| Admission Appropriateness Efficiency |
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The same data sets and exclusions, etc. are utilized in the Admission Appropriateness models as described in the LOS section. The analysis of avoidable admissions is based on specialty (primarily defined as Major Diagnostic Category (MDC) medicine vs. surgery). Additional sub-specialties are used for invasive neuro-surgery and invasive cardiac surgery.
The method used to develop potentially avoidable admissions reflects the relative mix of APR-DRG** admissions and severities within the specialty. In most MDCs, there are certain APR-DRGs** that are considered relatively immune to inappropriate admissions (e.g. kidney transplants, head trauma with coma, pulmonary embolism, etc.), as well as severity level 3 and 4 admissions, which are more likely to be appropriate. The ratio for each hospital is developed by specialty, representing the severity 1 and 2 percentage of admissions for the APR-DRGs** not considered immune to avoidable admissions to total admissions in the specialty. The benchmarks are chosen from the lowest of these ratios using a two level statistical test, a t test and Duncan’s test. However, the benchmarks are only chosen from hospitals/metropolitan areas/states that meet minimum volume of requirements and have admissions in each of the APR-DRGs** in the specialty. For example, if a specialty had 10 APR-DRGs**, a hospital that has admissions in only 5 of those APR-DRGs** would not be eligible as a benchmark. Where credible, separate benchmarks are developed for large teaching, other large and all other hospitals for each specialty, and separately for patients under and over age 18. When applying benchmarks to individual hospitals, only the APR-DRGs** admitted in that hospital are used. Therefore, if a hospital has admissions in only 5 out of 10 APR-DRGs** represented, then only the relationship of the 5 APR-DRGs** from the benchmarks are used in the comparison. The excess admissions over benchmark within a specialty are then allocated across the other APR-DRGs** and severities. The potential avoidable days due to admissions are calculated by assigning these allocated potential avoidable admissions to the lowest severity admissions and LOS within each APR-DRG** and summing them. We consider this method for admission appropriateness to be less precise than the method for LOS described above. ______________________________________________________________________________ Note: For APR-DRG** 165 – Coronary Bypass w/o Malfunctioning Coronary Bypass with Cardiac Cath, the days avoidable represent the difference between the ALOS with cardiac cath and the benchmark LOS without cardiac cath. For APR-DRG** 540 – Caesarian Delivery, the days avoidable are the difference between the ALOS for a C-section and the benchmark LOS for a Normal Delivery. Healthy Newborn statistics are now included in the non-Medicare Browsers. However, they are excluded from any of the data aggregations. Healthy Newborns are defined to be APR-DRG** 626 Severity 1 and APR-DRG** 640 Severity 1 and 2. In the Browser, APR-DRG** 626 Severity appears as APR-DRG** 627 and APR-DRG** 640 Severity 1 and 2 appears as APR-DRG** 641. _____________________________________________________________________________ |