Where do the data come from?
Most of the data in this report come from hospital claim records. Utah hospitals are required by law to submit a standard set of information about each patient who spends at least one night in the hospital to the Office of Health Care Statistics, Utah Department of Health, for the Utah Hospital Discharge Database. The Agency for Healthcare Research and Quality (AHRQ), a federal agency charged with overseeing quality of care, provided national information. For further information, visit the AHRQ Website.
Have the data been verified by others?
Yes. Utah hospitals review the data for accuracy during a review period of at least 30 days while the report is being developed. They also review the completed report before it is released. Hospitals may submit comments to be posted online as part of the report.
Why use these indicators/measures?
SB 132 mandates that the comparison reports use nationally recognized quality standards. A federal agency charged with overseeing health care quality, the Agency for Healthcare Research and Quality (AHRQ), developed the Inpatient Quality Indicators (IQIs). The IQIs allow comparison among Utah hospitals and similar patients nationwide. This report shows one IQI for pneumonia in-hospital deaths. For more information on the AHRQ IQIs, visit http://www.qualityindicators.ahrq.gov/iqi_overview.htm.
The measure for average charge is an All Patient Refined Diagnosis Related Group (APR-DRG) for similar, though not identical, pneumonia conditions. For this reason, the numbers of patients for APR-DRGs and similar IQIs are often not the same. Also, keep in mind that for pneumonia death rates, three years of data are used, while a single year is used for charge. For more information on APR-DRGs, visit http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/Products/APRDRG_Software/
Many factors affect a hospital’s performance on quality measures. Such factors include the hospital’s size, the number of pneumonia cases, available specialists, teaching status and especially the medical history of the hospital’s patients and how ill those patients are. Hospitals that treat high-risk (very ill) patients may have higher percentages of deaths than hospitals that transfer these patients. Hospitals that treat patients with do-not-resuscitate (DNR) orders or terminally ill patients receiving palliative care (comfort care) may have higher percentages of deaths. Hospitals may report patient diagnosis codes differently, which could impact the comparison of quality measurement among hospitals. The quality indicators adjust for how ill each hospital’s patients are, but the adjustment may not capture the full complexity of the patient’s condition. The Utah Hospital Discharge Database includes up to nine diagnoses and up to six procedures for each patient. Some patients have additional diagnoses and procedures that are not included in this database. As a result, the measures of patient illness may not be complete. See Glossary and Technical Document for more about pneumonia indicators.
The average charge shown in this report differs from “costs,” “reimbursement,” “price” and “payment.” Different payers have different arrangements with each hospital for payment. Many factors will affect the cost of your hospital stay, including whether you have health insurance, the type of insurance and the billing procedures at the hospital. This report excludes outlier (unusually high) charge cases and length of stay cases from the calculation of average charge (see Glossary). While APR-DRGs do consider levels for each patient’s severity of illness, these levels may not completely reflect the complexity of the patient’s condition. The indicators used in this report do not distinguish between patients expected to recover and patients with do-not-resuscitate (DNR) orders or patients receiving palliative care (comfort care).