Hospital Utilization: Hospitalization and Emergent Care

Transcription

1 Hospital Utilization: Hospitalization and Emergent Care SHP for Agencies Complete analysis of hospitalizations, rehospitalizations, and emergent care occurrences is available in the Agencies> Hospital Utilization section of the Report menu. This document outlines the Hospitalization and Emergent Care report and how each data point should be interpreted. Metrics & Parameters All measures in this report use the traditional CMS outcome methodology to calculate hospitalizations (acute care hospitalizations) and emergent care with and without hospitalization based on patient transfers and discharges that occurred in the reporting period. There are no exclusions based on prior facility or time since start of care. Filtering can be applied via the parameters available when running the report: Provider Selection (available to multi-site users) - Allows selection of multiple providers for rollup reporting. From Date - Uses clinical episode end date, beginning with the 1 st day of the selected month. To Date - Uses clinical episode end date, ending with the last day of the selected month. Payer Type - All standard SHP payer type selections are available. General Features Color-Coded Scores All red and green color-coding used in the report indicates worse than the SHP National Benchmark (red), and better that or equal to the SHP National Benchmark. Drill-Down Links All hyperlinks in the report drill-down to the Outcomes Patient Detail report where all patients included in the respective metric are listed. Report Details: Page 1 Hospitalizations Trended by Month The Hospitalizations Trended by Month chart is a standard SHP trended outcomes chart showing your actual score and your risk adjusted score, with the state and national benchmarks for each month. In the table above the chart, the cases and count numbers again represent the numerator and denominators behind the You Observed percentages.

2 Hospitalization Risk Factors (M1032) As noted in the title, this section corresponds to M1032 which is completed on the SOC/ROC OASIS assessment. This table compares the hospitalization risk factors indicated on the OASIS assessment for each patient to the actual hospitalizations. Column 1: You: Indicated at SOC/ROC Total number of times in the reporting period each of the risk factors was indicated. Note: Multiple factors can be selected on each assessment. Column 2: You: Indicated at SOC/ROC & Hospitalized Of those patients who had the risk factor indicated, the total counts that ended up being hospitalized. Column 3: You: % of All Patients Indicated The percentage of your total patient population in the reporting range that had each risk factor indicated on their SOC/ROC assessment. Column 4: You: % with Risk and Hospitalized The percentage of those patients who had the risk factor indicated, that ended up being hospitalized. Benchmarks: The benchmark columns use the same methodology as columns 3 and 4. SHP Risk of Hospitalization Alert The SHP Risk of Hospitalization Alert table provides some metrics on how often SHP alerts notified you that a patient was at risk for hospitalization. This SHP Predictive Alert uses a complex formula based on the CMS risk adjustment methodology in conjunction with proprietary regression analysis involving ICD-9 codes. Unlike the previous table, this does not take into account M1032 at all. Column 1: You: Alert Triggered Total number of times in the reporting period that SHP generated an alert on the SOC/ROC assessment to notify you of a patient at risk for hospitalization. Column 2: You: Alert Triggered & Hospitalized Of those patients for whom an alert was generated, the number that did end up being hospitalized. Column 3: You: % of All Patients with Alert The percentage of your total patient population in the reporting range that triggered the risk of hospitalization alert on their SOC/ROC assessment. Column 4: You: % with Alert and Hospitalized The percentage of those patients who had the alert and did end up being hospitalized. Benchmarks: The benchmark columns use the same methodology as columns 3 and 4.

3 Report Details: Page 2 - Hospitalizations by Home Health Primary Diagnosis Page 2 shows your hospitalizations by diagnosis group based on the primary diagnosis as indicated on the SOC/ROC from each episode in the reporting period. The calculations work by showing the hospitalizations (count) for each category over the total number of clinical episodes that had that particular primary diagnosis (cases). You can see in the example below that for the diagnosis group Infectious/Parasitic the percentage of those patients that were hospitalized is higher than the national benchmark, as indicated by the red at 50.00%. However, since the numerator and denominator are visible under the cases and count columns, you can see that this 50.00% represents one hospitalization out of every two patients with a primary diagnosis from that group. Looking at the Neoplasm category in this example, we can see that this is a much more common primary diagnosis for this agency with a total of 65 in the reporting period. In this case the hospitalization rate for these patients is lower than the national benchmark at 35.58% with only 15 of these patients being hospitalized. Note that the first category is Unknown. Occasionally we receive assessments containing an invalid ICD codes as the primary diagnosis. When applicable, those cases will be included in this category. The totals at the bottom of this page correspond with the total eligible patients (cases) and total hospitalizations (count) over the reporting period. Report Details: Page 3 - Hospitalizations by Home Health Primary and Other Diagnoses As on the previous page, these measures represent the hospitalizations (count) for each category over the total number of clinical episodes that had that particular diagnosis (cases). However, this page looks at all the Home Heath ICD codes on the SOC/ROC assessment. These include M1020, M1022, and M1024. If a patient has a primary diagnosis of hypertension and a secondary diagnosis of diabetes, they would be counted in both the hypertension and diabetes categories. Because each patient can have multiple diagnoses, the sum of the cases and counts will add up to more that the totals shown at the bottom of the page. The totals at the bottom of this page correspond with the total eligible patients (cases) and total hospitalizations (count) over the reporting period. Report Details: Page 4 - Hospitalizations by Reason The final page of charts dealing with hospitalizations looks at the reasons indicated on the transfer assessment. Multiple reasons may be checked for any single hospitalization so the counts on this page may total more than the number of hospitalizations in the reporting period. The total at the bottom of this page corresponds with the total eligible patients (cases) which is the denominator in the percentage calculations on this page.

4 Report Details: Page 5 - Emergent Care Trended by Month As with the hospitalizations section, the following pages use standard CMS outcome methodology to calculate emergent care with and without hospitalization. This means that these sections are based on the patient discharges that occurred in the reporting period unlike the first two pages of the report which are based on SOCs. Emergent Care with Hospitalization and Emergent Care without Hospitalization Both of the trended charts on this page are the standard SHP Trended Outcomes charts showing your actual score, along with the state and national benchmarks for each month. In the table above the chart, the cases and count numbers again represent the numerator and denominators behind the You Observed percentages. Note: Risk Adjusted numbers are not available for these measures since risk adjustment methodology has not been made public by CMS. Report Details: Page 6 - Emergent Care by Home Health Primary Diagnosis Page 6 shows your emergent care occurrences by diagnosis group based on the primary diagnosis as indicated on the SOC/ROC from each episode in the reporting period. As on the hospitalizations pages, these calculations work by showing the emergent care occurrences (count) for each category over the total number of clinical episodes that had that particular primary diagnosis (cases). Because there are two separate emergent care outcomes being included on this page, Emergent Care with Hospitalization and Emergent Care without Hospitalization, the data is shown using a stacked bar chart. The first You bar in each row corresponds with % with Hosp, the second corresponds with % without Hosp, and the bars together corresponds with % All which is the rollup total of the two emergent care outcomes. This same format is true of the national benchmarks. In the example below, note that the 17.91% circled in blue is color coded green indicating it is better than the national benchmark of 22.13%. This is also reflected in the chart, as the corresponding bar is smaller than the light grey bar below it that corresponds to the national benchmark for that metric. Likewise the 5.97% circled in orange is color coded red indicating that this score is worse than the national benchmark, this is also reflected in the color coded bar in the corresponding chart. % All is the sum of these two scores. In this example % All is color coded green indicating that together these scores are better than the sum of the two national benchmark scores.

5 Note that in this example, this agency s score for % w/o Hosp. for the Blood/Blood-Forming Organs diagnosis group is zero. Because of this the chart only shows the % with Hosp. score with a single bar. The totals at the bottom of this page correspond with the total eligible patients (cases) and total emergent care occurrences (count) over the reporting period. Report Details: Page 7 - Emergent Care by Home Health Primary and Other Diagnoses As on the previous page, the calculations on this page work by showing the emergent care occurrences (count) for each category over the total number of clinical episodes that had that particular diagnosis (cases). However, this page looks at all the Home Heath ICD codes on the SOC/ROC assessment. These include M1020, M1022, and M1024. So if a patient has a primary diagnosis of hypertension and a secondary diagnosis of diabetes, they would be counted on both the hypertension and diabetes categories. Because each patient can have multiple diagnoses and can be counted more than once, the sum of the cases and counts will add up to more that the totals shown at the bottom of the page. The totals at the bottom of this page correspond with the total eligible patients (cases) and total hospitalizations (count) over the reporting period. Report Details: Page 8 - Emergent Care by Reason The last page looks at emergent care occurrences by the reasons indicated on the transfer assessment. Multiple reasons may be checked for any single emergent care so the counts on this page may total more than the number of hospitalizations in the reporting period. The total at the bottom of this page corresponds with the total eligible patients (cases) which is the denominator in the percentage calculations on this page. For more information on this or any other SHP report, please contact our support department. Thank you. support@shpdata.com (805)