9% 102% > 65 Years of Age 10.2% 4.6% 122% Sources: 1) The Lewin Group, Inc., Community Assessment: Health Assessment Survey, 2000; 2) 1996 National Health Interview Survey. prevalence estimates do not include respondents for whom age could not be calculated because birth date was missing. The methodology used in the Health Assessment Survey to determine prevalence of disease in the community is different from the methodology used to determine national prevalence. National prevalence estimates also predate survey estimates by several years. Four patients with no age reported having asthma. N/A denotes data is not available. 568

20 Exhibit IV-A-17: The inpatient admission rate for pediatric asthma in was significantly higher than most benchmark communities but comparable to the nation. Pediatric Asthma Inpatient Admission Rate per 1,000 Persons Age 0 to % Over/(Under) Benchmark Norms U.S. (a) 5.58 (2%) Maryland (a) %* Pennsylvania (a) %* Comparison Communities Washington State (a) San Joaquin, CA (a) %* 65%* Seattle, WA (a) %* Wichita, KS (a) %* Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association. (a) Benchmarks were age-adjusted to the population, aged 0 to 17. * = statistically significant at the 0.05 level.\ 569

21 Exhibit IV-A-18: COPD accounts for 1.7 percent of total inpatient days in. Top DRGs by Number of Days 1997 DRG Code DRG Description Percent of Total Days 430 Psychoses 6.3% 462 Rehabilitation 5.1% 127 Heart Failure and Shock 3.2% 483 Tracheostomy Except for Face, Mouth and Neck Diagnoses 2.8% 373 Vaginal Delivery without Complicating Conditions, Age > % 148 Major Small and Large Bowel Procedures with Complicating Conditions 2.4% 391 Normal Newborn 2.3% 89 Simple Pneumonia and Pleurisy with Complicating Conditions, Age > % 14 Specific Cerebrovascular Disorders except TIA 2.1% 88 Chronic Obstructive Pulmonary Disease 1.7% All Other DRGs 69.3% Total Days = 460,396 Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc. 570

22 Exhibit IV-A-19: residents admission rate for COPD is slightly lower than Pennsylvania and the nation, but higher than the majority of other benchmark rates. Admissions per 1,000 Persons DRG 88: Chronic Obstructive Pulmonary Disease % Over/(Under) Benchmark Norms U.S (9%)* Maryland %* Pennsylvania 2.28 (12%)* Comparison Communities Washington State San Joaquin, CA %* 4% Seattle, WA %* Wichita, KS %* Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1996 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data. (a) Benchmark community rates are age/sex adjusted to the population. * = statistically significant at the 0.05 level. 571

23 Exhibit IV-A-20: In 1997, s residents experienced a COPD mortality rate that fell within the range of benchmarks. Chronic Obstructive Pulmonary Diseases and Allied Conditions Deaths per 100,000 Persons (a) % Over/(Under) Benchmark Norms U.S % Maryland % Comparison Communities New Jersey Pennsylvania % 14% Washington State 23.3 (9%) Consensusbased Standard Healthy People 2000 Objective 25.0 (15%) Sources: 1-6) 1997 data, U.S. National Center for Health Statistics; CDC, CDC Wonder Data Extraction Software; 7) Healthy People 2000 Objectives. (a) Death rates are age-adjusted to the 1940 U.S. national population. (b) Although uses five-year averages to compensate for small sample size, one-year rates are used here so that can be compared to benchmarks. The five-year average mortality rate for COPD in was (c) Healthy People 2000 objective to slow the rising COPD death rate to no more than 25.0 deaths per 100,000 persons. 572

24 Exhibit IV-A-21: The Kent County COPD mortality rate was nearly twice that of Sussex County in Chronic Obstructive Pulmonary Diseases and Allied Conditions Deaths per 100,000 Persons by County (a) 1997 New Castle 21.5 Deaths Kent 29.7 Deaths Sussex 15.3 Deaths N W E S Sources: Note: 1997 data, U.S. National Center for Health Statistics; CDC, CDC Wonder Data Extraction Software. (a) Death rates are age-adjusted to the 1940 U.S. national population. 573

25 Exhibit IV-A-22: Simple pneumonia and pleurisy with complicating conditions account for 1.9 percent of admissions in. Top DRGs by Number of Admissions 1997 DRG Code DRG Description Percent of Total Admissions 373 Vaginal Delivery without Complicating Conditions 6.9% 391 Normal Newborn 6.3% 430 Psychoses 3.5% 127 Heart Failure and Shock 3.0% 462 Rehabilitation 2.0% 89 Simple Pneumonia and Pleurisy with Complicating Conditions, Age > % 143 Chest Pain 1.8% 371 Cesarean Section without Complicating Conditions 1.7% 390 Neonate with Other Significant Problems 1.7% 209 Major Joint and Limb Reattachment Procedures of Lower Extremity 1.7% All Other DRGs 69.5% Total Admissions = 90,804 Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc. 574

26 Exhibit IV-A-23: residents experienced a high admission rate for simple pneumonia compared to Seattle, WA and Washington State, but a comparable admission rate compared to other benchmarks. Admissions per 1,000 Persons DRG 89: Simple Pneumonia and Pleurisy with Complicating Conditions, Age > % Over/(Under) Benchmark Norms U.S (6%)* Maryland % Pennsylvania % Washington State %* Comparison Communities San Joaquin, CA % Seattle, WA %* Wichita, KS 2.37 (3%) Sources: 1) 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1996 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data. (a) Benchmark community rates are age/sex adjusted to the population. * = statistically significant at the 0.05 level. 575

27 Exhibit IV-A-24: Average charges for respiratory system disorders in fell within the range of benchmarks. Charge per Admission (all payors) MDC 4: Respiratory System 1997 $9,672 % Over/(Under) Benchmark Maryland $7,302 32% Pennsylvania $18,222 (47%) Comparison Communities Washington State $7,932 22% San Joaquin, CA $18,143 (47%) Seattle, WA $7,570 28% Sources: 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 2) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 4,6) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 5) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD). (a) All payors charges: figures include charges associated with hospital discharge records, regardless of payor or age of patient. (b) Benchmarks were case mixed to control for differences in types of hospital admissions. Benchmarks were also adjusted to control for geographic differences in operating costs using 1997 wage index data from the US Department of Health and Human Services (Federal Register, v.62(168), August 29, 1997). 576

28 Exhibit IV-A-25: s tracheostomy charge per admission was within the range of benchmarks. Charge per Admission (all payors) DRG 483: Tracheostomy Except Face, Mouth and Neck Diagnoses 1997 $156,937 % Over/(Under) Benchmark Maryland $98,776 59% Pennsylvania $249,597 (37%) Comparison Communities Washington State $126,671 24% San Joaquin, CA $264,376 (41%) Seattle, WA $115,411 36% Sources: 1997 data, Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 2) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 4,6) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 5) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD). (a) All payors charges: figures include charges associated with hospital discharge records, regardless of payor or age of patient. (b) Benchmarks were adjusted to c ontrol for geographic differences in operating costs using 1997 wage index data from the US Department of Health and Human Services (Federal Register, v.62(168), August 29, 1997). 577