Study Guide Healthcare Statistics By Jacqueline K. Wilson, RHIA About the Author Jacqueline K. Wilson is a Registered Health Information Administrator (RHIA) who has more than ten years of experience consulting, writing, and teaching in the health care industry. She's a professional writer who has authored training manuals, study guides/materials, online courses, and articles on a variety of topics. In addition, Ms. Wilson develops curricula and teaches both traditional and online college courses in health information technology, anatomy and medical terminology, and standards in health care. In 2005, she received the distinguished national award of being included in Who's Who Among America's Teachers. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text should not be regarded as affecting the validity of any trademark or service mark. Copyright 2012 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America 11/3/14 1 LESSON ASSIGNMENTS 5 LESSON 1: UNDERSTANDING HEALTHCARE STATISTICS 7 LESSON 2: COMPILING AND PRESENTING HEALTHCARE STATISTICS 25 RESEARCH PROJECT 51 SELF-CHECK ANSWERS 57 Contents INSTRUCTIONS TO STUDENTS iii INTRODUCTION No matter what career you choose within the field of health information management, you'll likely deal with statistics regularly. Therefore, this course provides an overview of the basic types of healthcare statistics and describes how this information is used within the healthcare industry. OBJECTIVES When you complete this course, you'll be able to n Apply basic statistical principles n Define data elements for institute-wide collection n Calculate and report institutional healthcare quality indicators n Calculate routine institutional statistics, such as length of stay, death rates, autopsy rates, occupancy rates, bed turnover rates, and morbidities n Prepare and present research data n Distinguish between descriptive statistics and inferential statistics n Explain percentage of occupancy n Analyze patient data with quality improvement tools n Design reports using database information n Perform statistical analysis of patient information n Participate in committees utilizing health record information Instructions Statistics are used in a wide variety of fields, including business, academics, science, government, and of course, healthcare. Individuals and organizations use statistics to interpret data and make informed decisions based on those interpretations. As you've probably guessed, statistics play a very important role in the healthcare field, since they have a great impact on the types and quality of healthcare services offered to patients. 1 YOUR TEXTBOOK Your textbook, Calculating and Reporting Healthcare Statistics, Fourth Edition, by Loretta A. Horton, contains the material on which you'll be tested. You need to become familiar with this textbook prior to beginning your course. Begin by reading the contents on page iii. This will give you an overview of the entire textbook. Appendix A begins on page 263 and lists all the statistical formulas discussed in the textbook, along with the corresponding page number references. Appendix B begins on page 271 and is a complete glossary of healthcare services and statistical terms. Following Appendix C is an index on page 323. YOUR STUDY GUIDE This study guide is intended to be used as a supplement to the textbook. Therefore, it shouldn't replace your textbook reading. The study guide is designed to follow the topics in your textbook, so it's arranged in an outline format based on the textbook headings and subheadings. Each assignment in the study guide lists the page numbers of the corresponding assignment in the textbook. When you approach each assignment, you should first read the information in the study guide and then study the corresponding assignment in the textbook. The study guide provides an overview of the information in the textbook and highlights important passages that you should examine carefully. If you don't understand a topic or section in the textbook, take the time to reread the information. Because much of the material discussed in this course will be new to you, it's natural that you may need to read some sections more than once. Throughout your study guide, you'll come across small sections of text that are set apart from the main text material. These sidebars are included to provide additional information, to suggest readings, and to clarify or emphasize important points. Whenever you see one of these sidebars, refer to the corresponding passage in the textbook to be sure you fully understand the material presented. 2 Instructions to Students COURSE MATERIALS This course includes the following materials: 1. This study guide, which contains an introduction to your course, plus n A lesson assignments page with a schedule of study assignments as well as exams for the two lessons you'll complete during this course n Assignment lessons emphasizing the main points in the textbook n Self-checks and answers to help you assess your understanding of the material 2. Your course textbook, Calculating and Reporting Healthcare Statistics, which contains the assignment reading material A STUDY PLAN As mentioned, you'll use two texts for this course: Calculating and Reporting Healthcare Statistics and this study guide. For each lesson in this course, follow these steps: Step 1: Carefully note the pages where your assigned reading begins and ends. These pages are identified in the Lesson Assignments section of this study guide. Step 2: Skim through the assigned pages (in both the study guide and the textbook) to get a general idea of their content. Try to develop an overall perspective on the concepts and skills being taught and practiced in each assignment. Step 3: Carefully read through the study guide's assigned pages. These pages contain background information about the material covered in the textbook. Step 4: Study the assigned pages in your textbook, and take notes on any important points or terms that you feel are especially significant. Instructions to Students 3 4 Step 5: Complete the self-check exercises at the end of each assignment in the study guide. You don't have to send any of the answers to the school. These exercises are intended for your personal use in evaluating and directing your progress. Step 6: When you feel you've mastered all of the material presented in each assignment, complete the examination at the end of each lesson. Instructions to Students For: Read in the study guide: Read in your textbook: Assignment 1 Pages 7-10 Pages 1-7 Assignment 2 Page 11 Pages 9-20 Assignment 3 Pages 12-14 Pages 23-39 Assignment 4 Pages 14-15 Pages 43-54 Assignment 5 Pages 15-18 Pages 57-67 Assignment 6 Pages 18-19 Pages 71-91 Assignment 7 Pages 20-21 Pages 95-109 Assignment 8 Pages 21-23 Pages 115-133 Examination 409411 Material in Lesson 1 Lesson 2: Compiling and Presenting Healthcare Statistics For: Read in the study guide: Read in your textbook: Assignment 9 Pages 25-29 Pages 137-165 Assignment 10 Pages 30-35 No textbook reading Assignment 11 Pages 35-42 Pages 171-191 Assignment 12 Pages 42-45 Pages 195-225 Assignment 13 Pages 45-47 Pages 249-257 Assignment 14 Pages 48-50 Pages 227-245 Examination 409412 Material in Lesson 2 Research Project 40941300 Assignments Lesson 1: Understanding Healthcare Statistics 5 NOTES 6 Lesson Assignments INTRODUCTION Healthcare statistics come from a number of different sources, and they're used by many organizations within the healthcare field. As you'll learn in this lesson, your role as a health information management professional is to familiarize yourself with the types of statistics available and to use that information to better serve the patients within your healthcare facility. ASSIGNMENT 1: INTRODUCTION TO HEALTHCARE STATISTICS Read through the following material in your study guide. After you've read the study guide commentary, read pages 1-7 of your textbook, Calculating and Reporting Healthcare Statistics. The Importance of Healthcare Statistics Statistics play an important role in all aspects of health information management. They provide information that's essential to the quality, prioritization, effectiveness, cost, and reimbursement of patient care. For example, population statistics inform healthcare facilities about the types of services needed for patients in their area. Statistics from patient surveys help healthcare facilities improve their levels of service. Statistics from the Centers for Disease Control and Prevention (CDC) provide important information about contagious diseases and how they're controlled. Lesson 1 Understanding Healthcare Statistics 7 Nationwide, healthcare statistics allow facilities to identify trends and collect information regarding different groups within the population. According to the National Center for Health Statistics (NCHS), healthcare statistics allow facilities to n Document the health status of the population and of important subgroups n Identify disparities in health status and the use of healthcare by race, ethnicity, socioeconomic status, religion, and other population characteristics n Monitor trends in health status and healthcare delivery n Identify health problems n Support biomedical and health services research n Provide information regarding changes to public policies and programs n Evaluate the impact of health policies and programs Who Uses Healthcare Statistics? Each department within a healthcare facility relies on information from healthcare statistics. In a hospital, for example, administrators use healthcare statistics to analyze the costs of patient care and to create opportunities to introduce costsaving measures. Nurses use statistics to keep track of the types of patients they treat and the frequency with which they treat them. These statistics help nurses with supply orders and staff schedules. The use of healthcare statistics isn't limited to patient care facilities. For example, government agencies maintain healthcare statistics to determine which coverage services are needed and to identify specific areas of outbreak within the population. National registries, such as cancer registries, collect information about the available treatments and survival rates for diseases. This information affects federal funding for research and vaccine development. 8 Healthcare Statistics Your Role in Healthcare Statistics Gathering, maintaining, and storing information is an important role for health information management (HIM) professionals. According to Mervat Abdelhak, the president of the American Health Information Management Association (AHIMA), \"As the healthcare industry moves further into the information age, the role of the HIM professional is becoming even more critical. The move from paper to electronic health records will help doctors make important healthcare decisions on a real-time basis, but these decisions will rely on secure access to clear, concise, accurate, and easy-to-understand information.\" As a health information management professional, you're required to gather and analyze healthcare statistics. You may be responsible for reporting on a variety of statistics needed by your facility and by outside organizations. Most of the information you'll gather will come from the ICD-9-CM and CPT coding manuals. Other statistical information you may be responsible for as an HIM professional includes data related to n Birth and death records n Health records n Interview surveys n Cancer rates n Poisonings n Accidents n DRG case mixes n Transcription errors Types of Statistics As your textbook describes, the two main types of statistics are descriptive statistics and inferential statistics. Descriptive statistics summarize and describe a collection of data. Inferential statistics identify patterns in seemingly random Lesson 1 9 data and draw conclusions based on that information. They also help people make observations about the processes or population being studied. Inferential statistics are derived from a random sample of a particular population or a random process that's observed over a finite period of time. These statistics are based on probability and include the following techniques to draw conclusions from data: n Point estimation n Interval estimation n Hypothesis testing These techniques will be discussed in depth later in this course. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 1. Self-Check 1 At the end of each section of Healthcare Statistics, you'll be asked to pause and check your understanding of what you've just read by completing a \"Self-Check\" exercise. Answering these questions will help you review what you've studied so far. Please complete SelfCheck 1 now. Complete the Chapter 1 Test on pages 7 and 8 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 57. 10 Healthcare Statistics ASSIGNMENT 2: MATHEMATICAL STATISTICS REVIEW Read through the following material in your study guide. After you've read the study guide commentary, read pages 9-20 of your textbook, Calculating and Reporting Healthcare Statistics. Chapter 2 in your textbook serves as a review of the basic mathematical principles used in statistics. You should be familiar with each of these processes. Be sure to review the entire chapter to gain a thorough understanding of each of the following mathematical expressions: n Fractions n Quotients n Rounded numbers n Percentages n Ratios n Rates n Averages Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 2. Self-Check 2 Complete the Chapter 2 Test on pages 20-22 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 57. Lesson 1 11 ASSIGNMENT 3: PATIENT CENSUS DATA Read through the following material in your study guide. After you've read the study guide commentary, read pages 23-39 of your textbook, Calculating and Reporting Healthcare Statistics. Introduction to Patient Census Data An inpatient census reports the number of patients present in a healthcare facility during a specified period of time. Inpatients are classified as those patients who receive room, board, food, and care for a period of 24 hours or more. A daily census is generally calculated from midnight on one night to midnight the next night. To calculate census statistics, you must completely understand census terminology. 12 n A complete master census shows the number of patients admitted, discharged, and transferred each day. It's also referred to as the total hospital census. n A daily inpatient census shows the number of inpatients present on each unit during the census-taking time each day. This census includes inpatients who were admitted after the previous day's census and those discharged prior to the next day's census. n An inpatient service day denotes the services received by one inpatient during a 24-hour period. An inpatient service day is also referred to as a patient day, an inpatient day, a bed occupancy day, and a census day. n A total inpatient service day is the sum of all inpatient service days in a given period. Healthcare Statistics Calculating Inpatient Service Days As your textbook discusses, the calculation of inpatient service days takes place between midnight one night and midnight the next night. During this 24-hour period, the following information is recorded: n The number of patients admitted n The number of patients discharged (including deaths) n The number of intrahospital transfers (patients transferred from one unit in the hospital to another) Note that adults and children are reported separately from newborns because newborn statistics can skew information, since the maintenance costs of newborns differs from the maintenance costs of other patients. Newborns are counted as inpatients only if they're born at home or on the way to the hospital. Calculating an Average Daily Census Review the formulas and examples for calculating inpatient service days on pages 29-31 of your textbook. An average daily census is the mean number of hospital inpatients present each day for a specific period of time. A mean is calculated by dividing the sum of a set of terms by the number of terms. A mean is also known as an average. An average is based on a specific time period, generally the number of days in the month in question. Several variations of the average daily census are reported within a healthcare setting: n Average daily inpatient censusthe average number of inpatients present each day in a given period n Average daily newborn censusthe average number of newborns present each day in a given period n Average daily census for a patient care unitthe average number of inpatients in a specified care unit in a given period Lesson 1 13 Be sure to review the formulas for calculating the average daily inpatient census, the average daily newborn census, and the average daily census for a patient care unit on pages 38-39 of your textbook. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 3. Self-Check 3 Complete the Chapter 3 Test on pages 41 and 42 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 58. ASSIGNMENT 4: PERCENTAGE OF OCCUPANCY Read through the following material in your study guide. After you've read the study guide commentary, read pages 43-54 of your textbook, Calculating and Reporting Healthcare Statistics. The percentage of occupancy refers to the official percentage of beds occupied by inpatients in a given period. The percentage of occupancy is also referred to as the inpatient bed occupancy rate. Healthcare administrators are often very interested in this percentage because, in general, the greater the occupancy rate, the higher the revenues for the facility. As your textbook discusses, each healthcare facility is licensed for a specific number of beds based on certain factors, such as facility type and staffing needs. Each bed included in the inpatient bed occupancy rate must be ready for patient care and staffed for use. 14 Healthcare Statistics The following factors either determine or affect occupancy rates: n Bed count days n Bed occupancy ratios/percentages n Changes in bed count n Newborn occupancy ratios n Bed turnover rates Be sure to study each of these formulas on pages 45-53 of your textbook. Once you feel comfortable with the material covered in your textbook and study guide, complete SelfCheck 4. Self-Check 4 Complete the Chapter 4 Test on pages 54-56 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 59. ASSIGNMENT 5: LENGTH OF STAY Read through the following material in your study guide. After you've read the study guide commentary, read pages 57-67 of your textbook, Calculating and Reporting Healthcare Statistics. Introduction to Length of Stay Length of stay (LOS) refers to the total number of patient days for an inpatient stay. For each patient that's discharged from the hospital, a length of stay is calculated. As your textbook discusses, the length of stay is often reviewed to determine if Lesson 1 15 services are over- or underutilized. Generally speaking, the longer the length of stay for a patient, the more resources are used. As a result, reimbursement to a healthcare facility may not be enough to cover the costs of overused resources. As you can imagine, hospital managers and administrators are very interested in length-of-stay data. Calculating Length of Stay To calculate length of stay, subtract the date of admission from the date of discharge. If a patient is admitted during one month and discharged during another, this formula can't be used. To adjust for a patient admitted and discharged during different months, subtract the date of admission from the total number of days in that month, and then add the number of days in the new month. For example, the length of stay for a patient admitted on December 25 and released on January 2 is calculated as follows: (December 31 - December 25) + 2 days in January = 8 days for LOS Partial Days Partial days aren't reported as fractions. If a patient is admitted and discharged on the same day (even if he or she dies), that day is counted as an entire day because the patient used resources. For example, if a patient is admitted at 8:00 A.M. on February 1 and dies at 3:00 P.M. on the same day, February 1 is still reported as one day for LOS. Total Length of Stay Total length of stay is sometimes referred to as total discharge days. The total length of stay is used to determine the total days for a certain group of inpatients during a specific period. The total length of stay is calculated by adding the lengths of stay for all patients discharged during a given period of time. 16 Healthcare Statistics Let's consider an example. Suppose three patients are in an intensive care unit on March 15. The length of stay for each patient is as follows: Patient A: 5 LOS Patient B: 3 LOS Patient C: 4 LOS To calculate the total length of stay, add together the length of stay for each of the three patients. 5 + 3 + 4 = 12 The total length of stay for March 15 is 12. Average Length of Stay Average length of stay, or ALOS, refers to the mean length of stay for hospital inpatients discharged during a specified period of time. The formula for calculating the average length of stay is as follows: Total length of stay for a given time period Total number of discharges (including deaths) for the same period If we continue with the previous example, the ALOS for three patients discharged from the ICU on March 15 is 4 (12 3 = 4). Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 5. Lesson 1 Newborns are calculated separately. Review the formula for average newborn length of stay on page 64 of your textbook. 17 Self-Check 5 Complete Exercise 5.2 on page 59, Exercise 5.5 on pages 63-64, and Exercise 5.7 on pages 66-67 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 61. ASSIGNMENT 6: MORTALITY RATES Read through the following material in your study guide. After you've read the study guide commentary, read pages 71-91 of your textbook, Calculating and Reporting Healthcare Statistics. Mortality is the incidence of death in a specified population. In a healthcare facility, the death rate, also known as the mortality rate, reflects the inpatient discharges that end in death. The hospital death rate, or gross death rate, is the number of inpatient deaths for a specific period of time divided by the total number of discharges (live discharges and deaths) during the same period. You may wonder why we need to track and report information about hospital deaths. As your textbook discusses, death rate statistics are reported because they help us to 18 n Isolate items that cause death or increase death rates, such as handguns and motorcycles n Bring attention to causes, such as campaigns for heart disease and cancer research n Understand causes of death in certain populations Healthcare Statistics n Plan for health services n Improve patients' quality of care The following death rates are calculated within healthcare organizations: n Hospital death rates (or gross death rates) n Net death rates (or institutional death rates) n Postoperative death rates (or surgical death rates) n Anesthesia death rates n Maternal death rates n Newborn mortality rates n Fetal death rates n Cancer mortality rates Be sure to thoroughly review each of the mortality rate formulas in Chapter 6. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 6. Self-Check 6 Complete the Chapter 6 Test on pages 92-94 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 62. Lesson 1 19 ASSIGNMENT 7: AUTOPSY RATES Read through the following material in your study guide. After you've read the study guide commentary, read pages 95-109 of your textbook, Calculating and Reporting Healthcare Statistics. Understanding Hospital Autopsies An autopsy, also referred to as a necropsy and postmortem examination, is an examination of a dead body to determine the cause of death. Two kinds of autopsies are generally performed: 1. A hospital inpatient autopsy is performed on an inpatient who dies during a hospital stay. 2. A hospital autopsy is performed on a previous patient who wasn't in the hospital at the time of death. Healthcare facilities typically report the following autopsy rates: Review each of the autopsy rate formulas discussed in Chapter 7. n Gross autopsy rate n Net autopsy rate n Adjusted hospital autopsy rate n Newborn autopsy rate n Fetal autopsy rate Newborn Autopsy Rates versus Fetal Autopsy Rates It's important to distinguish newborn autopsy rates from fetal autopsy rates, since the two are sometimes confused. Newborn autopsy rates are derived from the number of autopsies performed on newborn infants. Fetal autopsy rates are derived from the number of autopsies performed on stillborn infants who are classified as either intermediate or late fetal deaths. As in other statistical computations, newborn autopsy rates are calculated separately from other inpatient autopsies. 20 Healthcare Statistics Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 7. Self-Check 7 Complete the Chapter 7 Test on pages 109-113 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 64. ASSIGNMENT 8: MORBIDITY RATES Read through the following material in your study guide. After you've read the study guide commentary, read pages 115-133 of your textbook, Calculating and Reporting Healthcare Statistics. Understanding Morbidity Morbidity is the state of being ill or diseased. It includes any illness, injury, or abnormal health problem. In statistical calculations, morbidity generally refers to the number of cases of disease in relation to a specific issue. It's important to note the distinction between morbidity rates and mortality rates, since they're sometimes confused within the healthcare community. Recall that mortality rate refers to the incidence of death within a specified population; morbidity rate refers to the incidence of illness. Misinterpreting morbidity rates as mortality rates can result in a huge misrepresentation of data. Lesson 1 21 Review the formulas for morbidity rates on pages 116-117 of your textbook. The most common hospital morbidities are nosocomial infections, or infections that patients acquire during a hospital stay. Nosocomial infections can be contracted in a number of ways. For example, patients may acquire a nosocomial infection from a healthcare provider who doesn't wash his or her hands properly or from an adverse reaction to the insertion of an intravenous tube. Other common morbidities are postoperative infections, which occur in patients who recently underwent surgery or another similar procedure. Both nosocomial infection rates and postoperative infection rates are reported as percentages. Miscellaneous Rates Several other miscellaneous statistics are reported by healthcare facilities, including Cesarean-section (C-section) rates and consultation rates. C-section rates reflect the percentage of C-sections (deliveries via abdominal incision) compared to the percentage of vaginal or spontaneous deliveries. C-section rates are often tracked due to concerns of adverse reactions to the mother and child and because of the costs associated with the procedure. Review the formulas for calculating C-section rates and consultation rates on pages 124-127 of your textbook. 22 Consultation rates reflect the percentage of opinions or consultations requested by one healthcare professional to another. For example, a family physician may request a consult from a podiatrist if his or her patient is experiencing a specific foot problem, like a heel spur. The consultant typically prepares a consultation report that consists of his or her opinion of the patient's condition and recommendations for treatment. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 8. When you're finished, proceed to your first examination. Healthcare Statistics Self-Check 8 Complete the Chapter 8 Test on pages 133-135 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 66. Lesson 1 23 NOTES 24 Healthcare Statistics INTRODUCTION Most of the statistical information gathered and reported within a health information management department deals with the business aspects of a facility, not the clinical aspects. As an HIM professional, you're responsible for calculating, compiling, and presenting the business statistics in your facility. In this lesson, you'll learn how to calculate employee compensation costs, unit labor costs, productivity levels, staffing levels, and budgets. You'll also learn how to verify statistical reports, maintain and update spreadsheets, conduct research for statistical reporting purposes, and prepare data for presentation. ASSIGNMENT 9: THE HIM DEPARTMENT AND STATISTICS Read through the following material in your study guide. After you've read the study guide commentary, read pages 137-165 of your textbook, Calculating and Reporting Healthcare Statistics. Employee Compensation and Unit Labor Costs As you can imagine, it's important for health information managers to track the costs associated with the productivity of staff members within a facility. One way HIM managers can do this is by keeping track of employee compensation and unit labor costs. Employee compensation refers to the amount of money an employee is paid. In some cases, employees are paid on an hourly basis. Other times, they're paid an annual salary. To calculate the annual compensation for an individual Lesson 2 Compiling and Presenting Healthcare Statistics 25 employee, you must consider the number of hours the employee works per year, the amount he or she is paid per hour, and the percentage of benefits he or she receives. Unit labor costs are the costs of labor per unit of output. These costs are calculated by dividing an employee's annual compensation by his or her annual productivity. Unit labor costs rise when compensation and benefits rise faster than labor productivity, so it's important to keep track of this information. Other Labor Unit Costs Review the formulas for calculating employee compensation and unit labor costs on pages 138-141 of your textbook. As you can imagine, additional labor unit costs are calculated within a health information management department. Some of these costs are associated with the amount of time staff members spend maintaining patient health records. Such maintenance responsibilities include n Chart pulling n Record scanning n E-mailing n Filing loose papers Technological advancements greatly impact health record maintenance costs. For example, many facilities now store patient records electronically, reducing the costs associated with paper chart retrievals. Yet as patients increasingly use e-mail to communicate with healthcare providers, the costs associated with maintaining e-mail systems and answering patient e-mails also increase. Productivity Just as important as the labor unit costs associated with the HIM department is the productivity of each staff member. Productivity is the ability to yield results, benefits, or profits. Each area of the HIM department has a different standard of productivity. For example, a transcriptionist's productivity is based on the number of reports he or she accurately transcribes 26 Healthcare Statistics within a specific period, while a coder's productivity is based on the number of records he or she accurately codes within a specific period. Review the productivity formulas on pages 147-148 of your textbook. Staffing Levels Statistics regarding labor costs and productivity levels help facilities determine how many staff members are needed to complete the work within the HIM department. To calculate staffing requirements, HIM professionals must consider the current and future staffing needs within the department. Outpatient facilities typically determine staff levels by dividing the number of patient encounters by the expected productivity of the department. Hospitals often determine staff levels based on the number of patients discharged from the facility. Review the staffing formulas on pages 148-149 of your textbook. Budgets All of the costs within a facility are considered in the creation of a budget. A budget is a plan that lists the amount of money a facility will spend and the amount it will record as profit within a specific period of time. Your textbook discusses two different types of budgets: n An operational budget, or operating budget, is an annual budget that estimates the total value of resources required for the operation of the facility, including reimbursable work and services for other facilities. It also includes estimates of workload in terms of the total work units identified by cost accounts. n A capital budget is a plan to finance long-term items and fixed assets, such as facilities and equipment. During capital budgeting, the HIM manager decides whether or not to invest in specific capital projects or assets. Since capital budget items are generally costly, an HIM manager must consider whether or not the project will last for more than a year and produce a favorable return on investment (ROI). For example, if a coding department Lesson 2 27 needs five new computers and printers, an HIM professional must calculate the return on investment and payback period for the capital budget. Verification of Statistical Reports Review the formulas for operational and capital budgets on pages 152-155 of your textbook. Another part of the job of an HIM professional is to verify the statistical reports produced by the computer system in a healthcare facility. Because only certain information can be entered into the system for certain reports, manual verification and calculation of computer-generated reports may be necessary. An HIM department may be responsible for verification and manual calculation of the following computer-generated hospital reports: n Discharge reports n Financial statistical reports n Readmission rate reports n Case-mix index reports You may wonder why the HIM department is responsible for verifying and calculating information from financial reports. Remember that an HIM department is responsible for coding patient records, and coding is directly related to reimbursement for the hospital. Therefore, the HIM department plays a major role in reporting and verifying certain types of hospital financial information. Spreadsheets Review the ALOS verification example on page 155 of your textbook and the case-mix formula on page 158 of your textbook. 28 A final requirement of an HIM professional is to create, maintain, and update spreadsheets for the facility. Spreadsheets are computerized programs that automatically perform calculations based on information that's manually entered into the program. (Although many different spreadsheet programs are available, you may already be familiar with one you've used at school or work, such as Microsoft Excel.) For example, it may be necessary for you to extract information from computer- Healthcare Statistics generated hospital reports and enter it into a spreadsheet to track certain information for your department or area. The spreadsheets will help you create charts, graphs, and diagrams that can be presented at meetings. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 9. Self-Check 9 Complete the Chapter 9 Test on pages 165-169 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 67. Lesson 2 29 ASSIGNMENT 10: INFORMATION SOURCES FOR HEALTHCARE STATISTICS Read through the following material in your study guide. Note that while there's no textbook reading for this assignment, you're still responsible for the material covered here. Introduction to the Benchmarking Process Members of an HIM department are often responsible for benchmarking within their facility. Benchmarking is the process of comparing rate historical data with another specific data set to analyze current information and project information for the future. For example, HIM professionals in a hospital may want to compare the average length of stay for C-section mothers and babies to the average length of stay for the same group nationwide. This comparison helps HIM professionals determine whether their facility uses more or less resources than other facilities across the nation. Such a comparison can also help identify and correct problems within the facility related to the care and services provided to this group of patients. HIM professionals obtain information for the benchmarking process from a number of sources of healthcare statistics. We'll discuss each of these sources and their role in healthcare statistics in the next few sections. Centers for Disease Control and Prevention As part of the Department of Health and Human Services, the Centers for Disease Control and Prevention, or CDC, is committed to public health efforts that help to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. In addition, the CDC provides a large amount of data and 30 Healthcare Statistics statistical information that's compiled from worldwide research findings. You can visit the CDC Web site at http://www.cdc.gov/. As an HIM professional, you may occasionally need to rely on information and resources compiled by the CDC for statistical reporting purposes. These helpful resources include n Cancer Surveillance, Epidemiology, and End Results (SEER)Statistics on new cancer cases grouped by age, gender, race, year, state, county, or ICD-9-CM code (http://seer.cancer.gov/) n Fatality Analysis Reporting System (FARS)Information on deaths caused by traffic accidents (http://www-fars.nhtsa.dot.gov/) n DATA2020: The Healthy People 2020 Website Provides an agenda for improving national health (http://healthypeople.gov/2020/) National Center for Health Statistics As part of the CDC, the National Center for Health Statistics, or NCHS, is the principal health statistics agency in the United States. The NCHS plays a key role in national public health by providing statistical information that helps to identify and address critical health problems. Health statistics compiled by the NCHS allow us to n Document the health status of the population and of important subgroups n Identify disparities in health status and the use of healthcare by race, ethnicity, socioeconomic status, region, and other population characteristics n Monitor trends in health status and healthcare delivery n Identify health problems n Support biomedical and health services research n Provide information for making changes in public policies and programs Lesson 2 31 n Evaluate the impact of health policies and programs The NCHS collects data from many sources, including n Birth and death records n Health records n Interview surveys n Physical exams n Laboratory tests Some of the NCHS resources that may prove useful for HIM professionals include birth and mortality data. You can find this information by visiting the NCHS Web site at http://www.cdc.gov/nchs. National Health Care Surveys The National Health Care Surveys are part of the CDC and NCHS. These surveys are designed to provide information to healthcare policymakers, healthcare professionals, and researchers. The surveys typically include information on the following topics: 32 n Factors that influence the use of healthcare resources n Quality of healthcare n Safety of care n Disparities in healthcare services n Resource use, including costs and staffing n Diffusion of technologies n Drugs n Surgical procedures n Patterns of care for specific conditions n Special topics n Bioterrorism and emergency preparedness n Electronic medical records Healthcare Statistics According to the CDC, the surveys are nationally representative and provider-based. They cover a broad spectrum of healthcare settings. Within each setting, data are collected from a sample of organizations that provide care (such as home healthcare agencies, inpatient hospital units, and physician offices) and from samples of patient (or discharge) encounters within the sampled organizations. Examples of National Health Care Surveys are as follows: n National Ambulatory Medical Care Survey (NAMCS) Provides information about ambulatory medical care services in the United States n National Hospital Ambulatory Medical Care Survey (NHAMCS)Collects data on the ambulatory care services in hospital emergency and outpatient departments n National Hospital Discharge Survey (NHDS)Provides information on characteristics of inpatients discharged from nonfederal short-stay hospitals in the United States n National Survey of Ambulatory Surgery (NSAS)Provides a nationally representative sample of ambulatory surgery visits. In 2006, the NSAS went back in the field to collect data from hospital-based and freestanding ambulatory surgery facilities. n National Home and Hospice Care Survey (NHHCS) Provides information about agencies that provide home and hospice care and about their current patients and discharges n National Nursing Home Survey (NNHS)Provides information about nursing homes, residents, and their staff You can find more information about the National Health Care Surveys at http://www.cdc.gov/nchs/surveys.htm. Lesson 2 33 Agency for Healthcare Research and Quality The Agency for Healthcare Research and Quality, or AHRQ, is part of the Department of Health and Human Services. Formerly the Agency for Health Care Policy and Research (AHCPR), it was renamed AHRQ in 1999. The AHRQ provides practical healthcare information, research findings, and clinical quality data. It also includes information regarding n Evidence-based practice n Clinical practice n Technological advancements n Outcomes and effectiveness You can find this information by visiting the AHRQ Web site at http://www.ahrq.gov/. The AHRQ also hosts the National Guideline Clearinghouse, which is a public resource for evidence-based clinical practice guidelines. Visit http://www.guideline.gov/ to learn more. Institutional Review Boards All healthcare organizations that conduct research and gather statistics require an evaluation from an institutional review board. An institutional review board, or IRB, is a committee of physicians, statisticians, researchers, and community advocates. The goal of each committee is to ensure that clinical trials and studies are ethical and that the rights of study participants are protected. All clinical trials in the United States must be approved by an IRB before they begin. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 10. 34 Healthcare Statistics Self-Check 10 Indicate whether each of the following statements is True or False. ______ 1. Benchmarking is the process of comparing rate historical data with another specific data set. ______ 2. The National Center for Health Statistics is part of the CDC. ______ 3. Information on deaths caused by traffic accidents is provided by FARS. ______ 4. The AHRQ is the principal health statistics agency in the United States. ______ 5. The purpose of an institutional review board is to gather statistics from healthcare organizations. Check your answers with those on page 69. ASSIGNMENT 11: DESCRIPTIVE STATISTICS IN HEALTHCARE Read through the following material in your study guide. After you've read the study guide commentary, read pages 171-191 of your textbook, Calculating and Reporting Healthcare Statistics. Recall from Assignment 1 that descriptive statistics are used to describe information from a specific group or population. In this assignment, you'll study the following types of descriptive statistics used in the healthcare industry: n Rank n Quartile n Decile Lesson 2 35 n Percentile n Measures of central tendency n Measures of variation n Variability n Range n Variance n Standard deviation n Correlation Rank A rank indicates the position of a score or number compared to other scores or numbers on a list. For example, Table 10.2 on page 171 of your textbook ranks the 15 leading causes of death in the United States in 2006. As you can see, diabetes ranks higher than pneumonia, while heart disease ranks highest on the list. Quartile Analyzing large amounts of healthcare data can sometimes be an overwhelming process. To make health information easier to understand, it's often helpful to divide it into quartiles, or four smaller groups of information that contain an equal number of observations. The information within each quartile can be compared to that of the other quartiles, or it can be analyzed independently. Decile Just as health information can be divided into quartiles, it can also be divided into deciles, or 10 equal parts. Such divisions are sometimes necessary when a very large amount of data is being analyzed. 36 Healthcare Statistics Percentile Data is more often analyzed in terms of percentiles than quartiles or deciles. Percentiles represent information that's divided into 100 equal parts. You may already be familiar with the term percentile rank, which is a distribution of scores in which a specific score is greater than or equal to others. For example, if you score in the 99th percentile of your class, your class rank is greater than or equal to 99 percent of all of your other classmates. Measures of Central Tendency An average number that represents a set of data is called a measure of central tendency. For example, when new parents compare their newborn's length and weight to that of typical newborns, they're making a comparison using measures of central tendency. The three most frequently used measures of central tendency are mean, median, and mode. Mean. The mean is determined by calculating the arithmetic average of items in a frequency distribution. When you hear people refer to the average of a range of data, they're referring to the mean. To find the mean, divide the sum of all of the items included (represented by the symbol ) by the total number of items (represented by the symbol N ) . The formula for determining the mean is as follows: Let's look at an example. Find the mean of the following test scores: 87, 100, 91, 98, 87, 88, 91, 92, 99, 90, and 100. Step 1: Add all of the test scores together. 87 + 100 + 91 + 98 + 87 + 88 + 91 + 92 + 99 + 90 + 100 = 1,023 Step 2: Lesson 2 Divide the sum of the scores by the total number of scores included in the calculation. 37 1,023 11 = 93 The mean is 93. Median. Finding the median of a group of data is also helpful in data analysis. The median can be found by arranging the items from lowest to highest, and then finding the midpoint of the distribution. Think of the median as the value that's located halfway through the ordered data set. There's an equal number of data values below and above the median. Let's revisit the example we just used involving test scores. If we arrange the test scores in order from lowest to highest, we can determine that the median, or middle point, of the scores is 91. Exactly half of the scores lie above 91, and half lie below it. 87, 87, 88, 90, 91, 91, 92, 98, 99, 100, 100 Now suppose that instead of 11 test scores, there were 10. In this case, the median would fall halfway between the fifth and sixth scores in the ordered set. You would find the median by adding the two scores together and dividing the sum by 2. Let's look at an example involving an even number of test scores. Find the median of the following test scores: 100, 100, 99, 98, 92, 91, 91, 90, 88, and 87. In this case, the median lies somewhere between the fifth score (92) and the sixth score (91). To find the median, add the fifth and sixth scores together and divide by 2. The median test score is 91.5. Mode. The most frequently or commonly occurring value in a data set is called the mode. Let's use another example involving test scores to find the mode. Suppose the list of test scores is as follows: 100, 99, 98, 92, 91, 91, 90, 88, 87, and 86. In this example, the mode is 91 because the number 91 occurs more frequently than any of the other numbers. The median in this example also happens to be 91. 38 Healthcare Statistics In some cases, there can be more than one mode if two or more values are equally common. The measure of central tendency is called bimodal in the case of two modes and multimodal in the case of more than two modes. Measures of Variation The measure of variation shows how information is spread out around the measure of central tendency. Think of the measure of variation as a range. For example, all examination scores, from the highest score to the lowest score, represent a measure of variation. Variability Variability indicates the differences among members of a group within a scale of measurement. In the medical field, heart rate variability (HRV) is a measure of the differences, or variations, in heart rate. Heart rate variability is usually calculated by analyzing the time series of beat-to-beat intervals from the electrocardiograph (EKG) or arterial pressure tracings. Range The range is the measure of variability between the lowest and highest items in a frequency distribution. Range is the simplest measure of variation to calculate because it equals the highest value minus the lowest value. Since the range involves only the largest and smallest values, it's greatly affected by extreme values. Therefore, it's not resistant to change. Let's use test scores again to illustration range. Find the range of the following test scores: 100, 99, 98, 92, 91, 91, 90, 88, 87, and 86. Subtract the lowest score from the highest score. 100 - 86 = 14 The range of the test scores is 14. Lesson 2 39 When calculating ranges, you should be aware of the outliers. Outliers are the unusually large or small values within the data sample. These values can greatly influence the range and may not provide the most accurate information. For example, find the range of the following test scores: 100, 99, 98, 92, 91, 91, 90, 88, 87, and 64. 100 - 64 = 36 In this case, the range of the scores is 36. Because the lowest test score (64) is an outlier, the range of the scores increased and isn't representative of the total group of scores. Variance Note: The definition of variance shown on page 182 of the textbook is incorrect. Variance isn't \". . . the average of the standard deviations,\" but rather the squared differences between the data values used and the mean of those data values. The formula used in applying variance to a population is correct. Variance is a common measure of dispersion. It's the squared differences between the data values used and the mean of those data values. Its use is important when considering the dispersion of the data values. If there's a small sample or population of data, then variance can be intuitively felt without putting an exact number on it. For example, suppose a student takes two subjects, math and English. Each subject has three exams. The student scored 90 percent on each of the exams for math, which is a high B grade. The student also scored 70 on each of the exams for English, which is a D and just passing, since 69 is failing. The data looks like this: Math Exam 1 Exam 2 Exam 3 Math Average 90 90 90 90 (90 3) = high B grade 3 English Exam 1 Exam 2 Exam 3 English Average 40 70 70 70 70 (70 3) = D grade 3 Healthcare Statistics Because of the small number of data values, you can easily calculate the mean as 80, which is a C. You can also intuitively understand what the variance is as the measure of dispersion. However, what if there are thousands of data points? The variance isn't as intuitive anymore. It still needs to be calculated and the use of the variance as part of the concept of the standard deviation becomes much more applicable. Standard Deviation Standard deviation is a measure of the spread or dispersion of data. The larger the spread between the values in a data group, the larger the standard deviation. You can find the standard deviation by calculating the square root of the variance. Review the formula for standard deviation on page 184 of your textbook. Correlation A correlation is a measure of the relationship between two variables. You've probably used correlations before without realizing it. For example, you might have noticed a correlation between the amount of time you spend studying for exams and the grade you receive. In the healthcare field, correlations are important because they help providers determine which treatments or services produce the best results for patients. Review the correlation formula and examples on pages 189-191 of your textbook. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 11. Lesson 2 41 Self-Check 11 Complete the Chapter 10 Test on pages 191-193 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 70. ASSIGNMENT 12: PRESENTATION OF DATA Read through the following material in your study guide. After you've read the study guide commentary, read pages 195-225 of your textbook, Calculating and Reporting Healthcare Statistics. Introduction to Data Presentation Now that you know how to accumulate and analyze data, what do you do with it? In this assignment, you'll learn how to present data so that it's understandable and accessible for future use. Before you present data to others, you must prepare it. Preparing data involves 42 n Logging the data n Checking the data for accuracy n Entering the data into a system n Transforming the data into something others can understand n Developing and documenting the data Healthcare Statistics Once you've finished preparing the data, you're ready to begin the process of presentation. You can present data in many different ways, depending on the type of data you're presenting and the message you want to convey. To understand how to present data, you first need to understand the different types of data. Types of Data As your textbook discusses, data can be categorical or numerical. Categorical data represents data that can be divided into groups. This type of data can include variables such as age, race, and sex. Categorical data is divided into four scales of measurement: n Nominal data n Ordinal data n Ratio data n Interval data Analysis of categorical data generally involves the use of data tables. Data tables can present categorical data by placing information about two or more variables into rows and columns. For example, imagine that you work in a pediatrician's office and you need to compile statistics regarding the height and weight of children. This information might best be presented in a data table. Numerical data is measured or identified on a numerical scale. It consists of two types of data: discrete data and continuous data. Discrete data is data that can be counted. For example, a healthcare facility can count the number of defective syringes over a certain period of time. On the other hand, continuous data is data that's measured and subject to change. For example, data regarding a person's height is considered continuous data. Lesson 2 43 Data Display Different types of data require different kinds of display tools. As your textbook discusses, data can be summarized in tables or it can be visually represented in graphs. Table formats include basic columnar tables, like the two-way table mentioned earlier, and frequency distribution tables. Graphs can include bar graphs, pie charts, line graphs, and histograms. With all of these choices, how do you know which display tool or method to use for presenting your statistical data? First, decide if you want to present the data in a summary (table) format or a visual (graphical) format. You may even want to present the data using a variety of formats (including tables, graphs, and narratives) to best serve your audience. If you decide to present the data using a graph, ask yourself the following questions: n What am I trying to communicate? n Who is my audience? n Does the graph tell the entire story? n Is any information incomplete or vague? The following guidelines may help you decide which type of graph to use: n To show frequency of occurrence, like simple percentages or comparisons of magnitude, use bar graphs or pie charts. Examples of these graphs are shown on pages 208-211 of your textbook. n To show trends over time, use line graphs, run charts, or control charts. Examples of line graphs are shown on pages 213-214 of your textbook. n To show distribution (variation that's unrelated to time), use histograms. Examples of histograms are shown on pages 214-215 of your textbook. n To show association, or a correlation between two things, use scatter diagrams. Sample scatter diagrams are shown on pages 217-219 of your textbook. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 12. 44 Healthcare Statistics Self-Check 12 Complete the Chapter 11 Test on pages 225-226 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 71. ASSIGNMENT 13: INFERENTIAL STATISTICS IN HEALTHCARE Read through the following material in your study guide. After you've read the study guide commentary, read pages 249-257 of your textbook, Calculating and Reporting Healthcare Statistics. Introduction to Inferential Statistics Inferential statistics allow us to draw conclusions based on a sample group of data. As your textbook points out, the conclusions and generalizations that comprise inferential statistics are prone to error, so a certain degree of confidence is necessary when using them. In this assignment, we'll discuss several types of inferential statistics. Standard Error of the Mean and Confidence Intervals Standard error of the mean is a measure of the amount of error that results from a sample. As the size of a sample increases, so does the likelihood that the sample accurately represents the whole. Thus, if the sample is large, the stan- Lesson 2 45 dard error of the mean is small. Conversely, if the sample is small, the chances of error are higher and the standard error of the mean is large. Review the formula and examples related to the standard error of the mean and confidence intervals on pages 250- 251 of your textbook. A confidence interval represents the range of values in which the mean lies. A confidence interval is determined when the standard error of the mean is added to and subtracted from the sample mean. For example, suppose that in a sample population of 100, the standard error of the mean is 3.5. When the standard error is added to the population (100 + 3.5 = 103.5) and subtracted from it (100 - 3.5 = 96.5), the resulting confidence interval is the range of numbers between 96.5 and 103.5. Null Hypothesis Review the null hypothesis examples on pages 251-253 of your textbook. A null hypothesis is a hypothesis that's presumed to be true until proven otherwise. It implies that the results observed in a study are no different from what might have occurred as a result of chance. For example, in a clinical trial of a new drug, the null hypothesis might state that the new drug is no better, on average, than the drug used currently. As your textbook points out, most research is conducted to reject a null hypothesis, although there's always the possibility that it will be proven true. Any level of uncertainty involved when proving a null hypothesis true or false can result in an error. Two types of errors can occur: Review the examples for t tests, ANOVA, and chi square on pages 254-256 of your textbook. 46 n Type I errors occur when the null hypothesis is rejected, but is actually true. n Type II errors occur when the null hypothesis is accepted, but is actually false. A number of different tests can be performed on a null hypothesis: n A t test is performed on a null hypothesis to determine whether or not the results are statistically significant. n An ANOVA (analysis of variance) test helps identify sources of variability from two or more potential means. Healthcare Statistics n Chi square is a statistical test that's used to determine the probability that an observed deviation from the expected event or outcome occurs solely by chance. Once you feel comfortable with the material covered in your textbook and study guide, complete Self-Check 13. Self-Check 13 Complete the Chapter 13 Test on pages 257-258 of your textbook, Calculating and Reporting Healthcare Statistics. Check your answers with those on page 71. Lesson 2 47 ASSIGNMENT 14: BASIC RESEARCH PRINCIPLES Read through the following material in your study guide. After you've read the study guide commentary, read pages 227-245 of your textbook, Calculating and Reporting Healthcare Statistics. Introduction to Research Principles Your textbook discusses two types of research: basic research and applied research. Basic research is the study of data or information for the purpose of increasing knowledge. This type of research is performed to gain a more comprehensive understanding of a subject without specific applications or results in mind. Applied research is the study of the applicability of theories or principles to the solution of a problem. Applied research produces results that relate to real-world situations. It helps develop new ideas, knowledge, solutions, or products. Review Table 12.1 on page 229 of your textbook to learn the differences between qualitative and quantitative research. Your text also discusses two different research methods, or systematic approaches. Qualitative research describes events without using numbers. Qualitative research can include methodologies such as interviews, observations, and document reviews. Quantitative research expresses information in numerical form. This type of research includes any methodologies with numerical tabulation and statistical analysis, such as experiments, observations, and surveys. The Research Process The process of conducting research generally follows six steps: Step 1: Defining the problem. The first step in the research process is to identify a problem, question, or issue that will help you form a hypothesis. For example, an HIM department that doesn't have enough space to store patient records may hypothesize that it would be beneficial to introduce an electronic health record system to the facility. 48 Healthcare Statistics Step 2: Reviewing the literature. Once you identify a problem, the next step is to review all of the information about the topic to determine whether similar research has already been performed. If the topic has already been covered in another research project, you can use that information as a guide or you can present it to avoid repeating it. Since the advent of the Internet, accessing and reviewing literature has become a very easy process. Not only can you rely on printed trade industry journals and books, but you can also find information about your topic using the Web. Step 3: Designing the research. The next step in the research process is design. A specific design is used to structure the research and to show how the research will answer questions about the identified problem. Proper research design is very important because it increases the probability of gaining useful results and makes the entire process much less time consuming. Step 4: Collecting the data. Data collection is the heart of the research process because without it, the project won't be able to support the hypothesis. Data collection involves gathering the information needed for the study. As we discussed earlier, data is collected through surveys, observations, and experiments. Step 5: Analyzing the data. Once you collect all of the necessary data, the next step is to analyze it. In this step, you'll examine all of the information you gathered and prepare to draw a conclusion based on that analysis. As discussed earlier, two statistical applications are used to analyze data: Step 6: Lesson 2 n Descriptive statistics n Inferential statistics Review Figure 12.1 on page 230 of your textbook for an example of defining a re