Utilization Information

People are able to make better decisions about health care when they are well-informed. For this reason, residents of Maryland should use the Maryland Hospital Performance Evaluation Guide to assist them when choosing where to receive healthcare services. The Maryland Health Care Commission carefully gathers information about the performance of Maryland acute care hospitals in several areas. The information is then presented in a way that compares one hospital to another in the Hospital Guide. This section helps you to understand the Hospital Guide by explaining where the Maryland Health Care Commission gets its information and how it is used in the Hospital Guide.

Source of Data Used for Analyses
Information in the Hospital Guide comes from reports submitted by hospitals to the Maryland Health Services Cost Review Commission. Additionally, the Maryland Health Care Commission reviews similar reports from hospitals in Washington, D.C. to include cases connected to Maryland hospitals such as when a patient from a Maryland hospital goes to a hospital in Washington, D.C. within 15 days after leaving the hospital.

To protect privacy, the information from the Commission does not contain the names of patients or any other information that could reveal someone’s identity. It does include information about the care patients receive at Maryland acute-care hospitals.

Types of Cases Not Included in the Guide
Some cases from the Commission are not included because:

• Hospital billing claims (a primary source of much of this information) are missing a discharge date.
• Cases are not from an acute-care hospital.
• The reason for discharge is marked as "left against medical advice," "expired," or "transferred."
• Patients have a billing charge of zero. (A zero billing charge marks cases that are initially billed incorrectly and are later submitted as a different claim.)
• Patients are under age 18.
• Cases have a missing gender code.
• Patients are admitted to a facility after an immediate transfer from another facility.
• Patients are discharged from one facility and readmitted the same day to a different facility for the same medical condition or for infection.

Selecting Diagnosis Related Groups (DRGs) for the Hospital Performance Evaluation Guide
Diagnosis related groups (DRGs) are broad categories describing general medical conditions that Maryland hospitals treat. Over 30 DRGs for common medical conditions are included in the Hospital Guide. To be included, at least 40 out of Maryland’s 47 acute-care hospitals must have had at least 20 discharges in a previous year. Obstetric conditions are a new feature, and the Commission is planning to develop specialized reports on pediatrics in the future.

Calculating Hospital Discharges
Volume is calculated as the number of cases a hospital treats for a particular medical condition. If a patient is admitted and discharged twice for the same medical condition from the same hospital, that patient would be counted twice in the hospital's volume for that medical condition.

Calculating Length of Stay
Length of stay is calculated by  subtracting the admission date from the discharge date. If a patient is admitted and discharged on the same date, the length of stay is counted as one day.

Note: Length-of-stay rates are risk-adjusted. (See information on Risk Adjustment Methodology below.)

Calculating Readmission Rates
Readmission rates describe how often a patient returns to the hospital for additional treatment of the same or a related condition. The cases included in the hospital volume, as described previously, were checked to see whether they were followed by readmission. To count as readmission status, a patient must have been readmitted within 15 days of discharge for a similar condition, or readmitted due to infection. Infections were defined as admissions with a medical condition of 18 or coded with certain DRGs (079, 080, 081, 089, 090, 091, 320, or 321).

Note: Readmission rates have been risk-adjusted. (See information on Risk Adjustment Methodology below.)

Rating Hospitals Based on Readmission Rates
To create the rating system based on readmission rates, the following decision rules are applied:

• Ties are allocated to the more favorable rating.
• Hospitals whose patients are re-admitted less often to the same hospital for the same problem than a majority (90%) of other hospitals in Maryland have lower readmission rates.  These hospitals are designated by a filled circle in the sections of the Guide which compare hospital volumes.
• Hospitals that are reporting that their patients are re-admitted to the same hospital for the same problem more often than a majority (80%) of other Maryland hospitals have higher readmission rates. These hospitals are designated by an empty circle in the volume sections of the Guide.
• The remaining hospitals are assigned a symbol of a half-filled circle.

Risk Adjustment Methodology
Some hospitals take care of patients who are sicker, or who are at greater risk of developing complications, than the average patient. Because they take care of a greater number of patients with risky medical conditions, these hospitals may have longer lengths of stay on record and higher readmission rates. Other hospitals may have shorter lengths of stay and lower readmission rates because a greater number of their patients are not seriously ill. It is not appropriate to compare all hospitals without compensating for the varying levels of serious conditions they treat. Therefore, some factors in the Hospital Guide have been “risk-adjusted.”

Risk- adjusting is a process that attempts to insure that hospitals are compared fairly according to an comparable group of patients. The risk adjustment process takes into consideration the medical conditions, age, and other factors about patients. These factors are used to adjust a hospital's rates for length of stay and readmission to show consumers how length of stay and readmission rates would compare if all Maryland hospitals were treating patients who were comparably ill or at risk of complications.

Risk-adjusting involves a special method of calculating data (called APR-DRG), which adjusts the actual length of stay and readmission numbers for each hospital and each diagnosis according to the severity of illness of the patients. For hospitals with more severely ill patients, this method lowers the rates for length of stay and readmission. For hospitals with less severely ill patients, it increases the rates. Risk adjusting allows consumers to fairly compare hospitals in a way that reflects the differences in care delivered, rather than the differences in the patients. Additional information on APR-DRG, developed by 3M, can be found at http://www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml.