Managing and Evaluating Rapid-Cycle Process Improvements as Vehicles for Hospital System Redesign: Appendix C
Note: Numbers below correspond to metric number in Table 4.
1. The Joint Commission core measure data are obtained from the Quality Measurement and Reporting System report from the University HealthSystem Consortium (UHC) Web site. (Note: The Joint Commission was formerly known as the Joint Commission on Accreditation of Healthcare Organizations.)
2. Total operating costs includes all costs related to the hospital and clinics and excludes costs related to activities that are self-supported such as the Denver Health Medical Plan, an insurance plan created by Denver Health and the Rocky Mountain Poison Center, a self-funded entity providing telephone hotline services to the Rocky Mountain region and beyond.
3. Cost per discharge includes costs related to the inpatient side of operations only and the associated administrative costs. This information was obtained from the Key Indicator Report from the UHC Web site. The statistic is defined to be "total operating expense (WI-adjusted) / (adjusted discharges * CMI [all patients])". It does not include the expense for physicians, residents, and interns on the hospital payroll as well as physician/provider professional fee expense. Note: CMI is the casemix index, a Medicare patient statistic; WI is the wage index, adjusted for each region.
4. Cost per encounter includes costs related to the outpatient operations of Denver Health only and the associated administrative costs.
5. Net revenue is gross revenue minus the total operating costs.
6. Net revenue per discharge includes the revenue and costs related to inpatient operations only and the associated administrative costs.
7. Net revenue per encounter includes the revenue and costs related to outpatient operations only and the associated administrative costs.
8. Employee engagement includes the number of employees on RIE teams and the employees who were called in to participate by the team during RIE week, if necessary.
9. FTE per adjusted occupied bed is obtained from the Key Indicator Report from the UHC Web site. The statistic is defined to be "[(total paid hours + contracted hours worked) / (2,080* (days in period / 365))] / [(total patient days excluding newborns / days in period) * (gross patient charges / total gross inpatient charges) * CMI (all patients)]." It does not include the hours for physicians, residents, and interns on the hospital payroll.
10. ALOS (total) is obtained from the UHC Clinical Database. It is the average length of all inpatient visits.
11. Risk adjusted mortality is calculated from numbers obtained in the same report as ALOS (Total). It is the actual observed death rate divided by the expected death rate, as calculated after the risk adjustments have been applied.0.86 = 1.25 / 1.46, and 0.61 = 0.92 / 1.51
12. ALOS (top 10 diagnoses) is also obtained from the UHC Clinical Database.
13. Physician productivity is measured in relative value units.
14. Medication errors are calculated by dividing the specific error type (total, causing harm, not causing harm) by the total doses and prescriptions dispensed. The primary value reported is for the total errors (causing harm and not causing harm). The calculation for 2004 is described below as an example.
|2004 Data||Errors reported||Errors causing harm||Errors not causing harm||Doses and prescriptions dispensed|
15. For a detailed listing of the categories in errors related to procedure/treatment or test, refer to UHC Patient Safety Net Guide to Event Types.
16. For occurrences of COR zero (cardiac arrest), the denominator of the rate is the number of unduplicated patients admitted to the hospital.
17. Readmission rate is the proportion of patients who return to the hospital within 30 days of discharge from prior (index) admission for the same or related condition. Both planned and unplanned readmissions are included.
18. Patient satisfaction is the mean score for standard questions on Press Ganey Patient Satisfaction surveys conducted at Denver Health. Weighted average of responses to questions: Very Poor = 0, Poor = 0.25, Fair = 0.50, Good = 0.75, Very Good = 1.00.
19-20. Almost three-quarters of the nurses at Denver Health are charge nurses and staff nurses. The nurse turnover rate and nurse vacancy rate are calculated for charge and staff nurses only. Therefore, excluded from this calculation are the licensed practical nurses, nursing program managers, nursing operations managers, etc. Note that Human Resources determines voluntary and involuntary turnover.
21-22. Of the total employees, almost 3 percent are residents, interns, or trainees that are NOT included in the calculation for employee turnover rate and employee vacancy rate.
24-27. Patient statistic data (percent private payer, patients served, outpatient visits, and inpatient admits) are from the Health Services Research Department using the Biostats Server data. The 2006 data include quarters 1 and 2 (Q1 and Q2).
28. Prescriptions filled includes the total number of doses and prescriptions dispensed by Denver Health. It does not include prescriptions filled outside of Denver Health using a Denver Health prescription, such as at Walgreens.
29. On-hand inventory value is an annual sum of the on-hand inventory at the end of the year, as reported on the balance sheet.