This report describes: Patient Demographics and Distribution Most Frequent Reason for Hospitalizations Patient Admissions Hospital Charges and Billing Patterns Patient Discharge Status Patient Distribution Data in this report will cover the most current (2001-2004) Delaware hospital discharge data, as well as trend data for selected characteristics. Hospitalization or hospital discharge, refers to any discharge from a non-federal, short-stay, acute-care hospital in Delaware. Hospitalizations are expressed as numbers of discharges, not as unduplicated patients; as a result, a single patient with multiple hospitalizations can be counted more than once. Delaware hospital discharge data are based upon inpatient hospitalizations and do not include outpatient, clinic, or emergency room data. Unless otherwise specified, the data presented represent discharges from the following hospitals and systems: A.I. duPont, St. Francis, Christiana Care Health System (consists of Wilmington and Christiana Care), Bayhealth Medical Center (consists of Kent General and Milford), Beebe, and Nanticoke. More information on how annual files are created, as well as definitions of terms used in this report can be found in the Technical Notes. Maps displaying patient distribution and hospital location are located in the Maps section. Key findings: • There were over 100,000 discharges from acute care hospitals in Delaware in 2001. By 2004, that had increased by more than 11,000 to 111,806 discharges. During the same time, aggregate charges rose from almost $1.1 billion to $1.7 billion. • During the 2001 to 2004 time period, the average length of stay was 4.9 days and the mean charge for a hospitalization was $13,059.06. • The maximum charges for each year from 2001 to 2004 were the result of infants suffering from birth defects, perinatal conditions, or complications due to short gestation and very low birth weight. • Admissions from the Emergency department accounted for 48 percent of all hospital admissions from 2001 to 2004; 47 percent came from physicians, and the remaining 5 percent were admitted from clinics, HMOs, or transferred from other facilities. • 74.6 percent of uninsured admissions come from emergency department. • The most frequent reasons for hospitalization fell under the category of diseases and disorders of the circulatory system, and include heart attack, heart disease, and stroke. • From 2001 to 2004, an average of 11,418 women per year delivered their children in Delaware hospitals. Executive Summary • Hospital stays for liveborn infants vary by type of delivery and plurality. o The average length of stay (LOS) for infants delivered by cesarean section are almost twice that of infants delivered vaginally, and o The LOS for infants who are part of a plural birth is three times that of singleton births. Discharge trends by hospital: The number of hospital discharges increased by 11 percent from 2001 to 2004, increasing from 100,681 in 2001 to 111,806 in 2004. As the largest health care system in the state, Christiana Care Health System (CCHS) accounted for over half of the total annual discharges1. Though CCHS showed the largest numerical increase from 2001 to 2004, A.I duPont and Beebe Medical Center showed the largest percentage increases, at 38.1 and 24.3 percent, respectively. Number of Discharges by Hospital System and Year of Discharge Delaware, 2001-2004 0 10,000 20,000 30,000 40,000 50,000 60,000 A I DUPONT HOSPITAL BAYHEALTH MEDICAL CENTER BEEBE MEDICAL CENTER CHRISTIANA CARE HEALTH SYSTEM NANTICOKE MEMORIAL HOSPITAL SAINT FRANCIS HOSPITAL Number of Discharges 2001 2002 2003 2004 38.1% increase 13.4% increase 0.8% increase 9.8% increase 24.3% increase 2.2 % increase Executive Summary 1 See the Hospital Profiles at the end of this report for details on each of Delaware's acute care hospitals. Number of Discharges by Gender and Year Delaware, 2001-2004 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 2001 2002 2003 2004 Number of Discharges Male Female Patients over 65 accounted for 33 percent of those admitted to the hospital; 26 percent were ages 18- 44, and the remaining 41 percent were split almost evenly between those ages 45-64 and those under 18. With the exception of the under 18 age groups, there were more women than men in each age group. Threequarters of patients ages 18-44 were women, primarily a result of those hospitalizations being related to pregnancy and childbirth (see page 6 for the most common reasons for hospitalizations of women). Number of Discharges by Sex and Age Group Delaware Hospitalizations, 2001-2004 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 Under 1 1-17 18-44 45-64 65+ Age Group Number of Discharges Male Female Patient Characteristics over the four year period; women continued to account for approximately 60 percent of all hospital discharges. Though male and female patients experienced similar decreases in mean LOS from 1994 and 2004, there was little or no change from 1999 to 2004. When female obstetrical patients were excluded from the calculation of average length of stay, male and female patients had very similar LOS figures in all time periods. Surprisingly, the only increase in LOS from 1994 to 2004 was seen in e c As the percent of patients staying three or fewer days in the hospital increased, the average length of stay decreased from 1994 to 2004. In 2004, patients in Delaware hospitals stayed an average of 4.9 days in the hospital. Percent Distribution of Hospital Discharges by Length of Stay (LOS) Delaware, Selected Years 1994-2004 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1994 1996 2000 2004 15+ days 8-14 days 4-7 days <=3 days Mean LOS 5.6 days Mean LOS 4.9 days Mean LOS 5.0 days Mean LOS 5.1 days Mean Length of Stay by Patient Type Delaware Hospitals, 1994-2004 0 1 2 3 4 5 6 7 1994 1999 2004 Year of Discharge Length of Stay in Days Male Patients Female Patients Non-obstetric Female Patients Obstretric-only Female Patients Patient Characteristics On average, there were 105,264 hospital discharges per year, 87 percent of which were Delaware residents. Of the non-residents who used Delaware hospitals, Pennsylvania and Maryland residents had the highest number of discharges and accounted for 9 percent of the total average annual discharges. With the exception of Christiana Care and A.I. duPont, fewer than 10 percent of patients admitted to Delaware hospitals came from out of state. Almost half of A.I. duPont’s admissions came from a state other than Delaware. Percent of Total Discharges by Residency and Hospital System Delaware, 2001-2004 0 10 20 30 40 50 60 70 80 90 100 A I DUPONT HOSPITAL BAYHEALTH MEDICAL CENTER BEEBE MEDICAL CENTER CHRISTIANA CARE HEALTH SYSTEM NANTICOKE MEMORIAL HOSPITAL SAINT FRANCIS HOSPITAL Non-resident Delaware Resident Patient Characteristics Most frequent reasons for hospitalization by primary diagnosis and body system2: Diseases of the circulatory system accounted for 17.1 percent of the total discharges and represented the most common reasons for hospitalization, regardless of sex or age; some of the most common diagnoses in that category were heart failure, coronary atherosclerosis and other heart disease, heart attack, and chest pain. Pregnancy and childbirth comprised 12.2 percent of the total discharges, and 10.5 percent of all discharges were related to newborn infants (those infants admitted to the hospital by virtue of being born). Together, these three categories accounted for approximately 40 percent of all hospitalizations. Percent of Discharges by Body System Delaware Hospitals, 2001-2004 0 2 4 6 8 10 12 14 16 18 Diseases of the circulatory system Complications of pregnancy, childbirth, & the puerperium Liveborn Diseases of the respiratory system Diseases of the digestive system Injury and poisoning Diseases of the musculoskeletal system and connective tissue Neoplasms Diseases of the genitourinary system Endocrine, nutritional & metabolic diseases, & immunity disorders Body System Percent of Discharges Although hospitalizations due to infections and parasitic diseases did not occur frequently enough for them to appear in the graph above, the largest percent increase (42.5) in hospitalizations from 2001 to 2004 occurred in the infections and parasitic diseases category. This increase was driven primarily by a rise in the number of septicemia hospitalizations. Diseases of the skin and subcutaneous tissue also demonstrated a large percentage increase (33.2) from 2001 to 2004, and at 30.4 percent, the third largest increase in hospitalizations was due to mental disorders. Affective disorders, such as depression and bipolar disorder, along with schizophrenia and other psychoses were the most significant contributors to the upward trend in diagnoses due to mental disorders (for a more detailed review of rates of depression, see the "Why Delaware Patients were Hospitalized" section). Why Patients Were Hospitalized 2 See Appendix A for details about the primary diagnoses and body system classifications. Most frequent reasons for hospitalization by sex (excluding liveborn infants): Specific diagnoses varied by sex, but much of that was a result of the large number of women hospitalized due to pregnancy and delivery related conditions. Though 4 out the top 10 diagnoses for women were related to pregnancy and childbirth, men and women both experienced high numbers of discharges due to pneumonia (except that caused by tuberculosis and sexually transmitted diseases), congestive heart failure, chest pain, rehabilitation care (including fitting of prosthesis and adjustment of devices), and falls. The following two graphs show the 10 most frequent diagnoses for both men and women. Discharges of Women by Primary Diagnosis and Year Delaware Hospitals, 2001-2004 0 500 1000 1500 2000 2500 OB-related trauma to perineum and vulva Other complications of birth; puerperium affecting management of mother Pneumonia (except that caused by tuberculosis or STD) Congestive heart failure; nonhypertensive Rehabilitation care; fitting of prostheses; and adjustment of devices Other complications of pregnancy E Codes: Fall Nonspecific chest pain Osteoarthritis Previous Csection Number of Discharges 2001 2002 2003 2004 Why Patients are Hospitalized Why Patients Were Hospitalized Discharges of Men by Primary Diagnosis and Year Delaware Hospitals, 2001-2004 0 500 1000 1500 2000 2500 Coronary atherosclerosis and other heart disease Pneumonia (except that caused by tuberculosis or STD) Congestive heart failure; nonhypertensive Acute myocardial infarction Nonspecific chest pain Cardiac dysrhythmias Rehabilitation care; fitting of prostheses; and adjustment E Codes: Fall Spondylosis; intervertebral disc disorders; other back problems Acute cerebrovascular disease Number of Discharges 2001 2002 2003 2004 Most frequent reasons for hospitalization by age groups: Though the most common reasons for hospitalization differ greatly by age, pneumonia appeared in the 10 most frequent diagnoses for all age groups (when pregnancy and childbirth were excluded from the 18-44 age group). .. Excluding liveborn infants, patients under 1 were hospitalized most often for bronchitis, cardiac and circulatory birth defects, and other perinatal conditions. .. For those ages 1 to 17, asthma, fluid and electrolyte disorders, and pneumonia made up the top three diagnoses. .. For those ages 18 to 44, the first 9 out of the top 10 diagnoses were associated with pregnancy and childbirth. If pregnancy and childbirth were excluded, motor vehicle accidents, back pain and disorders, and affective disorders become the three most common reasons for hospitalization. .. For those ages 45 to 64, coronary atherosclerosis and other heart disease, chest pain, and heart attack comprised the top three diagnoses. .. For those over 65, heart failure, pneumonia, and rehabilitation care were the top three diagnoses. Why Patients Were Hospitalized SAINT FRANCIS Procedures: Sixty percent of hospital inpatients underwent a primary procedure. The most commonly performed procedures were: .. obstetrical, including procedures to assist delivery, cesarean section, and repair of current obstetric laceration, .. operations on the cardiovascular system, including diagnostic cardiac catheterization, percutaneous transluminal coronary angioplasty (PCTA), and other vascular catheterization, and .. operations on the digestive system, including upper gastrointestinal endoscopy, cholecystectomy and common duct exploration, and colorectal resection. Thirty-one percent of the first-listed procedures performed on females were obstetrical, 14 percent were digestive, and 12 percent were cardiovascular. Twenty percent of the first-listed procedures performed on males were cardiovascular, 19 percent were genital (primarily newborn circumcisions) , and 16 percent were digestive3. A major component of obstetrical procedures is related to cesarean delivery of newborn infants. Since 1994 annual cesarean delivery rates have increased for every hospital in Delaware; by 2004 30.5 of every 100 deliveries were cesarean. Milford, Nanticoke, and Kent General Hospitals have shown the greatest increases, at 63.8, 62.5 and 62.2 percent respectively. Though Beebe showed the smallest percent increase from 1994 to 2004, it continues to have the highest rate, at 34.7 cesareans per 100 deliveries in 2004. Annual Cesarean Delivery Rates by Hospital Delaware Hospitals, 1994-2004 0 5 10 15 20 25 30 35 40 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Discharge Year Cesareans per 100 Deliveries BEEBE NANTICOKE KENT GENERAL Why Patients Were Hospitalized 3 See Appendix B for a table of first-listed procedures by sex. Hospital discharges of Delaware residents: Hospital discharge rates for Delaware residents should be interpreted with caution. The rates were calculated based on the number of discharges of Delaware residents from Delaware hospitals; they do not account for residents who obtained inpatient hospital services out of state. The graph below shows the four-year average discharge rates for men, women, and both sexes combined for diagnoses that represent some of the more high-profile diseases and disorders. Four-year Average Discharge Rates of Delaware Residents by Sex and Selected Primary Diagnoses Delaware Hospitals, 2001-2004 0 10 20 30 40 50 60 70 80 Pneumonia Congestive heart failure Chest Pain Asthma Diabetes Cancer HIV infection Heart Attack Stroke CCS Diagnosis Discharges per 10,000 Male Female Total Though diseases of the circulatory system are often thought to affect men more than women, the figures show women experienced higher hospitalization rates for diagnoses of heart failure, chest pain, and stroke. Out of the 9 selected diagnoses, only 3 show higher discharge rates for men: diabetes, HIV infection, and heart attack. Why Delaware Residents Were Hospitalized Annual Discharge Rates of Delaware Residents by Selected CCS Diagnoses Delaware Hospitals, 2001-2004 0 2 4 6 8 10 12 14 16 18 20 Septicemia (except in labor) Diabetes Acute and unspecified renal failure Respiratory failure; insufficiency; arrest (adult) Other nutritional; endocrine; and metabolic disorders Schizophrenia and related disorders Affective disorders Primary Diagnosis Discharges per 10,000 2001 2002 2003 2004 From 2001 to 2004, certain diagnoses demonstrated significantly large increases. The discharge rate for septicemia, a bacterial infection of the blood, increased 67 percent from 2001 to 2004. Both renal failure and schizophrenia increased by 90 percent, and the rate of other nutritional, endocrine, and metabolic disorders more than doubled. CCS Diagnosis Number Rate Number Rate Number Rate Number Rate Septicemia (except in labor) 694 8.7 836 10.4 940 11.5 1,210 14.6 67.0 Diabetes 1,222 15.4 1,273 15.8 1,368 16.7 1,424 17.1 11.6 Acute and unspecified renal failure 402 5.1 530 6.6 669 8.2 798 9.6 90.2 Respiratory failure; insufficiency; arrest (adult) 637 8.0 796 9.9 900 11.0 987 11.9 48.4 Other nutritional; endocrine; and metabolic disorders 242 3.0 415 5.1 517 6.3 584 7.0 131.2 Schizophrenia and related disorders 153 1.9 151 1.9 209 2.6 302 3.6 89.1 Affective disorders 875 11.0 608 7.5 1,027 12.6 1,320 15.9 44.5 2001 2002 % Difference from 2001 to 2004 2003 2004 Why Delaware Residents Were Hospitalized Looking more closely at rates of hospitalization for depression4 among men and women shows distinct differences between the sexes and various age groups of patients. Though women have consistently shown higher hospitalization rates for depression than men, women's rates have been steadily decreasing since the 1994-1996 time period, while men's rates have been increasing slightly since the 1998-2000 time period, with the result that the rates are moving closer to convergence. Three-year Average Hospitalization Rates for Depression by Sex Delaware, 1994-2004 0 2 4 6 8 10 12 14 16 18 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 Discharges per 10,000 population Male Female Why Delaware Residents Were Hospitalized 4 Depression was defined as a first listed diagnosis of ICD-9-CM codes 296.2-296.3, 298.0, 300.4, 301.12, 309.0-309.1, 311, or 313.1. Hospitalizations for depression do not include data from psychiatric facilities. The only age group to show a decrease in depression hospitalization rates for both sexes was the 65 and older age group. The rate for males decreased by 49.3 percent to 6.0 and the female rate decreased by 63.6 percent to 8.2. Three-year Average Hospitalization Rates for Depression Among Adolescents Aged 10-19 Years, by Sex Delaware, 1994-1996 and 2002-2004 4.5 5.7 7.2 10.7 0 2 4 6 8 10 12 1994-1996 2002-2004 Discharges per 10,000 population Male Female Rates for females in every age group declined from 1994-1996 to 2002-2004, with the exception of females aged 10-19 years, whose rates increased by 50 percent to 10.7 per 10,000 population in 2002- 2004. Rates for males of the same age also increased, though by about half as much, rising 26.7 percent to 5.7 per 10,000 in 2002-2004. The greatest increase in male rates occurred in the 35-49 year-old age group, which increased 37.2 percent to 15.7 per 10,000 in 2002-2004. Three-year Average Hospitalization Rates for Depression Among People Aged 35-49 Years, by Sex Delaware, 1994-1996 and 2002-2004 11.4 15.7 20.7 17.4 0 5 10 15 20 25 1994-1996 2002-2004 Discharges per 10,000 population Male Female Why Delaware Patients Were Hospitalized Though more women than men were admitted through the emergency department, males had a higher percentage of their admissions come from the ED, particularly in the 18- 44 age group. Source of admissions: Routine and emergency admissions were split almost equally, with admissions from physicians and the emergency department (ED) accounting for 95 percent of all hospital admissions from 2001 to 2004; the remaining 5 percent were admitted from clinics, HMOs, or transferred from other facilities. Over one-fifth of all admissions originating from physicians were for normal deliveries. Percent of Male and Female Admissions that Originated in the Emergency Department Delaware, 2001-2004 0 10 20 30 40 50 60 70 80 Under 1 1-17 18-44 45-64 65+ Percent of Admissions MALE FEMALE Patients who were uninsured were more frequently admitted through the emergency department than any other route; 74.6 percent of uninsured patients were admitted through the emergency department. At $13,848, the average charge for a hospitalization originating in the ED was similar to the average charge for all types of admissions, though higher than routine admissions through a physician. Average Charge by Source of Admission Total Charges Discharges SOURCE OF ADMISSION Mean Number Percent PHYSICIAN $ 10,627.71 197,575 46.9 CLINIC $ 23,441.77 9,252 2.2 HMO $ 26,745.78 425 0.1 TRANSFER FROM A HOSPITAL $ 33,009.81 10,186 2.4 TRANSFER FROM SKILLED NURSING FACILITY $ 20,446.93 436 0.1 TRANSFER FROM OTHER FACILITY $ 23,000.56 951 0.2 EMERGENCY ROOM $ 13,848.28 201,816 47.9 COURT/LAW ENFORCEMENT $ 13,991.01 67 0.0 UNKNOWN $ 22,404.65 349 0.1 Total $ 13,059.06 421,057 100 How Patients Were Admitted The most common diagnoses of patients admitted through the emergency department were pneumonia, congestive heart failure, chest pain, falls, and acute myocardial infarctions (heart attack). ED Admissions - Most Common Diagnoses Frequency Percent* 1 Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 10533 5.2 2 Congestive heart failure; nonhypertensive 10077 5.0 3 Nonspecific chest pain 7861 3.9 4 E Codes: Fall 7608 3.8 5 Acute myocardial infarction 6295 3.1 6 Coronary atherosclerosis and other heart disease 5850 2.9 7 Acute cerebrovascular disease 5752 2.9 8 Chronic obstructive pulmonary disease and bronchiectasis 5433 2.7 9 Cardiac dysrhythmias 5255 2.6 10 Fluid and electrolyte disorders 4745 2.4 The diagnoses that had the majority of their admissions come from the emergency department were very different from the ones that made up the most common diagnoses. Not surprisingly, 98.5 percent of all firearm injuries, 96 percent of all poisonings, and 94.7 percent of all motor vehicle injuries were admitted through the ED. * Refers to the percent of all discharges admitted through the emergency department. How Patients Were Admitted Cost of hospitalizations: The total charges for a hospital discharge represent the total amount billed for that particular stay. These charges include accommodations, ancillary services (e.g. pharmacy, lab, radiology and anesthesiology), and services of resident physicians. In this report, hospital charges for care are reported, not the actual costs of providing the care or what the hospitals were reimbursed. The average charge for a hospital stay in 2004 was $15,222. At $8,464, median charges for 2004 were considerably lower, illustrating how the average can be skewed by extremely high charges, such as the 13 discharges with total charges of over $1,000,000.00. The diagnostic groups with the highest average charges per hospital stay were congenital anomalies, perinatal conditions, and infections and parasitic diseases, with average charges ranging from $20,000 to $50,000. These three diagnostic groups also had the longest average stays, ranging from 8 to 11 days. Looking at specific diagnoses within groups shows that the most expensive diagnoses were spinal cord injuries, disorders of lipid metabolism, and cardiac and circulatory anomalies. However, the 10 most expensive diagnoses occurred relatively rarely and accounted for less than 1 percent of all discharges from 2001 to 2004. Insurance status: The following payer sources are listed in this report: .. Medicare .. Medicaid .. Private insurance carriers, such as: o Blue Cross Blue Shield o HMOs o Commercial Insurance .. Uninsured o Patients who have no insurance and self pay .. Other types of insurance, such as: o Workman’s compensation o CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) o Other government sponsored programs Hospital Charges and Billing Medicare, Medicaid, and private insurance accounted for 93 percent of all billed charges. With the exception of patients whose primary insurance was private, the number of discharges billed to each primary insurance carrier increased from 2001 to 2004. Number of Discharges by Primary Insurance and Year Delaware Hospitals, 2001-2004 2001 2001 2001 2001 2001 2002 2002 2002 2002 2002 2003 2003 2003 2003 2003 2004 2004 2004 2004 2004 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 Medicare Medicaid Private Uninsured Other Primary Payer Number of Discharges 16% increase 34.2% increase 11% increase 3.8% decrease 25.3% increase Hospital Charges and Billing Patient discharge status: A patient’s discharge status refers to how a person is discharged from the hospital, and includes discharges to home, long-term care and other non-acute care facilities, other short-term hospitals, patients who left against medical advice, and patients who died while in the hospital. The majority of patients (67 percent) from 2001 to 2004 were discharged to their homes, less than 3 percent of patients died in the hospital, and fewer than 1 percent left against medical advice. Percent of Discharges by Discharge Status Delaware Hospitals, 2001-2004 Home, 67.0 Long-Term Care and other facilites, 9.0 Another Short-Term Hospital, 2.8 Against Medical Advice, 0.6 Expired, 2.6 Home Health Care, 17.1 Unknown, 1.0 Expired patients: Patients who died during their hospital stay contributed to the “in-hospital mortality” figures. Data about in-hospital mortality are expressed as either numbers of deaths, or percentages of deaths. Both the frequencies and percentages are presented, as each statistic provides a different perspective for reviewing the data. Frequencies Patients with the following diagnoses experienced the highest numbers of in-hospital mortality: .. septicemia, .. acute cerebrovascular disease, .. and respiratory failure. How Patients Were Discharged Diagnoses with the Greatest Numbers of In-Hospital Deaths Delaware Hospitals, 2001-2004 0 100 200 300 400 500 600 700 800 900 Septicemia Stroke Respiratory failure Pneumonia Heart Attack Congestive heart failure; nonhypertensive Secondary malignancies Aspiration pneumonitis Cancer of bronchus; lung Renal failure Number of Deaths Age affects which diagnoses contribute to the largest numbers of deaths. .. For those under 1, low birthweight and prematurity accounted for the highest number. .. For those ages 1-17 and 18-44, motor vehicle accidents accounted for the highest number of deaths. .. For those ages 45-64, secondary malignancies accounted for the highest number of deaths, and .. For those 65 and older, septicemia accounted for the highest number of deaths. Septicemia was the only diagnosis to appear in the top 10 list for each age group5, from those under 1 to those ages 65 and older. Patients ages 65 and older accounted for 71 percent of all in-hospital mortality6. Percentages Those diagnoses with the greatest percentages of in-hospital mortality were: .. cardiac arrest and ventricular fibrillation, .. shock, and .. cancer without specification of site. How Patients Were Discharged 5 See Appendix C for the top 10 list of conditions by age group. 6 See Appendix D for detailed graph. Four out of the ten diagnoses with the greatest percentages of in-hospital mortality are cancer related, and include cancer without specification of site, liver cancer, pancreatic cancer, and leukemias. Diagnoses with the Greatest Percent of In-Hospital Mortality Delaware Hospital, 2001-2004 0 10 20 30 40 50 60 70 Cardiac arrest and ventricular fibrillation Shock Malignant neoplasm without specification of site Cancer of liver and intrahepatic bile duct Coma; stupor; and brain damage Intrauterine hypoxia and birth asphyxia Cancer of pancreas Leukemias Respiratory failure; insufficiency; arrest (adult) Septicemia (except in labor) Percent Patients who left against medical advice: Of those patients who left the hospital against medical advice, 52.5 percent were ages 18-44 and 58.2 percent were male. In the 18-44 age group, 2.5 percent of men left the hospital against medical advice, more than three times the percent of women. The three most frequent diagnoses of patients who left the hospital against medical advice were nonspecific chest pain, diabetes with complications, and alcohol-related mental disorders. Only one of the top three diagnoses changed when patients were separated by gender. .. For women, nonspecific chest pain, early or threatened labor, and diabetes with complications made up the top three. .. For men, alcohol-related mental disorders, nonspecific chest pain, and diabetes with complications made up the top three. Patients transferred to another facility: The majority of patients discharged to another facility were transferred to a long-term care facility (LTC). With each 10 year increase in age of patients 65 and older, the percentage of those transferred to longterm care facilities almost doubles. How Patients Were Discharged With the exception of the under 65 age group, the percent of patients transferred to a long-term care facility has increased significantly since 1994. By 2004, 10.9 percent of patients aged 65-74, 21.9 percent of patients aged 75-84, and 40.8 percent of patients 85 and older were discharged to a long-term care facility. Percent of Patients Transferred to a Long Term Care or Other Similar Facility by Age Group Delaware Hospitals, 1994-2004 0 5 10 15 20 25 30 35 40 45 <65 65-74 75-84 85+ Age Group Percent 1994 1999 2004 • In 2004, the most common diagnoses for patients transferred to long-term care facilities were falls, pneumonia, and heart failure7. Though these same diagnoses were included in the 10 most common diagnoses in 1994, only pneumonia was one of the top 3; stroke and osteoarthritis occupied the number 1 and number 3 spots. • The most common procedures in 2004 that resulted in patient transfers to long-term care facilities were vascular catheterization, treatment for hip fracture or dislocation, and upper gastrointestinal endoscopy. In 1994, the most common procedures resulting in patient transfers to long-term care facilities were treatment for hip fracture or dislocation, hip replacement, and knee arthroplasty. How Patients Were Discharged 7 See Appendix E for the top 10 list of diagnoses by age group. Clinical Classification System: Diagnoses and procedures were coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). These codes were then aggregated into broader diagnostic categories using the Clinical Classification System (CCS) developed by the Agency of Healthcare Research and Quality (AHRQ). The CCS diagnoses are used to categorize clinically similar diagnoses for ease in presentation and interpretation of hospital discharge data. A complete listing of CCS diagnostic codes and selected corresponding measures are presented below. Number and Percent of Discharges, Mean Length of Stay, Mean Charges, Percent Expired, and Percent Admitted from the ED by Principal Diagnosis Delaware Hospitals, 2001-2004 Clinical Classifications Software Categories and Chapter Headings Number of Discharges Percent of Discharges Mean LOS Mean Total Charges Percent Expired Percent Admitted from ED Infectious and Parasitic Diseases 7236 1.7 8.5 $ 20,371.68 12.9 77.6 Tuberculosis 52 0.0 16.8 $ 26,236.73 5.8 46.2 Septicemia (except in labor) 4014 1.0 10.0 $ 24,705.14 19.9 83.1 Bacterial infection; unspecified site 163 0.0 7.5 $ 18,847.07 2.5 65.0 Mycoses 270 0.1 11.6 $ 28,848.81 9.3 70.4 HIV infection 777 0.2 10.3 $ 21,590.17 11.7 84.9 Hepatitis 290 0.1 4.7 $ 12,421.22 2.4 65.9 Viral infection 1275 0.3 3.5 $ 8,313.95 0.3 67.2 Other infections; including parasitic 335 0.1 5.9 $ 13,288.59 0.6 65.7 Sexually transmitted infections (not HIV or hepatitis) 48 0.0 5.5 $ 9,200.06 0.0 50.0 Immunizations and screening for infectious disease 12 0.0 8.6 $ 12,185.44 8.3 50.0 Neoplasms 21082 5.0 6.4 $ 19,391.06 7.5 21.1 Cancer of head and neck 320 0.1 8.2 $ 22,155.00 6.9 24.7 Cancer of esophagus 150 0.0 13.9 $ 40,487.20 15.3 40.0 Cancer of stomach 226 0.1 10.7 $ 31,856.30 14.6 38.1 Cancer of colon 1358 0.3 9.5 $ 25,409.93 6.3 28.0 Cancer of rectum and anus 477 0.1 9.5 $ 24,127.03 3.4 16.6 Cancer of liver and intrahepatic bile duct 138 0.0 8.8 $ 33,492.66 31.9 52.2 Cancer of pancreas 296 0.1 10.3 $ 25,674.00 24.3 46.6 Cancer of other GI organs; peritoneum 173 0.0 11.5 $ 35,373.20 11.0 39.3 Cancer of bronchus; lung 1695 0.4 8.7 $ 23,600.30 18.3 41.2 Cancer; other respiratory and intrathoracic 42 0.0 8.3 $ 23,528.21 9.5 45.2 Cancer of bone and connective tissue 116 0.0 6.9 $ 28,024.93 8.6 20.7 Melanomas of skin 29 0.0 3.7 $ 9,935.40 6.9 10.3 Other non-epithelial cancer of skin 97 0.0 3.5 $ 10,639.71 1.0 7.2 Cancer of breast 761 0.2 2.7 $ 10,851.93 2.4 5.9 Cancer of uterus 521 0.1 4.1 $ 12,262.85 1.7 5.2 Cancer of cervix 307 0.1 3.8 $ 11,489.77 2.0 7.8 Cancer of ovary 250 0.1 7.8 $ 20,071.07 6.8 19.6 Cancer of other female genital organs 91 0.0 4.6 $ 12,529.51 2.2 8.8 Cancer of prostate 812 0.2 3.5 $ 13,416.73 0.7 6.3 Cancer of testis 16 0.0 6.4 $ 24,122.91 0.0 12.5 Cancer of other male genital organs 3 0.0 3.7 $ 16,439.43 0.0 33.3 Cancer of bladder 393 0.1 5.9 $ 18,146.76 6.1 21.4 Cancer of kidney and renal pelvis 446 0.1 5.7 $ 19,113.26 2.2 10.1 Cancer of other urinary organs 27 0.0 6.7 $ 18,076.79 0.0 14.8 Cancer of brain and nervous system 367 0.1 8.1 $ 27,631.81 8.7 41.7 Cancer of thyroid 96 0.0 2.8 $ 12,749.63 3.1 2.1 Hodgkin's disease 87 0.0 6.8 $ 22,099.41 3.4 23.0 Appendix A Clinical Classifications Software Categories and Chapter Headings Number of Discharges Percent of Discharges Mean LOS Mean Total Charges Percent Expired Percent Admitted from ED Non-Hodgkin's lymphoma 487 0.1 11.7 $ 33,726.59 15.0 39.8 Leukemias 465 0.1 15.7 $ 59,255.25 22.2 32.5 Multiple myeloma 199 0.0 11.6 $ 29,191.86 16.1 31.2 Cancer; other and unspecified primary 94 0.0 8.7 $ 38,333.60 7.4 21.3 Secondary malignancies 2714 0.6 8.2 $ 19,078.56 19.8 47.6 Malignant neoplasm without specification of site 29 0.0 7.4 $ 19,851.00 34.5 62.1 Neoplasms of unspecified nature or uncertain behavior 504 0.1 6.5 $ 20,459.57 3.2 31.7 Maintenance chemotherapy; radiotherapy 2027 0.5 4.8 $ 18,765.71 1.0 0.3 Benign neoplasm of uterus 3275 0.8 2.4 $ 8,488.65 0.0 1.7 Other and unspecified benign neoplasm 1994 0.5 4.8 $ 15,813.44 0.6 13.4 Endocrine, nutritional, and metabolic diseases and immunity disorders 16049 3.8 4.8 $ 11,669.20 2.0 63.0 Thyroid disorders 309 0.1 4.7 $ 12,716.57 2.3 47.2 Diabetes mellitus without complication 277 0.1 2.7 $ 5,109.70 0.0 68.6 Diabetes mellitus with complications 5541 1.3 5.6 $ 12,121.29 1.2 74.7 Other endocrine disorders 418 0.1 5.7 $ 12,387.59 1.4 68.9 Nutritional deficiencies 188 0.0 9.1 $ 19,956.99 5.3 46.3 Disorders of lipid metabolism 5 0.0 21.0 $ 110,214.98 0.0 80.0 Gout and other crystal arthropathies 218 0.1 5.0 $ 7,634.66 0.9 82.1 Fluid and electrolyte disorders 6655 1.6 4.0 $ 7,655.54 3.0 71.3 Cystic fibrosis 114 0.0 12.7 $ 55,313.23 0.9 22.8 Immunity disorders 14 0.0 13.2 $ 55,954.35 0.0 7.1 Other nutritional; endocrine; and metabolic disorders 2310 0.5 4.4 $ 19,735.09 1.3 13.2 Diseases of the blood and blood forming organs 4380 1.0 4.8 $ 12,340.90 1.7 61.6 Deficiency and other anemia 1778 0.4 4.4 $ 12,089.33 1.9 61.6 Acute posthemorrhagic anemia 129 0.0 4.0 $ 10,670.16 3.1 72.9 Sickle cell anemia 1097 0.3 5.4 $ 9,796.20 0.3 75.0 Coagulation and hemorrhagic disorders 679 0.2 4.4 $ 15,382.32 2.7 54.9 Diseases of white blood cells 616 0.1 5.3 $ 13,893.72 1.8 42.9 Other hematologic conditions 81 0.0 5.5 $ 17,682.97 6.2 63.0 Mental Disorders 10413 2.5 6.4 $ 6,894.32 0.3 66.0 Mental retardation 3 0.0 2.7 $ 1,907.47 0.0 66.7 Alcohol-related mental disorders 1123 0.3 4.3 $ 7,619.87 0.4 89.9 Substance-related mental disorders 777 0.2 6.1 $ 6,701.55 0.3 78.0 Senility and organic mental disorders 926 0.2 8.9 $ 10,721.11 2.3 83.6 Affective disorders 4099 1.0 7.4 $ 7,034.85 0.1 53.4 Schizophrenia and related disorders 847 0.2 8.4 $ 7,374.53 0.0 64.3 Other psychoses 414 0.1 6.3 $ 6,801.21 0.5 72.0 Anxiety; somatoform; dissociative; and personality disorders 492 0.1 4.0 $ 5,586.44 0.2 75.8 Preadult disorders 23 0.0 6.3 $ 6,029.82 0.0 34.8 Other mental conditions 1709 0.4 4.2 $ 4,276.08 0.0 62.6 Diseases of the nervous system and sense organs 9788 2.3 4.9 $ 12,001.53 2.0 73.7 Meningitis (except that caused by tuberculosis or STD) 866 0.2 4.1 $ 10,018.56 2.1 85.3 Encephalitis (except that caused by tuberculosis or STD) 88 0.0 9.8 $ 24,436.23 5.7 70.5 Other CNS infection and poliomyelitis 113 0.0 20.0 $ 47,363.15 11.5 57.5 Parkinson's disease 159 0.0 8.0 $ 11,379.73 2.5 92.5 Multiple sclerosis 257 0.1 6.1 $ 9,229.56 0.4 67.7 Other hereditary and degenerative nervous system conditions 420 0.1 9.2 $ 27,005.43 2.1 54.0 Paralysis 104 0.0 4.7 $ 16,296.31 0.0 44.2 Epilepsy; convulsions 3071 0.7 3.9 $ 9,538.86 1.4 77.0 Headache; including migraine 890 0.2 2.9 $ 5,710.83 0.2 82.1 Coma; stupor; and brain damage 230 0.1 12.7 $ 29,131.63 25.2 87.0 Cataract 8 0.0 4.9 $ 7,388.54 0.0 0.0 Retinal detachments; defects; vascular occlusion; and retinopathy 36 0.0 4.4 $ 12,726.81 0.0 69.4 10.9 Clinical Classifications Software Categories and Chapter Headings Number of Discharges Percent of Discharges Mean LOS Mean Total Charges Percent Expired Percent Admitted from ED Glaucoma 7 0.0 5.7 $ 7,418.16 0.0 57.1 Blindness and vision defects 47 0.0 2.5 $ 5,842.75 0.0 89.4 Inflammation; infection of eye (except that caused by tuberculosis 233 0.1 3.6 $ 6,411.12 0.0 54.5 Other eye disorders 63 0.0 3.4 $ 8,482.49 1.6 60.3 Otitis media and related conditions 278 0.1 2.4 $ 8,615.08 0.0 30.6 Conditions associated with dizziness or vertigo 815 0.2 2.9 $ 6,268.09 0.0 93.0 Other ear and sense organ disorders 151 0.0 2.5 $ 9,462.36 0.0 45.0 Other nervous system disorders 1952 0.5 6.0 $ 15,980.02 2.2 66.9 Diseases of the circulatory system 71901 17.1 5.0 $ 17,670.28 4.1 72.5 Heart valve disorders 1002 0.2 10.3 $ 54,649.63 5.7 25.8 Peri-; endo-; and myocarditis; cardiomyopathy 913 0.2 8.0 $ 26,861.88 6.8 69.1 Essential hypertension 609 0.1 3.0 $ 7,389.67 0.2 81.6 Hypertension with complications and secondary hypertension 1738 0.4 6.0 $ 15,328.00 3.2 77.6 Acute myocardial infarction 8649 2.1 5.6 $ 24,832.98 7.6 72.8 Coronary atherosclerosis and other heart disease 10572 2.5 4.0 $ 21,955.79 0.8 55.3 Nonspecific chest pain 8643 2.1 1.8 $ 6,807.23 0.0 91.0 Pulmonary heart disease 1283 0.3 7.3 $ 18,703.99 6.9 79.3 Other and ill-defined heart disease 46 0.0 3.9 $ 19,327.81 4.3 45.7 Conduction disorders 703 0.2 4.2 $ 24,565.40 2.0 68.6 Cardiac dysrhythmias 7458 1.8 4.0 $ 15,135.20 1.7 70.5 Cardiac arrest and ventricular fibrillation 229 0.1 8.1 $ 35,297.34 58.5 86.9 Congestive heart failure; nonhypertensive 11905 2.8 6.1 $ 16,173.37 4.6 84.6 Acute cerebrovascular disease 6288 1.5 7.9 $ 17,685.67 11.8 91.5 Occlusion or stenosis of precerebral arteries 1853 0.4 2.5 $ 11,825.90 0.3 13.0 Other and ill-defined cerebrovascular disease 282 0.1 4.4 $ 11,361.37 1.8 81.9 Transient cerebral ischemia 2310 0.5 3.3 $ 8,529.52 0.4 91.0 Late effects of cerebrovascular disease 201 0.0 5.8 $ 10,713.50 1.0 90.5 Peripheral and visceral atherosclerosis 1721 0.4 6.8 $ 23,422.68 7.0 38.1 Aortic; peripheral; and visceral artery aneurysms 950 0.2 8.1 $ 39,186.79 14.6 34.1 Aortic and peripheral arterial embolism or thrombosis 512 0.1 7.2 $ 26,880.77 4.7 42.6 Other circulatory disease 1550 0.4 4.8 $ 12,628.83 2.6 76.8 Phlebitis; thrombophlebitis and thromboembolism 1865 0.4 5.8 $ 11,935.63 1.8 56.4 Varicose veins of lower extremity 57 0.0 8.4 $ 13,618.51 3.5 42.1 Hemorrhoids 315 0.1 3.7 $ 7,521.33 0.3 76.2 Other diseases of veins and lymphatics 247 0.1 8.1 $ 17,129.94 1.6 42.9 Diseases of the respiratory system 39401 9.4 5.9 $ 14,490.63 5.5 79.3 Pneumonia (except that caused by tuberculosis or STD) 12710 3.0 6.2 $ 14,288.60 5.5 82.9 Influenza 251 0.1 4.2 $ 13,216.61 2.0 73.7 Acute and chronic tonsillitis 746 0.2 1.7 $ 6,309.40 0.0 31.9 Acute bronchitis 2961 0.7 3.4 $ 9,997.05 0.2 67.9 Other upper respiratory infections 1061 0.3 2.6 $ 7,124.22 0.1 68.4 Chronic obstructive pulmonary disease and bronchiectasis 6267 1.5 5.6 $ 11,690.39 2.7 86.7 Asthma 5919 1.4 2.9 $ 7,192.73 0.1 78.5 Aspiration pneumonitis; food/vomitus 2042 0.5 $ 24,409.05 17.1 89.6 Pleurisy; pneumothorax; pulmonary collapse 1387 0.3 8.6 $ 21,789.60 5.6 71.8 Respiratory failure; insufficiency; arrest (adult) 3543 0.8 11.0 $ 31,103.71 20.6 87.4 Lung disease due to external agents 102 0.0 5.8 $ 14,799.52 13.7 65.7 Other lower respiratory disease 1729 0.4 4.5 $ 13,611.61 4.3 61.0 Other upper respiratory disease 683 0.2 5.7 $ 19,041.93 1.3 60.9 Diseases of the digestive system 38291 9.1 5.2 $ 14,029.45 2.4 73.4 Intestinal infection 1983 0.5 4.1 $ 8,589.57 1.5 79.6 Disorders of teeth and jaw 197 0.0 2.6 $ 9,933.96 0.5 34.5 Diseases of mouth; excluding dental 214 0.1 4.3 $ 10,539.16 1.4 52.3 Esophageal disorders 2314 0.5 3.7 $ 11,211.61 0.5 62.2 Clinical Classifications Software Categories and Chapter Headings Number of Discharges Percent of Discharges Mean LOS Mean Total Charges Percent Expired Percent Admitted from ED Gastroduodenal ulcer (except hemorrhage) 421 0.1 6.6 $ 19,652.91 6.2 82.7 Gastritis and duodenitis 1324 0.3 4.2 $ 9,701.53 1.7 82.2 Other disorders of stomach and duodenum 859 0.2 5.5 $ 12,425.74 2.1 70.2 Appendicitis and other appendiceal conditions 3152 0.7 3.1 $ 11,698.00 0.2 88.6 Abdominal hernia 2164 0.5 4.6 $ 16,487.82 1.9 36.5 Regional enteritis and ulcerative colitis 947 0.2 6.0 $ 14,912.17 0.4 60.9 Intestinal obstruction without hernia 3395 0.8 7.1 $ 17,376.82 3.6 82.8 Diverticulosis and diverticulitis 3523 0.8 5.8 $ 14,421.27 1.3 70.2 Anal and rectal conditions 540 0.1 4.7 $ 10,815.42 1.3 59.1 Peritonitis and intestinal abscess 259 0.1 9.5 $ 25,603.24 6.2 72.6 Biliary tract disease 4453 1.1 4.3 $ 14,596.64 0.9 70.9 Liver disease; alcohol-related 588 0.1 7.6 $ 18,587.34 13.4 86.1 Other liver diseases 1326 0.3 6.9 $ 17,102.05 9.7 78.4 Pancreatic disorders (not diabetes) 2963 0.7 6.8 $ 16,217.65 1.9 88.1 Gastrointestinal hemorrhage 3702 0.9 5.1 $ 13,231.59 5.5 85.9 Noninfectious gastroenteritis 1373 0.3 3.1 $ 6,906.81 0.1 78.6 Other gastrointestinal disorders 2594 0.6 6.4 $ 17,019.99 2.9 51.7 Diseases of the genitourinary system 19143 4.5 4.2 $ 10,438.97 2.1 53.1 Nephritis; nephrosis; renal sclerosis 151 0.0 5.1 $ 13,795.04 0.7 45.0 Acute and unspecified renal failure 2596 0.6 7.8 $ 17,276.73 9.7 81.6 Chronic renal failure 157 0.0 7.7 $ 29,184.87 4.5 42.7 Urinary tract infections 5467 1.3 5.2 $ 9,135.20 2.2 85.2 Calculus of urinary tract 2078 0.5 2.3 $ 7,733.13 0.0 73.0 Other diseases of kidney and ureters 629 0.1 4.1 $ 13,190.96 1.1 35.8 Other diseases of bladder and urethra 289 0.1 6.5 $ 19,237.85 1.7 37.0 Genitourinary symptoms and ill-defined conditions 367 0.1 3.6 $ 9,930.30 1.4 55.3 Hyperplasia of prostate 712 0.2 2.6 $ 7,867.98 0.0 10.0 Inflammatory conditions of male genital organs 234 0.1 4.1 $ 8,031.30 0.0 69.7 Other male genital disorders 123 0.0 3.0 $ 11,093.10 0.0 58.5 Nonmalignant breast conditions 233 0.1 3.1 $ 9,573.86 0.4 37.8 Inflammatory diseases of female pelvic organs 760 0.2 3.1 $ 8,656.45 0.0 40.1 Endometriosis 940 0.2 2.4 $ 8,436.20 0.0 3.2 Prolapse of female genital organs 1271 0.3 2.0 $ 8,973.57 0.1 0.3 Menstrual disorders 1046 0.2 2.3 $ 8,377.85 0.1 6.3 Ovarian cyst 884 0.2 2.5 $ 8,463.16 0.0 29.0 Menopausal disorders 122 0.0 2.7 $ 8,338.20 0.0 14.8 Female infertility 3 0.0 1.7 $ 7,574.92 0.0 33.3 Other female genital disorders 1081 0.3 2.7 $ 9,740.45 0.1 12.5 Complications of pregnancy, childbirth, and the puerperium 51206 12.2 2.7 $ 4,842.17 0.0 3.6 Contraceptive and procreative management 11 0.0 1.5 $ 5,503.00 0.0 0.0 Spontaneous abortion 122 0.0 2.1 $ 5,275.09 0.0 49.2 Induced abortion 108 0.0 1.8 $ 3,851.59 0.0 12.0 Postabortion complications 29 0.0 2.5 $ 4,897.48 0.0 75.9 Ectopic pregnancy 298 0.1 1.8 $ 8,267.25 0.0 62.8 Other complications of pregnancy 5339 1.3 2.5 $ 4,405.59 0.0 12.6 Hemorrhage during pregnancy; abruptio placenta; placenta previa 741 0.2 5.4 $ 7,604.91 0.0 6.1 Hypertension complicating pregnancy; childbirth and the puerperium 2727 0.6 3.4 $ 6,104.08 0.0 3.6 Early or threatened labor 2657 0.6 4.1 $ 5,037.46 0.0 5.3 Prolonged pregnancy 2428 0.6 2.4 $ 4,253.49 0.0 0.5 Diabetes or abnormal glucose tolerance complicating pregnancy 990 0.2 2.4 $ 4,260.35 0.0 2.0 Malposition; malpresentation 2318 0.6 3.4 $ 6,778.70 0.0 1.1 Fetopelvic disproportion; obstruction 758 0.2 2.7 $ 5,273.79 0.0 0.5 Previous C-section 4574 1.1 2.8 $ 6,298.64 0.0 0.6 Fetal distress and abnormal forces of labor 2761 0.7 2.9 $ 5,506.55 0.0 1.7 Polyhydramnios and other problems of amniotic cavity 3099 0.7 3.3 $ 5,054.84 0.0 1.1 Umbilical cord complication 2402 0.6 2.2 $ 3,540.34 0.0 1.2 OB-related trauma to perineum and vulva 9065 2.2 2.1 $ 3,564.81 0.0 1.0 Forceps delivery 542 0.1 2.3 $ 3,946.95 0.0 0.9 Other complications of birth; puerperium affecting management 7157 1.7 2.9 $ 5,093.27 0.0 3.9 Normal pregnancy and/or delivery 3080 0.7 2.1 $ 3,795.58 0.0 0.9 Diseases of the skin and subcutaneous tissue 6480 1.5 6.1 $ 10,978.36 1.1 65.0 Skin and subcutaneous tissue infections 5276 1.3 5.1 $ 8,864.48 0.6 70.8 Other inflammatory condition of skin 158 0.0 6.5 $ 14,371.17 1.3 60.1 Chronic ulcer of skin 870 0.2 12.7 $ 23,384.17 4.5 38.0 Other skin disorders 176 0.0 3.1 $ 9,976.49 0.0 27.3 Diseases of the musculoskeletal system and connective tissue 21766 5.2 3.8 $ 19,579.29 0.4 18.3 Infective arthritis and osteomyelitis 904 0.2 8.8 $ 18,815.81 1.7 48.7 Rheumatoid arthritis and related disease 200 0.0 4.6 $ 16,454.95 0.0 36.5 Osteoarthritis 7311 1.7 3.3 $ 21,103.18 0.1 1.3 Other non-traumatic joint disorders 498 0.1 3.8 $ 11,377.20 0.0 51.2 Spondylosis; intervertebral disc disorders; other back problems 7128 1.7 3.0 $ 15,951.24 0.2 20.3 Osteoporosis 21 0.0 4.5 $ 14,383.45 0.0 33.3 Pathological fracture 1042 0.2 6.8 $ 16,632.43 3.5 58.3 Acquired foot deformities 299 0.1 2.8 $ 18,481.09 0.0 0.7 Other acquired deformities 996 0.2 6.0 $ 41,839.71 0.4 2.0 Systemic lupus erythematosus and connective tissue disorders 230 0.1 6.5 $ 15,570.64 1.3 62.6 Other connective tissue disease 1781 0.4 3.9 $ 12,924.14 0.5 39.2 Other bone disease and musculoskeletal deformities 1356 0.3 3.9 $ 30,074.08 0.1 15.2 Congenital anomalies 3370 0.8 7.9 $ 49,800.25 3.5 7.5 Cardiac and circulatory congenital anomalies 1418 0.3 10.7 $ 76,962.14 7.5 4.1 Digestive congenital anomalies 450 0.1 7.5 $ 30,014.95 0.4 26.4 Genitourinary congenital anomalies 207 0.0 4.2 $ 19,717.90 0.0 8.2 Nervous system congenital anomalies 123 0.0 12.4 $ 63,793.24 1.6 10.6 Other congenital anomalies 1172 0.3 4.9 $ 28,393.90 0.8 3.8 Liveborn 44417 10.5 3.3 $ 3,993.45 0.6 0.1 Certain conditions originating in the perinatal period 1866 0.4 10.7 $ 31,118.57 2.2 23.4 Short gestation; low birth weight; and fetal growth retardation 354 0.1 20.0 $ 46,462.43 2.8 0.3 Intrauterine hypoxia and birth asphyxia 8 0.0 7.8 $ 23,918.53 25.0 0.0 Respiratory distress syndrome 155 0.0 16.7 $ 41,522.08 3.2 0.0 Hemolytic jaundice and perinatal jaundice 486 0.1 2.1 $ 2,868.03 0.2 25.1 Birth trauma 19 0.0 5.2 $ 16,228.85 5.3 10.5 Other perinatal conditions 844 0.2 10.8 $ 39,443.21 2.6 36.8 Injury and poisoning 33411 7.9 5.5 $ 16,236.34 2.3 72.2 Joint disorders and dislocations; trauma-related 333 0.1 3.2 $ 19,473.79 0.3 4.5 Fracture of neck of femur (hip) 104 0.0 19.2 $ 47,479.53 8.7 94.2 Spinal cord injury 3 0.0 102.3 $ 385,039.55 0.0 33.3 Skull and face fractures 6 0.0 5.2 $ 15,975.41 0.0 83.3 Fracture of upper limb 15 0.0 4.7 $ 14,111.29 6.7 66.7 Fracture of lower limb 45 0.0 12.2 $ 32,183.73 2.2 60.0 Other fractures 118 0.0 5.0 $ 13,199.52 0.8 49.2 Sprains and strains 38 0.0 5.4 $ 17,457.93 2.6 34.2 Intracranial injury 24 0.0 26.9 $ 74,487.20 12.5 75.0 Crushing injury or internal injury 27 0.0 13.3 $ 52,940.87 7.4 74.1 Open wounds of head; neck; and trunk 5 0.0 5.2 $ 23,672.82 0.0 80.0 Open wounds of extremities 12 0.0 5.3 $ 12,658.00 0.0 8.3 Complication of device; implant or graft 4827 1.1 6.2 $ 22,545.61 2.6 38.0 Complications of surgical procedures or medical care 4706 1.1 6.4 $ 15,425.57 1.9 53.8 Clinical Classifications Software Categories and Chapter Headings Number of Discharges Percent of Discharges Mean LOS Mean Total Charges Percent Expired Percent Admitted from ED Clinical Classifications Software Categories and Chapter Headings 6.4 Number of Discharges $ 21,384.65 Percent of Discharges 2.1 Mean LOS 81.3 Mean Total Charges Percent Expired Percent Admitted from ED E Codes: Fall Superficial injury; contusion 16 0.0 5.9 $ 12,020.61 0.0 62.5 Burns 10 0.0 24.5 $ 11,777.26 0.0 20.0 Poisoning by psychotropic agents 99 0.0 3.5 $ 8,468.39 2.0 97.0 Poisoning by other medications and drugs 572 0.1 3.5 $ 8,297.01 1.2 97.0 Poisoning by nonmedicinal substances 38 0.0 4.1 $ 11,909.17 0.0 94.7 Other injuries and conditions due to external causes 386 0.1 3.9 $ 10,445.95 3.4 90.9 Other conditions 20011 4.8 7.4 $ 11,752.91 0.7 39.6 Syncope 3508 0.8 3.1 $ 8,782.43 0.2 92.0 Fever of unknown origin 1340 0.3 3.2 $ 7,253.17 0.4 57.5 Lymphadenitis 198 0.0 2.9 $ 7,820.21 0.0 55.6 Gangrene 597 0.1 13.1 $ 30,044.97 7.0 29.3 Shock 95 0.0 6.2 $ 24,790.29 54.7 92.6 Nausea and vomiting 523 0.1 3.7 $ 7,753.99 0.2 69.0 Abdominal pain 2825 0.7 2.8 $ 6,830.55 0.3 82.7 Malaise and fatigue 165 0.0 4.0 $ 6,873.72 0.6 87.3 Allergic reactions 244 0.1 3.4 $ 7,192.49 0.4 69.3 Rehabilitation care; fitting of prostheses; and adjustment of devices 9448 2.2 11.5 $ 14,488.33 0.2 0.6 Administrative/social admission 13 0.0 4.0 $ 6,897.35 0.0 76.9 Medical examination/evaluation 14 0.0 2.4 $ 3,472.44 0.0 21.4 Other aftercare 97 0.0 3.6 $ 10,804.12 0.0 7.2 Other screening for suspected conditions (not mental disorders) 17 0.0 2.5 $ 5,983.48 0.0 47.1 Residual codes; unclassified 927 0.2 3.5 $ 9,066.53 1.0 50.2 E Codes: Cut/pierce 510 0.1 3.0 $ 10,089.62 1.0 92.9 E Codes: Drowning/submersion 48 0.0 8604 2.0 5.6 $ 14,743.11 2.8 88.4 E Codes: Fire/burn 145 0.0 4.8 $ 8,011.07 1.4 71.0 E Codes: Firearm 331 0.1 6.5 $ 22,950.54 8.8 98.5 E Codes: Machinery 150 0.0 4.1 $ 15,393.65 0.7 94.0 E Codes: Motor vehicle traffic (MVT) 4554 1.1 6.0 $ 19,392.29 3.2 94.7 E Codes: Pedal cyclist; not MVT 241 0.1 2.8 $ 10,981.16 0.8 85.1 E Codes: Pedestrian; not MVT 36 0.0 6.9 $ 21,262.74 5.6 91.7 E Codes: Transport; not MVT 539 0.1 4.1 $ 13,140.58 0.7 92.0 E Codes: Natural/environment 243 0.1 3.6 $ 7,801.90 0.0 84.0 E Codes: Overexertion 331 0.1 3.0 $ 9,810.65 0.3 69.8 E Codes: Poisoning 1835 0.4 2.6 $ 7,224.87 1.0 90.3 E Codes: Struck by; against 973 0.2 3.1 $ 9,328.68 0.8 86.1 E Codes: Suffocation 109 0.0 3.4 $ 11,931.24 8.3 74.3 E Codes: Adverse effects of medical care 1759 0.4 6.0 $ 21,388.43 0.5 36.6 E Codes: Adverse effects of medical drugs 212 0.1 5.1 $ 16,904.74 0.9 68.9 E Codes: Other specified and classifiable 483 0.1 4.0 $ 10,848.34 0.8 66.7 E Codes: Other specified; NEC 155 0.0 4.6 $ 12,666.92 2.6 70.3 E Codes: Unspecified 720 0.2 4.6 $ 13,569.23 1.9 59.7 E Codes: Place of occurrence 49 0.0 4.3 $ 15,867.35 0.0 71.4 Other/unknown 846 0.2 3.8 $ 8,425.72 4.4 51.8 Total 421057 100.0 4.9 $ 13,059.06 2.6 47.9 Number of Patients who had Primary Procedures during the Inpatient Stay by Primary Procedure and Sex of Patient Delaware Hospitals, 2001-2004 Single- level CCS Procedure Categories and Chapter Headings Male Female Total Operations on the nervous system 5391 5471 10862 Incision and excision of CNS 528 474 1002 Insertion; replacement; or removal of extracranial ventricular shunt 214 224 438 Laminectomy; excision intervertebral disc 2032 1999 4031 Diagnostic spinal tap 1821 1934 3755 Insertion of catheter or spinal stimulator and injection into spinal canal 152 184 336 Decompression peripheral nerve 14 13 27 Other diagnostic nervous system procedures 105 75 180 Other non-OR or closed therapeutic nervous system procedures 57 91 148 Other OR therapeutic nervous system procedures 468 477 945 Operations on the endocrine system 165 376 541 Thyroidectomy; partial or complete 57 196 253 Diagnostic endocrine procedures 16 25 41 Other therapeutic endocrine procedures 92 155 247 Operations on the eye 139 106 245 Corneal transplant 1 0 1 Glaucoma procedures 1 2 3 Lens and cataract procedures 3 8 11 Repair of retinal tear; detachment 3 2 5 Destruction of lesion of retina and choroid 3 4 7 Diagnostic procedures on eye 0 6 6 Other therapeutic procedures on eyelids; conjunctiva; cornea 89 55 144 Other intraocular therapeutic procedures 18 14 32 Other extraocular muscle and orbit therapeutic procedures 21 15 36 Operations on the ear 228 176 404 Tympanoplasty 8 11 19 Myringotomy 139 82 221 Mastoidectomy 9 21 30 Diagnostic procedures on ear 4 2 6 Other therapeutic ear procedures 68 60 128 Operations on the nose, mouth, and pharynx 1062 862 1924 Control of epistaxis 154 113 267 Plastic procedures on nose 54 32 86 Dental procedures 69 66 135 Tonsillectomy and/or adenoidectomy 285 221 506 Diagnostic procedures on nose; mouth and pharynx 38 41 79 Other non-OR therapeutic procedures on nose; mouth and phary 115 74 189 Other OR therapeutic procedures on nose; mouth and pharynx 347 315 662 Operations on the respiratory system 4186 3390 7577 Tracheostomy; temporary and permanent 621 489 1110 Tracheoscopy and laryngoscopy with biopsy 166 129 295 Lobectomy or pneumonectomy 577 467 1044 Diagnostic bronchoscopy and biopsy of bronchus 865 743 1608 Other diagnostic procedures on lung and bronchus 98 79 177 Incision of pleura; thoracentesis; chest drainage 1124 995 2120 Other diagnostic procedures of respiratory tract and mediast 169 122 291 Other non-OR therapeutic procedures on respiratory system 93 99 192 Other OR Rx procedures on respiratory system and mediastinum 473 267 740 Appendix B Single- level CCS Procedure Categories and Chapter Headings Male Female Total Operations on the cardiovascular system 21611 18036 39648 Heart valve procedures 495 433 928 Coronary artery bypass graft (CABG) 2128 820 2948 Percutaneous transluminal coronary angioplasty (PTCA) 4431 2568 6999 Coronary thrombolysis 1 0 1 Diagnostic cardiac catheterization; coronary arteriography 3897 4046 7943 Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator 1658 1321 2979 Other OR heart procedures 781 700 1481 Extracorporeal circulation auxiliary to open heart procedure 3 5 8 Endarterectomy; vessel of head and neck 1016 760 1776 Aortic resection; replacement or anastomosis 445 147 592 Varicose vein stripping; lower limb 4 3 7 Other vascular catheterization; not heart 2297 3333 5631 Peripheral vascular bypass 714 482 1196 Other vascular bypass and shunt; not heart 94 68 162 Creation; revision and removal of arteriovenous fistula or vessel to vessel cannula 256 225 481 Hemodialysis 1323 1208 2531 Other OR procedures on vessels of head and neck 20 12 32 Embolectomy and endarterectomy of lower limbs 128 118 246 Other OR procedures on vessels other than head and neck 1289 1279 2568 Other diagnostic cardiovascular procedures 281 229 510 Other non-OR therapeutic cardiovascular procedures 350 279 629 Operations on the hemic and lymphatic system 718 596 1314 Bone marrow transplant 71 48 119 Bone marrow biopsy 262 208 470 Procedures on spleen 122 124 246 Other therapeutic procedures; hemic and lymphatic system 263 216 479 Operations on the digestive system 16471 20911 37382 Injection or ligation of esophageal varices 2 2 4 Esophageal dilatation 48 70 118 Upper gastrointestinal endoscopy; biopsy 3641 4825 8466 Gastrostomy; temporary and permanent 453 534 987 Colostomy; temporary and permanent 50 60 110 Ileostomy and other enterostomy 39 27 66 Gastrectomy; partial and total 95 83 178 Small bowel resection 278 337 615 Colonoscopy and biopsy 1089 1719 2808 Proctoscopy and anorectal biopsy 103 129 232 Colorectal resection 1912 1899 3811 Local excision of large intestine lesion (not endoscopic) 9 9 18 Appendectomy 1783 1460 3243 Hemorrhoid procedures 63 48 111 Endoscopic retrograde cannulation of pancreas (ERCP) 81 135 216 Biopsy of liver 235 235 470 Cholecystectomy and common duct exploration 1370 2772 4142 Inguinal and femoral hernia repair 278 108 386 Other hernia repair 510 880 1390 Laparoscopy (GI only) 41 136 177 Abdominal paracentesis 635 567 1202 Exploratory laparotomy 111 86 197 Excision; lysis peritoneal adhesions 260 544 804 Peritoneal dialysis 61 63 124 Other bowel diagnostic procedures 28 31 59 Other non-OR upper GI therapeutic procedures 551 447 998 Other OR upper GI therapeutic procedures 773 1681 2454 Other non-OR lower GI therapeutic procedures 491 495 986 Single- level CCS Procedure Categories and Chapter Headings Male Female Total Other OR lower GI therapeutic procedures 752 674 1426 Other gastrointestinal diagnostic procedures 62 89 151 Other non-OR gastrointestinal therapeutic procedures 194 255 449 Other OR gastrointestinal therapeutic procedures 473 511 984 Operations on the urinary system 2486 2483 4969 Endoscopy and endoscopic biopsy of the urinary tract 302 196 498 Transurethral excision; drainage; or removal urinary obstruction 660 365 1025 Ureteral catheterization 256 382 638 Nephrotomy and nephrostomy 175 193 368 Nephrectomy; partial or complete 329 305 634 Kidney transplant 12 7 19 Genitourinary incontinence procedures 2 357 359 Extracorporeal lithotripsy; urinary 20 19 39 Indwelling catheter 27 11 38 Procedures on the urethra 129 19 148 Other diagnostic procedures of urinary tract 90 70 160 Other non-OR therapeutic procedures of urinary tract 77 252 329 Other OR therapeutic procedures of urinary tract 407 307 714 Operations on male genital organs 19701 19701 Transurethral resection of prostate (TURP) 853 853 Open prostatectomy 609 609 Circumcision 17907 17907 Diagnostic procedures; male genital 41 41 Other non-OR therapeutic procedures; male genital 58 58 Other OR therapeutic procedures; male genital 233 233 Operations on the female genital organs 11130 11130 Oophorectomy; unilateral and bilateral 1065 1065 Other operations on ovary 352 352 Ligation or occlusion of fallopian tubes 378 378 Removal of ectopic pregnancy 188 188 Other operations on fallopian tubes 120 120 Hysterectomy; abdominal and vaginal 7309 7309 Other excision of cervix and uterus 394 394 Abortion (termination of pregnancy) 37 37 Dilatation and curettage (D&C); aspiration after delivery or abortion 178 178 Diagnostic dilatation and curettage (D&C) 87 87 Repair of cystocele and rectocele; obliteration of vaginal vault 407 407 Other diagnostic procedures; female organs 123 123 Other non-OR therapeutic procedures; female organs 42 42 Other OR therapeutic procedures; female organs 450 450 Obstetrical procedures 46121 46121 Episiotomy 1970 1970 Cesarean section 12916 12916 Forceps; vacuum; and breech delivery 3071 3071 Artificial rupture of membranes to assist delivery 1427 1427 Other procedures to assist delivery 19955 19955 Diagnostic amniocentesis 38 38 Fetal monitoring 1482 1482 Repair of current obstetric laceration 5174 5174 Other therapeutic obstetrical procedures 88 88 Operations on the musculoskeletal system 12561 15200 27761 Partial excision bone 359 289 648 Bunionectomy or repair of toe deformities 9 20 29 Treatment; facial fracture or dislocation 260 75 335 Treatment; fracture or dislocation of radius and ulna 346 272 618 Treatment; fracture or dislocation of hip and femur 1145 1952 3097 Other diagnostic procedures on musculoskeletal system Treatment; fracture or dislocation of lower extremity (other than hip or femur) 985 1071 2056 Other fracture and dislocation procedure 600 544 1144 Arthroscopy 14 29 Division of joint capsule; ligament or cartilage 51 54 105 Excision of semilunar cartilage of knee 35 24 59 Arthroplasty knee 3653 5757 Hip replacement; total and partial 1469 2389 3858 Arthroplasty other than hip or knee 139 262 401 Arthrocentesis 201 504 Injections and aspirations of muscles; tendons; bursa; joint 58 42 100 Amputation of lower extremity 823 555 1378 Spinal fusion 1706 3042 203 258 461 Other therapeutic procedures on muscles and tendons 1115 819 1934 Other OR therapeutic procedures on bone 467 1058 Other OR therapeutic procedures on joints 391 317 708 Other non-OR therapeutic procedures on musculoskeletal system 51 105 156 Other OR therapeutic procedures on musculoskeletal system 111 284 Operations on the integumentary system 4107 5096 9203 Breast biopsy and other diagnostic procedures on breast 0 49 49 Lumpectomy; quadrantectomy of breast 3 124 Mastectomy 4 599 603 Incision and drainage; skin and subcutaneous tissue 669 601 1270 Debridement of wound; infection or burn 1329 2698 Excision of skin lesion 91 124 215 Suture of skin and subcutaneous tissue 684 522 1206 Skin graft 185 397 Other diagnostic procedures on skin and subcutaneous tissue 81 96 177 Other non-OR therapeutic procedures on skin and breast 895 1025 1920 Other OR therapeutic procedures on skin and breast 445 544 Miscellaneous diagnostic and therapeutic procedures 16168 18261 34429 Other organ transplantation 22 30 52 Computerized axial tomography (CT) scan head 3 7 CT scan abdomen 2 3 5 Other CT scan 0 1 1 Myelogram 8 28 Intraoperative cholangiogram 4 5 9 Upper gastrointestinal X-ray 1 0 1 Lower gastrointestinal X-ray 2 7 Intravenous pyelogram 21 33 54 Cerebral arteriogram 58 78 136 Contrast aortogram 90 178 Contrast arteriogram of femoral and lower extremity arteries 57 43 100 Arterio- or venogram (not heart and head) 60 89 149 Diagnostic ultrasound of head and neck 3 3 Diagnostic ultrasound of heart (echocardiogram) 1746 1771 3517 Diagnostic ultrasound of urinary tract 1 0 1 Diagnostic ultrasound of abdomen or retroperitoneum 1 2 Other diagnostic ultrasound 12 18 30 Magnetic resonance imaging 440 562 1002 Electroencephalogram (EEG) 3 5 Cardiac stress tests 4 3 7 Electrocardiogram 0 1 1 Electrographic cardiac monitoring 1 1 Swan-Ganz catheterization for monitoring 49 52 101 Arterial blood gases 13 21 34 Single- level CCS Procedure Categories and Chapter Headings Male Female Total 15 2104 303 1336 591 173 121 1369 212 99 4 20 5 88 0 1 2 0 Microscopic examination (bacterial smear; culture; toxicology) 2 2 Radioisotope bone scan 1 0 1 Radioisotope scan and function studies 0 4 4 Therapeutic radiology for cancer treatment 279 490 Diagnostic physical therapy 5 11 16 Physical therapy exercises; manipulation; and other procedures 6 12 18 Traction; splints; and other wound care 267 457 Respiratory intubation and mechanical ventilation 3857 3799 7656 Other respiratory therapy 19 14 33 Psychological and psychiatric evaluation and therapy 87 131 Alcohol and drug rehabilitation/detoxification 154 69 223 Ophthalmologic and otologic diagnosis and treatment 2 1 3 Nasogastric tube 20 34 Blood transfusion 1177 1112 2289 Enteral and parenteral nutrition 83 77 160 Cancer chemotherapy 1027 2373 Conversion of cardiac rhythm 657 459 1116 Other diagnostic radiology and related techniques 140 207 347 Other diagnostic procedures (interview; evaluation; consultation) 5090 9197 Prophylactic vaccinations and inoculations 491 1431 1922 Nonoperative removal of foreign body 34 38 72 Other therapeutic procedures 1425 2453 Other/unknown/NA 1 0 1 Total 104994 148215 253211 Single- level CCS Procedure Categories and Chapter Headings Male Female Total 0 211 190 44 14 1346 4107 1028 Top 10 Conditions with the Highest Number of In-Hospital Deaths by Age Group Delaware Hospitals, 2001-2004 Primary Diagnosis Age Group in Years Under 11 1-17 18-44 45-64 65+ Liveborn2 Cardiac and circulatory congenital anomalies 91 14 Other perinatal conditions 22 Other congenital anomalies 8 Short gestation; low birth weight; and fetal growth retardation 8 Septicemia (except in labor) 7 37 152 594 Respiratory distress syndrome 4 Coma; stupor; and brain damage 3 5 Peripheral and visceral atherosclerosis 3 19 61 E Codes: Suffocation Other acquired deformities 4 Secondary malignancies 3 27 187 320 Epilepsy; convulsions 3 Leukemias 3 Meningitis (except that caused by tuberculosis or STD3) 3 HIV infection 38 51 Respiratory failure; insufficiency; arrest (adult) 28 139 559 27 87 587 Acute cerebrovascular disease 25 125 594 Liver disease; alcohol-related 19 E Codes: Firearm 18 Other liver diseases 17 59 Acute myocardial infarction 103 545 Aspiration pneumonitis; food/vomitus 306 Cancer of bronchus; lung 97 Congestive heart failure; nonhypertensive 42 494 204 Total Deaths 435 564 2102 7866 250 7 E Codes: Motor vehicle traffic (MVT) 4 Pneumonia (except that caused by tuberculosis or STD) 206 E Codes: Fall 127 Notes: 1. Due to multiple ties among the 10th diagnosis, the under 1 age group lists only the top 9 diagnoses. 2. Information from secondary diagnoses identified that 85.6 percent of these infants were classified as very low birth weight (i.e. weighing less than 3 pounds, 5 ounces) at birth. 3. STD is the acronym for Sexually Transmitted Disease. Appendix C Percent of All Patients who Died while Hospitalized by Age Group Delaware Hospitals, 2001-2004 45-54 7% 55-64 12% 65-74 21% 75+ 50% <1 4% 1-14 1% 15-24 1% 35-44 3% 25-34 1% Appendix D Top 10 Conditions with the Highest Number of Transfers to LTC and Similar Facilities by Age Group Delaware Hospitals, 2004 Primary Diagnosis Age Group in Years Under 65 65-74 75-84 85+ TOTAL E Codes: Poisoning 193 193 Liveborn 77 77 Aspiration pneumonitis; food/vomitus 69 69 Pneumonia (except that caused by tuberculosis or STD1) 64 75 200 225 564 Septicemia (except in labor) 64 57 127 104 352 E Codes: Fall 63 92 285 340 780 Affective disorders 59 59 Diabetes mellitus with complications 58 58 Urinary tract infections 46 56 151 156 409 Respiratory failure; insufficiency; arrest (adult) 44 61 105 Congestive heart failure; nonhypertensive 77 203 220 500 Acute cerebrovascular disease 54 123 109 286 Chronic obstructive pulmonary disease and bronchiectasis 47 86 133 Acute myocardial infarction 46 76 122 Rehabilitation care; fitting of prostheses; and adjustment 43 109 152 Aspiration pneumonitis; food/vomitus 88 85 173 Acute and unspecified renal failure 86 88 174 Fluid and electrolyte disorders 94 94 Total Transfers 737 608 1458 1497 4300 Top 10 Conditions with the Highest Number of Transfers to LTC and Similar Facilities by Age Group Delaware Hospitals, 1994 Primary Diagnosis Age Group in Years Under 65 65-74 75-84 85+ TOTAL E Codes: Poisoning 88 88 Acute cerebrovascular disease 88 121 142 83 434 Affective disorders 40 40 Liveborn 70 70 Osteoarthritis 56 149 94 299 Diabetes mellitus with complications 48 48 Pneumonia (except that caused by tuberculosis or STD) 39 50 106 112 307 Acute myocardial infarction 44 36 51 131 E Codes: Accident by Place of occurrence 39 29 54 122 E Codes: Motor vehicle Accident 38 38 Rehabilitation care, fitting of prostheses, and adjustment 47 72 41 160 Congestive heart failure; nonhypertensive 35 62 85 182 Fracture of neck of femur (hip) 35 99 104 238 Coronary atherosclerosis and other heart disease 35 35 E Codes: Fall 30 69 68 167 Septicemia (except in labor) 47 37 84 Urinary tract infections 54 42 96 Fluid and electrolyte disorders 47 47 Total Transfers 550 567 796 673 2586 Appendix E 1. STD is the acronym for Sexually Transmitted Disease. PATIENT DISTRIBUTION MAPS 2001-2004 Patient distribution data for each health care system in Delaware are displayed by ZCTA (Census Defined Zip Code Tabulation Area). Alfred I. duPont Hospital for Children Profile Introduction: Name General Background Accreditation Alfred I. duPont Hospital for Children Since our founding in 1940, the Alfred I. duPont Hospital for Children has served thousands of children from across the country and around the world. The hospital is a division of Nemours, which operates one of the nation's largest health systems devoted to pediatric patient care, teaching, and research. Located just outside of Wilmington, Delaware, on 300 acres of parkland, the hospital offers a remarkably beautiful and tranquil setting in which to heal. The Nemours Children's Clinic provides the physician services of the hospital at its main campus, and at pediatric primary and specialty care locations throughout Delaware, southeastern Pennsylvania, and southern New Jersey. Together the duPont Hospital and Nemours Children's Clinic are the academic partner of Thomas Jefferson University and Jefferson Medical College. Mission Statement: To provide leadership, institutions, and services to restore and improve the health of children through care and programs not readily available, with one high standard of quality and distinction regardless of the recipient's financial status. Ownership: Nemours (Jacksonville, Fla.) Medical Staff: Over 400 Nemours subspecialty physicians and surgeons Services Offered: The Nemours/Alfred I. duPont Hospital or Children offers all the specialties of pediatric medicine, surgery, and dentistry in a spacious, comfortable, and family-focused facility. Number of Employees: 2,700 Licensed Beds: Staffed Beds: 180 159 Location of Facilities: 1600 Rockland Road Wilmington, Delaware 19803 St. Francis Hospital Profile Introduction: Name General Background Accreditation St. Francis Healthcare Services The Sisters of St. Francis of Philadelphia established St. Francis Hospital in 1924. Today, St. Francis Hospital is a member of Catholic Health East, the largest Catholic healthcare system on the East Coast and operates under the identity of St. Francis Healthcare Services. In addition to the hospital, St. Francis Healthcare Services includes Franciscan Care Center at Brackenville, the Center of Hope and the North Wilmington Women’s Center. St. Francis Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. St. Francis Home Care is accredited by the Joint Commission on Accreditation of Healthcare Services, and the Family Practice Residency Program is accredited by the American Council on Graduate Medical Education. Mission Statement: Our Mission St. Francis Healthcare Services, a member of Catholic Health East, under the sponsorship of Hope ministries, seeks to be a compassionate, healing presence in the communities we serve. We continue in the tradition of our founders, the Sisters of St. Francis of Philadelphia. Our Vision Living out our core values, we will provide high quality holistic care. Our Core Values Reverence for each person We believe that each person is a manifestation of the sacredness of human life. Community We demonstrate our connectedness to each other through inclusive and compassionate relationships. Justice We advocate for a society in which all can realize their full potential and achieve the common good. Commitment to those who are poor We give priority to those whom society ignores. Stewardship We care for and strengthen the ministry and all resources entrusted to us. Courage We dare to take the risks our faith demands of us. Integrity We keep our word and are faithful to who we say we are. Ownership: Not for profit Catholic healthcare system Medical Staff: 682 medical staff members, 806 including retirees Services Offered: 24-Hour Emergency Services - Level IV Trauma Designation with fasttrack minor emergency care Home Care Services Imaging Services, including general x-rays, CT, nuclear medicine, ultrasound, MRI, R2 ImageChecker System (computerized detection unit that assists the radiologist in locating abnormalities depicted in mammograms) and vascular studies 20-bed, two-level Intensive Care Unit Inpatient Rehabilitation Bariatric Surgical Services Wound Care Services GI Lab Inpatient and Outpatient Cardiac Catheterization Lab Level II Neonatal Nursery Maternity and Family Birthplace Minimally Invasive Surgery Center Passport Health (travel medicine service) Skilled Nursing Facility Neurodiagnostics/Sleep Center Franciscan Care Center at Brackenville North Wilmington Women’s Center St. Francis Family Practice Center St. Francis Heart Center St. Francis OB/GYN Centers St. Francis Pain Center Women’s Center Number of Employees: 1,400 (SFH & Brackenville) Licensed Beds: Staffed Beds: 395 225 Location of Facilities: St. Francis Hospital, Wilmington, DE Franciscan Care Center at Brackenville, Hockessin, DE St. Francis Bariatric Surgery Center, Wilmington, DE St. Francis Family Practice Center, Wilmington, DE St. Francis Heart Center, Wilmington, DE St. Francis Home Care, Wilmington, DE St. Francis OB/GYN Center .. St. Francis Hospital, Wilmington, DE .. McBride/Heinle OB/GYN, Wilmington, DE .. North Wilmington Women’s Center, Wilmington, DE .. Henderson OB/GYN, Wilmington, DE St. Francis Pain Center, Wilmington, DE St. Francis Radiology .. St. Francis Hospital, Wilmington, DE St. Francis Rehabilitation .. Inpatient only – St. Francis Hospital, Wilmington, DE .. Cardiac Rehabilitation, Wilmington, DE St. Francis Wound Care Center, Wilmington, DE Center of Hope (providing medical care to all people – immigrants and citizens, insured and uninsured), Newark, DE Passport Health (travel medicine service), Wilmington and Newark, DE & West Chester, PA St. Clare Medical Outreach Program (providing medical care to the uninsured, in partnership with the Ministry of Caring), Wilmington, DE Tiny Steps (providing prenatal and postpartum care to low-income women) Wilmington (Family Practice Center) Christiana Care Hospital Profile Introduction: Name General Background Accreditation Christiana Care Health System Christiana Care Health System serves Delaware and neighboring areas of Pennsylvania, Maryland and New Jersey. Christiana Care offers a continuum of services-including in-and out-patient hospital-based care, home health care, preventive medicine and rehabilitation, diagnostic and imaging services, transitional and long-term care, and a commercial managed care health plan-in partnership with more than 1,300 community physicians, surgeons and dentists representing every medical practice and specialty. In the 2001 survey, Christiana Care was accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Mission Statement: Christiana Care Health System is dedicated to improving the health of all individuals in the communities we serve through health care services, education and research. Ownership: Christiana Care is a not-for-profit, private teaching health system operated by the Board of Directors of the Christiana Care Corporation. The Board represents a cross-section of business and community leaders. Medical Staff: Christiana Care's Medical-Dental Staff includes more than 1,300 community physicians, surgeons and dentists representing every medical practice and specialty. Services Offered: Christiana Hospital, Christiana Care's flagship tertiary care facility, is the state's designated Level I (highest capability) trauma center. The Christiana Hospital campus is also home to Christiana Care's: • Helen F. Graham Cancer Center – a state-of-the-art outpatient facility, which serves as headquarters for our regionally acclaimed cancer program. The Cancer Program emphasizes improving prevention and early detection and improving survival and quality-of-life. Designated by the National Cancer Institute as a community clinical oncology program, Christiana Care provides access to today’s most promising cancer research clinical trials. • Center for Heart and Vascular Health– the program’s comprehensive services include open heart surgery (more than 800 cardiovascular surgeries each year), diagnostic and interventional cardiac catheterization, dedicated electrophysiology lab, noninvasive studies, research, lipid program, rehabilitation and primary and secondary heart disease prevention. • Women's health program – one of the busiest (7,122 births a year), most advanced maternity services in the nation, including a Level III (highest capability) neonatal intensive care unit. The Eugene du Pont Preventive Medicine & Rehabilitation Institute features a full range of medically supervised preventive and alternative/complementary health services including nutrition and fitness, stress reduction and smoking cessation, adolescent pregnancy prevention, and special programs for arthritis, asthma, cancer, cardiovascular disease, diabetes weight management and osteoporosis. Wilmington Hospital – includes an inpatient rehabilitation facility, joint replacement center, outpatient surgical facility, psychiatry services, speech and hearing services and an accredited sleep disorders center. Number of Employees: 9,910 full and part-time, system-wide Licensed Beds: Staffed Beds Wilmington Hospital -- 291 Christiana Hospital -- 780 Riverside -- 108 Total Licensed Beds -- 1179 Wilmington and Christiana - 869 Location of Facilities: .. Wilmington Hospital, Wilmington, DE .. Christiana Hospital, Newark, DE .. Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington, DE .. Helen F. Graham Cancer Center, Newark, DE .. RiversideTransitional Care, Wilmington, DE .. Christiana Care Visiting Nurse Association, New Castle, DE .. Primary Care/Internal Medicine Offices .. Foulkstone Plaza, Wilmington, DE .. Stoney Batter Medical Pavilion, Wilmington, DE .. HealthcareCenter at Christiana, Newark, DE .. Springside Plaza, Glasgow, DE .. Middletown CareCenter, Middletown, DE .. Beiser Boulevard, Dover, DE Bayhealth Medical Center Hospital Profile Introduction: Name General Background Accreditation Bayhealth Medical Center Kent General Hospital, founded in 1927, and Milford Memorial Hospital, founded in 1907, will celebrate ten years as Bayhealth Medical Center in January 2007. The combined organization, Bayhealth Medical Center, is a not-for-profit health care facility that includes the St. Jones Center for Behavioral Health. Bayhealth is the second largest healthcare system in Delaware and is a member of the Premier Health Alliance. • Bayhealth – Kent General Hospital and Milford Memorial Hospital - Accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). • Cancer Programs - The American College of Surgeons Community Hospital Comprehensive Cancer Program • Diagnostic Imaging and Women’s Centers– ACR Mammography Accreditation, ACR Ultrasound Breast & Breast Biopsy Accreditation and ACR Ultrasound & Vascular Accreditation. • Laboratory - The American Association of Blood Banks, JCAHO – Pathology and Clinical Laboratory Services, and Certification by the Healthcare Financing Administration. • Home Care - Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). • St. Jones Center for Behavioral Health - Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). • Rehabilitation Services – Council for the Accreditation of Rehabilitation Facilities (CARF). Mission Statement: To improve the health status of all members of the communities of Bayhealth’s service area. Ownership: Bayhealth, Inc. is the non-profit and parent corporation of Bayhealth Medical Center, Inc. and six other corporate entities, including the Bayhealth Foundation. Medical Staff: The medical staff of Bayhealth totals 358 active, provisional active and courtesy staff – 95% of Bayhealth’s physicians are board certified or board-eligible. Services Offered: • Surgical Services .. Cardiovascular Surgery and Cardiac Intervention .. Major services include orthopedics, general and vascular surgery, ophthalmology, urology, gynecology and plastic surgery. .. Day Surgery Services .. Endoscopic Suite .. Incontinence Center .. Otolaryngology .. Thoracic • Diagnostic Imaging .. 64 Slice CT .. CT Angiography .. PET Scanning .. Magnetic Resonance Imaging .. Digital PACS (Picture Archiving Communications System) .. Magnetic Resonance Angiography .. Computerized Tomography .. Nuclear Medicine .. Digital Vascular Imaging .. Ultrasonography .. Low-dose Mammography .. General Radiography .. Fluoroscopy .. Stereotactic Breast Biopsy .. Bone densitometry .. Sleep Labs • Psychiatric Care .. Psychiatric care of adults and adolescents .. Substance abuse programs .. Adult inpatient, outpatient and day treatment programs .. Outward bound obstacle/endurance program • Critical Care .. Cardiovascular Surgical Intensive Care .. Intensive Care, Intermediate Care & Dialysis Units .. 26 all private monitored beds were recently added on the new 4th Floor Unit • Emergency Services .. 24-hour a day emergency services .. Kent General and Milford Memorial Emergency Departments are designated trauma centers • Obstetric and Pediatric Services .. The new Center for Women and Infants opened Summer 2005 at Kent General featuring 26 all private rooms, 10 delivery rooms, 15 neonatal intensive care beds, and a newborn nursery .. LDRP Suites at Milford Memorial .. Level II neonatal intensive care (KGH) .. Inpatient Pediatric Centers .. Ronald Room • Cancer Care Services .. Chemotherapy .. Radiation Therapy .. 3 – D imaging .. Prostate Seed Implants .. IMRT .. Clinical Trials • Rehabilitation Services .. Inpatient Rehabilitation Center (MMH) – CARF accredited .. Inpatient/Outpatient Physical and Occupational Therapy Services .. Certified Speech Pathologists and Audiologists .. Sports Medicine .. Aquatic Therapy .. Home Health Care • Community Related Services .. Planetree Affiliate .. Community based outpatient laboratory and diagnostic services .. Occupational Health Programs .. Consumer Health Education Programs .. Diabetes Care Centers .. Support Groups .. Free Health Screenings .. Health Fairs .. Guest Relations Program .. High School-based Wellness Centers at Brandywine, Milford, Smyrna, Caesar Rodney and Woodbridge. Number of Employees: 2,800 Licensed Beds: 439 Location of Facilities: - Kent General Hospital, Dover, DE - Milford Memorial Hospital, Milford, DE - Bayhealth Cardiovascular Surgical Associates, Dover, DE - WalkIn Medical Care, Dover, DE - WalkIn Medical Care, Modern Maturity Center, Dover, DE - WalkIn Medical Care, Milford, DE - WalkIn Medical Care, Middletown, DE - Cancer Center in Dover, Dover, DE - Cancer Centers at Kent, Dover, DE - Cancer Center at Milford, Milford, DE - Outpatient Rehabilitation Center, Dover, DE - Middletown Medical Center, Middletown, DE - Inpatient Rehabilitation Center, Milford, DE - Center for Women and Infants at Kent General, Dover, DE - Women’s Wellness & Resources Center, Milford, DE - Outpatient Services Center at Kent General, Dover - Outpatient Service Center at Milford Memorial, Milford - Smyrna Clayton Medical Services, Smyrna, DE - Harrington Outpatient Services Center, Harrington, DE - Milton Outpatient Services Center, Milton, DE Beebe Medical Center Hospital Profile Introduction: Name General Background Accreditation Beebe Medical Center, in conjunction with its Medical-Dental Staff, provides healthcare services in a variety of locations throughout eastern Sussex County. Beebe Medical Center Beebe Medical Center is a community hospital system offering a broad spectrum of services and facilities to serve people living in or visiting our service area. Beebe Medical Center – Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Beebe Home Health Agency – Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Lewes Convalescent Center – Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Cancer Program – The Commission on Cancer, the American College of Surgeons Beebe School of Nursing – National League for Nursing Vascular Laboratory – Intersocietal Commission for the Accreditation of Vascular Laboratories Laboratory – The College of American Pathologists; American Association of Blood Banks Mammography – The American College of Radiology Ultrasonography – The American College of Radiology Mission Statement: To encourage healthy living, prevent illness, and restore optimal health with the people residing, working, or visiting in the communities we serve. Ownership: Community owned, private, not-for-profit hospital, governed by a local Board of Directors Medical Staff: 187 Active Staff doctors serving a variety of medical specialties. Services Offered: .. Tunnell Cancer Center, offering comprehensive, hospitalbased diagnosis and treatment, including medical oncology, radiation oncology, and surgical oncology. .. Hastings HeartCare Center, offering comprehensive cardiac care, including cardiac catheterization, non-invasive diagnostic testing, cardiac rehabilitation, and preventive care. Interventional cardiology and cardiac surgery in the fall 2006 in affiliation with Christiana Care Health System. .. Baylis Rehabilitation Center offering physical therapy, occupational therapy, and speech therapy. .. Women's Health Pavilion .. Diagnostic imaging services including magnetic resonance imaging (MRI), computed tomography (CT), nuclear imaging, digital interventional radiology, ultrasonography, mammography, stereotactic breast biopsy, bone densitometry, fluoroscopy, and general radiography Specialized programs such as: .. Wound Care Center .. Sleep Disorders Center .. Integrative Health .. 24-hour Emergency Medicine Department in Lewes Level III Trauma Designation .. Millville Emergency Medicine Department (summer) .. Accredited Vascular Laboratory .. Inpatient and Outpatient surgery .. Home Health services .. Skilled nursing facility and Transitional Care (Lewes Convalescent Center) .. Beebe School of Nursing (RN to BSN option offered in conjunction with Wilmington College) .. High School-based Wellness Centers (Cape Henlopen, Indian River and Sussex Central High Schools) .. Open Heart Surgery in affiliation with Christiana Care Health Services, fall 2006 Number of Employees: 1,600 employees Licensed Beds: Staffed Beds: 158 – Beebe Medical Center 89 – Lewes Convalescent Center 128 – Beebe Medical Center Location of Facilities: Beebe Medical Center Lewes, DE Beebe Medical Foundation Lewes, DE Beebe Health Campus Route 24, quarter mile west of Route One Diagnostic Imaging Physical Therapy Walk-in lab, x-ray, EKG, and blood draw Beebe Physician Network Practices Lewes, DE (Lewes Pulmonary) Lewes, DE (Lewes Infectious Diseases) Beebe Imaging and Lab Centers Georgetown, DE Millsboro, DE Long Neck, DE (lab only) Millville, DE Beebe Emergency Services Lewes, DE Millville, DE (summer only) Gull House Adult Day Care Center Rehoboth Beach, DE Lewes Convalescent Center Lewes, DE Beebe Lab Express Lewes, DE Beebe Physical Therapy Millsboro, DE Millville, DE Wellness Centers Indian River High School Cape Henlopen High School Sussex Central High School Peach Tree Acres Assisted living facility for persons with brain and spinal cord injuries Nanticoke Memorial Hospital Profile Introduction: Name General Background Accreditation Nanticoke Memorial Hospital Nanticoke Memorial Hospital was originally incorporated in 1945 by a group of citizens concerned by the lack of health care facilities in western Sussex County. Over the years, involved citizens and a progressive administrative team have continued to direct the course of Nanticoke Memorial Hospital, and its affiliates, organized under the corporate title of Nanticoke Health Services. What started as a 32-bed hospital in 1952 has grown to include extended care, business services, outpatient services, cancer care services, medical centers across Sussex County Delaware, and a host of preventative medicine and health programs. Accreditation • Joint Commission on Accreditation of Healthcare Organizations • American Association of Blood Banks • Nuclear Regulatory Commission • American College on Radiology • Mammography Quality Standards Act Mission Statement: "We exist to positively impact our communities' quality of life through improved health status." Ownership: Nanticoke Health Services, Inc. is the non-profit and parent corporation of Nanticoke Memorial Hospital and four other corporate entities. Medical Staff: The medical staff of Nanticoke Memorial Hospital totals 139 active and consultant staff members. Services Offered: Medical Services • Major services include acute inpatient care comprised of cardiology, gastroenterology, infectious disease, neurology and pulmonology. • Nutrition Services • Cardiac Services including cardiac catherizations, echocardiography, pacemakers, stress testing and telemetry • Cancer Services including radiation therapy, chemotherapy and pain management Surgical Services • Major services include orthopedics, general and vascular surgery, ophthalmology, urology, gynecology, plastic/reconstructive surgery, bariatric (obesity) surgery, otolaryngology (ENT), thoracic, podiatry and laser • Day Surgery Services • Lithotripsy Diagnostic Services • General radiology • Fluoroscopy • Magnetic resonance imaging • Computerized tomography • Nuclear medicine • Ultrasound • Endoscopy suite • EEG • Sleep disorder studies • Mammography • Stereotactic breast biopsy Critical Care • Multidisciplinary intensive care and progressive care unit • Hemodialysis • Peritoneal dialysis Emergency Services • 24-hour emergency services • Level III Trauma Center Obstetric and Pediatric Services • Birthing suites • Ronald McDonald rooms Rehabilitation Services • Physical and occupational therapy • Speech pathology • Cardiac rehabilitation services • Enterostomal therapy • Positive Steps Fitness Center Community Related Services • Laboratory courier services • Consumer health education programs • Support groups • Health Screenings: cholesterol, blood sugar monitoring, prostate cancer screening, risk for stroke assessment, blood pressure checks • High school-based wellness centers • Nutrition counseling Number of Employees: 1100 Licensed Beds: 140 Hospital Beds 110 Extended Care Beds Location of Facilities: Acute Care Nanticoke Memorial Hospital, Seaford, DE Extended Care LifeCare at Lofland Park, Seaford, DE Off Campus Care Mid-Sussex Medical Center, Millsboro, DE Georgetown Medical Center Seaford Medical Center Laurel Family Practice Center Wellness Centers Seaford High School Wellness Center Laurel High School Wellness Center Delmar High School Wellness Center Business Services Nanticoke Occupational Health Services, Seaford, DE Practice Management Associates, Seaford, DE Small Wonders Child Care, Seaford, DE Affiliations • Clinical rotations with various schools in nursing, radiology, laboratory, and certified nursing assistant • Student intern program with Seaford and Laurel High School Patient Mix: Based on Discharges (FY05) Medicare % 42 Medicaid % 16 Others (Commercial & Self Pay) % 42 Based on Patient Days (FY05) Medicare % 61 Medicaid % 11 Others (Commercial & Self Pay) % 28 Uncompensated Care: Charity Care & Bad Debt at cost – (FY05) - $ 13,000,000 Definitions: Admission source - The source of the patient’s admission, e.g., emergency, another hospital, or long term care facility, which describes how the patient was admitted. Aggregate charges - The sum of all charges for all hospital stays. Body System – In this report, it represents the more generalized grouping of CCS categories that correspond with ICD-9 CM chapter headings. Clinical Classification System (CCS) – This refers to the classification system developed at the Agency for Healthcare Research and Quality (AHRQ) used to aggregate ICD-9-CM codes into broader, homogeneous groups. In this report, the 2006 version of the single-level diagnosis classification scheme is used for both diagnoses and procedures. Because CCS codes are based on ICD-9-CM diagnoses, they can be mapped to ICD-9-CM chapter headings. Data in this report are presented by both CCS diagnoses and by ICD-9-CM chapters. For more information, see http://www.ahrq.gov/data/hcup/. Discharge - A completed inpatient hospitalization. A hospitalization may be completed by death or by releasing the patient to his or her home, a long-term care facility, another hospital, or if the patient leaves against medical advice. Discharge Status - The disposition of a patient at discharge from the hospital into one of the following categories: .. Home or routine discharge - patient returned to previous place of residence after discharge from the hospital. .. Long-term care facility - patient entered a nursing home including skilled nursing facilities, .. extended care facilities, custodial care facilities, or other long term care placement upon discharge from the hospital. .. Another short-term hospital - patient transferred to another short-term hospital at discharge, including short-term maternity hospitals. .. Against medical advice (AMA) – patient left the hospital against medical advice. .. Expired - patient who died during the inpatient stay. .. Home health care – patient discharge to home where care is provided by a home health care agency for the purpose of promoting, maintaining, or restoring health, or for minimizing the effects of disability and illness, including terminal illness. .. Unknown - patient whose status was not entered. Expected source of payment - The principal expected source of payment for the hospitalization. .. Medicare - The health insurance program for the aged and disabled administered by the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration). .. Medicaid - A jointly funded Federal-State health insurance program providing medical care to those unable to afford it. .. Worker’s compensation - A State or municipal disability insurance or industrial accident insurance. .. Private health insurance- Includes HMO/PPO, Blue Cross/Blue Shield, and other private. o HMO/PPO - Any health maintenance organization (HMO) or preferred provider organization (PPO) sponsored by consumers, communities, physicians, or hospitals. o Blue Cross/Blue Shield and other private - A private insurance plan not specified as an HMO/PPO. This includes Blue Cross/Blue Shield plans, medical coverage provided by life insurance companies, casualty insurance companies, health insurance companies, and independent plans such as employer/union-sponsored plans and/or self-funded plans (partial or total). .. Self-pay - The majority of the costs for the hospitalization were expected to be paid by the patient, spouse, family, or next-of-kin. .. Other government- Other Federal, State, or local government other than worker’s compensation, Medicare, and Medicaid not listed separately including casualty insurance paid by the State, Federal or State medical research grant. Technical Notes .. No charge- Patients admitted with the understanding that payment would not be expected because the medical services are free, e.g., charity patients or research or teaching patients. .. Other and not stated- Other Hospital charges - The amount the hospital charged for the entire hospital stay. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - The official system of assigning codes to diagnoses and procedures associated with hospital stays in the United States. The ICD-9-CM is based on and is compatible with the World Health Organization’s International Classification of Diseases, Ninth Revision. ICD-9-CM is divided into 17 chapters and 2 supplemental classifications. Diagnoses are grouped under chapters arranged primarily by body system. In addition, there are chapters for infectious and parasitic diseases; neoplasms; endocrine, metabolic, and nutritional diseases; mental disorders; complications of pregnancy, childbirth and puerperium; certain conditions originating in the perinatal period; congenital anomalies; and symptoms, signs and ill-defined conditions. The two supplemental classifications are for factors influencing health status and contact with health services and classification of external causes of injury and poisoning. More information can be found online at www.cdc.gov/nchs/icd9.htm. Length of stay - The number of nights the patient remained in the hospital for this stay. Liveborn – The term for the hospitalization that results from an infant being born in the hospital, also referred to as newborn. They are identified by a specific range of ICD-9 CM codes on the discharge record. Records of infants born in the hospital are separate and distinct from the mothers' discharge records, so excluding liveborn infants does not remove the mother's discharge data from the analysis. Long-term care facility – A facility that provides a specific level of personal or medical care or supervision to residents. Types of long-term care facilities include licensed nursing homes, skilled nursing facilities (SNF), intermediate care facilities (ICF), hospice medical facilities, and other health care institutions, such as institutions for the mentally retarded and developmentally disabled. Mean length of stay - Average length of stay for discharges. It is calculated by dividing the total number of days of care by the number of discharges. Obstetric – The branch of care that deals with the management of pregnancy, labor, and the puerperium. Puerperium – The period or state of confinement after labor and giving birth. Primary diagnosis - The diagnosis chiefly responsible for the admission of the patient to the hospital; it is the first-listed diagnosis specified on the discharge summary of the medical record. Rate - A rate is a measure of an event, disease, or condition in relation to a unit of population for a specified time. For example, the four-year average discharge rate per 10,000 population is calculated as follows: (Four-year total number of discharges / Four-year total population) *10,000 Short-stay Hospitals - A short-stay hospital is one where the average length of stay is less than 30 days. Due to its status as a long-term care facility, Select Specialty in Wilmington is excluded from the data presented in this report. Select Specialty is associated with St. Francis hospital. Uninsured patients – A term for those patients whose primary payer is listed as self-pay. Technical Notes CMS National Health Expenditure Data. Accessed 3/24/2006. http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPag e DeFrances CJ, Hall MJ, Podogornik MN. 2003 National Hospital Discharge Survey. Advance data from vital and health statistics; no 359. Hyattsville, MD: National Center for Health Statistics. 2005. DHSC Hospital Discharge Summary Report, 1992-2000. Division of Public Health, Delaware Health and Social Services, Jan 2002. Doc. No. 350520-020106. Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS), 2006. U.S. Agency for Healthcare Research and Quality. Available: http://www.ahrq.gov/data/hcup/ccs.htm#download. HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/HCUPnet/ Merrill CT, Elixhauser A. Hospitalization in the United States, 2002. Rockville, MD: Agency for Healthcare Research and Quality, 2005. HCUP Fact Book No. 6. AHRW Publication No. 05-0056. ISBN 1-58763-217-9. National Center for Health Statistics. Health, United States, 2005 with Chartbook on Trends in the Health of Americans. Hyattsville, Maryland: 2005. National Center for Health Statistics. National Trends in Injury Hospitalizations 1979-2001. Hyattsville, Maryland: 2005. National Health Expenditure Accounts: Definitions, Sources, and Methods Used in the NHEA 2004. http://www.cms.hhs.gov/NationalHealthExpendData/downloads/dsm-04.pdf The National Association of Health Data Organizations. 2005. Public Health Data Dissemination Guidelines: NAHDO Working Technical Paper Series. References