|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The Vermont Health Care Quality Report 2008 |
Ch2: Measuring Quality of Care Ch3: Chronic Illness in Vermont
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
What are the Trends in Inpatient Care in Vermont? Characteristics and Trends in Hospital Discharges from 2002 - 2006 (click for printable PDF) Introduction This section of the Quality Report provides a broad overview of inpatient care in Vermont based on publicly available data on each person discharged from a Vermont hospital. The data does not allow the identification of the patient, nor individual physicians who were attending the patient. The data set is an extract of the financial billing data generated by the hospital. Other reports such as the annual Vermont Hospital Monograph Series focus on presenting a single year of hospital discharges for five select inpatient conditions. However, VPQ chose to aggregate data from the most recent five years of data to identify trending patterns over time. This section is intended to give a high level overview of healthcare utilization in the state and identify any trends. This section provides a 5-year trend of information on:
· Data source and Methodology The Vermont Inpatient Hospital Discharge Data file was used to provide an overview of the trends in inpatient care in Vermont hospitals for 2002 through 2006. The data files include patient demographic and clinical information such as age, gender, diagnoses, and procedures performed and additional information such as payer source, admission source and discharge status for each patient. These files are limited to treatment provided on an inpatient basis. Conditions treated on an outpatient basis are not reflected. Additionally, the VA White River Junction did not submit a full year of data for 2006 and were excluded from all analysis (2002-2006). The data files are generated from inpatient discharge claims from all Vermont Hospitals through the uniform billing format. The data are maintained by the Vermont Department of Health under contract with the Department of Banking, Insurance, Securities, and Health Care Administration and undergoes extensive review for completeness and accuracy. Hospital discharge data are summarized overall as well as by hospital size (primary care or critical access, secondary care, and tertiary care). Primary Care Hospitals provide basic general healthcare to patients seeking assistance from the medical care system. Secondary Care Hospitals provide specialized medical services usually following referral by a primary care physician. Secondary care hospitals generally treat a more specialized level of care for patients who cannot be treated at the primary-care level. Typically this comprises services provided by medical specialists who do not have initial contact with a patient (cardiologists, urologists, dermatologists, etc.) A Tertiary Care Center provides highly specialized services requiring specialized human resources, technology and facilities. A tertiary care center is generally a university medical center, specialty hospital, or specialty medical clinic. The critical access hospitals in Vermont include: Copley Hospital, Gifford Medical Center, Grace Cottage Hospital, Mt. Ascutney Hospital and Health Center, North Country Hospital and Health Center, Northeastern Vermont Regional Hospital, Porter Hospital, and Springfield Hospital. Vermont’s secondary care hospitals are: Brattleboro Memorial Hospital, Central Vermont Medical Center, Northwestern Vermont Medical Center, Rutland Regional Medical Center, and Southwestern Vermont Medical Center. Fletcher Allen Health Care is Vermont’s only tertiary care center. Findings The most impressive aspect of Inpatient Care is how constant it has been: Ø Over the past five years, the number of hospital discharges has decreased slightly (4%) with the largest decrease occurring from 2005 to 2006 (3%). This includes all hospitalizations including obstetric and newborn stays.
Ø Each year, women account for about 58% of all hospital stays. Ø Nearly 40% of hospital discharges are patients 65 + years, 22% are 45 to 64 years, 26% are 18 to 44 years, 1% are 13 to 17 years, and 15% are 0 to 12 years (mostly healthy newborns). Ø Among hospital patients 18 to 44 years of age, more than ¾ were female (includes all obstetric admissions).
Ø
Ø Approximately 40% of discharges list Medicare as the primary payer followed by commercial insurance (30%) and Medicaid (20%).
Charges for Inpatient Care have not been constant: Ø While there has been a slight decrease in the number of hospital discharges and total patient days, total charges of these hospitalizations in Vermont has increased 27%. In this highest level overview, childbirth and newborns are included. Ø The average charge per hospitalization has increased from $10,200 in 2002 to $13,400 in 2006.
Does Hospital Size Influence Hospitalization? Ø The following summarizes characteristics of hospitalization in Vermont by primary care or critical access hospitals, secondary care, or tertiary care. In this highest level overview section, childbirth and newborns are included. Ø As seen above, total charges have been on the rise and patient days have been declining. The increase in total charges was more prominent at the tertiary care and secondary care hospitals (30% and 28% increases, respectively). Total charges have increased more gradually at the critical access hospitals (16%).
Ø The average charge per discharge was, not surprisingly, higher at the tertiary care hospital most likely because, on average, patients have substantially more days in the ICU and have longer hospital stays. Ø Secondary care hospitals tend to have more patient days in the ICU/special care unit and longer average length of stay than the critical access hospitals, but the average charge per hospitalization is very similar.
Ø The average length of a hospital stay has remained fairly consistent since 2002.
How are patients admitted? Ø Source of admission varies slightly by hospital size. Approximately half of patient admissions at critical access hospitals and the tertiary care center are referrals. The most common source of admission for the secondary care hospitals is through the ER.
Does patient status on discharge differ by hospital size? Ø Patient status on discharge is very consistent over time. Discharge patterns do not vary across the three hospital categories. Ø Most patients are discharged to home (about 60% of discharges). Ø 15% of discharges from critical access and secondary care hospitals are to Home Health whereas about 30% of discharges from the tertiary care center are to Home Health. Ø Critical access and secondary care hospitals discharge to “another short term facility” and to a “skilled nursing facility” more often than the tertiary care center. What are the most frequent reasons for being admitted to the hospital? The top 10 reasons for hospitalization do not change much from year-to-year. Reasons for hospitalization at critical access and secondary care hospitals are very similar. The tables below show the top causes of admission for each hospital type in 2006. Notable changes in frequency are mentioned. Ø The most common reason for hospitalization, regardless of hospital size, continues to be childbirth. About 20% of all discharges are related to pregnancy and childbirth. Ø After excluding hospitalizations relating to pregnancy and childbirth, pneumonia is the most common reason for hospitalization at the Critical Access Hospitals. Top 10 reasons for Hospitalization at Critical Access Hospitals
* Excludes hospitalizations for pregnancy and childbirth (including neonatal) Ø After excluding hospitalizations relating to pregnancy and childbirth, pneumonia is the most common reason for hospitalization at the Secondary Care Hospitals. Ø Nonspecific chest pain moved up 6 positions to number 7 in the top 10 reasons for hospitalization between 2005 and 2006. Top 10 reasons for Hospitalization at Secondary Care Hospitals
* Excludes hospitalizations for pregnancy and childbirth (including neonatal) Ø The most common reasons for hospitalization at the tertiary care center are very consistent from year-to-year. Ø The most common reason for hospitalization at the tertiary care center, after excluding stays relating to pregnancy and childbirth, is hardening of the arteries and other heart disease which accounts for 6% of discharges. Top 10 reasons for Hospitalization at Tertiary Care Hospitals
* Excludes hospitalizations for pregnancy and childbirth (including neonatal) Discussion Rock Solid Trends The most notable aspect of Inpatient Care between the years 2002 and 2006 is how consistent it has been. The number of hospitalizations, the reasons people needed to be in the hospital, and how long they stayed in the hospital remained very constant. There has been a slight decrease in number of admissions and a slight decrease in the length stay. Who is Admitted? Women are hospitalized slightly more than men if one includes obstetric care. Among younger adults (18 to 44 years of age) more than 75% of patients are women. Nearly 40% of patients hospitalized are 65 or older. Influence of Hospital Size The theme of constancy holds true across hospitals of different size. There are some distinct differences that track between institutional sizes, but these differences are not changing for the most part. Discharge rates dropped in all three hospital groups: Critical Access, Secondary Care, and Tertiary Care. The average charge per discharge and average length of stay was higher at the tertiary care hospital. The average charge for a hospitalization was similar between CAH and secondary facilities. Diagnoses The top 10 reasons for hospitalization are constant. The most common reason for hospitalization, regardless of hospital size, continues to be childbirth. About 20% of all discharges are related to pregnancy and childbirth. Reasons for hospitalization at critical access and secondary care hospitals are very similar. After excluding hospitalizations relating to pregnancy and childbirth, pneumonia is the most common reason for hospitalization at both Critical Access Hospitals and Secondary hospitals. At the tertiary center, the most common reason for hospitalization, after excluding stays relating to pregnancy and childbirth, is related to arteriosclerosis and other heart conditions. Discharge Destination Patient status on discharge is very consistent over time. Sixty per cent of discharges are to the home. More patients are discharged to Home Health Agencies from the tertiary center. Critical access and secondary care hospitals discharge to “another short term facility” and to “skilled nursing facility” more often than the tertiary care center. Payment While there has been a slight decrease in the number of hospital discharges and total patient days, total charges for these hospitalizations in Vermont has increased 27%. The average charge per hospitalization has increased from $10,200 in 2002 to $13,400 in 2006. In alignment with the preponderance of elderly patients, 40% of all patients had Medicare as the primary payer. Twenty percent of patients had Medicaid as primary payer.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
