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Med/Surg Bed Projections

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Med/Surg Bed Projections

Delaware Health Resources Board

April 25, 2013

- Review past med/surg bed projections in Delaware
- Look at methodological details specific to Delaware that impact med/surg bed projections
- Walk through calculation steps
- Explore if/how to revise med/surg bed projection procedures

- Last set of med/surg bed projections was calculated in Nov. 2008
- This set of med/surg projections was for the 2005-2010 period
- These projections were presented along with 2005-2010 LTC projections

- At that time, HRB members requested updated LTC projections and stated that LTC projections be updated annually
- Although the current HRMP states that med/surg projections will also be updated annually, the most recent set of projections remained those for the 2005-2010 period

- 2005-2010(calculated in 2008)
- 2006-2011
- 2007-2012
- 2008-2013
- 2009-2014
- 2010-2015(available today)
- 2011-2016(available today)

- Delaware Office of Health Facilities Licensing and Certification
- Licensed bed counts represent ALL* licensed beds for the facility (not broken down by type)
- Licensed bed counts do NOT include labor/delivery/recovery beds or bassinets/isolettes (such as NICU or nursery)

- To obtain bed tallies by type (i.e., “medical/surgical beds”), each hospital will need to be contacted individually

- As with all surveillance data, there is a lag in data availability that determines the most up-to-date time period for which you can calculate projections
- Delaware LTC data:
- Most recently-available data (i.e., “base year”) = 2011
- Most up-to-date time period for projections = 2012-2017

- Delaware med/surg data:
- Most recently-available data (i.e., “base year”) = 2010
- Most up-to-date time period for projections = 2011-2016

- Delaware LTC data:

- Calculated at the hospital-level
- Each hospital has its own annual projection (*with the exception of A.I. DuPont)

- Additionally, one county-level projection is produced annually for NCC
- County-level projections are not produced for Kent or Sussex

- A.I. DuPont is excluded from all analyses
- There are no hospital-level projections for A.I.
- Also, data from A.I. are not included in the county-level NCC projection

- Med/surg projections are calculated from patient day data for two age groups only:
- 15-64 year olds
- 65+ year olds

- Pediatric med/surg data (<15 year olds) are excluded from each hospital’s calculations

Med/Surg Calculation steps

Examples: (1) Beebe Medical Center, 2011-2016

(2) Wilmington Hospital, 2011-2016

Step 1: Calculate Average Daily Census (ADC) for Base Year

Step 2:Calculate Projected Average Daily Census (ADC)

Step 3: Calculate Projected Bed Need

- Base year = one year prior to the start of the projection period you’re calculating
- Example: if you’re calculating projections for 2011-2016, your base year is 2010
- Note: you also need data for one year prior to the base year (i.e., “prior year data”). If you’re calculating projections for 2011-2016, your prior year is 2009

- When projections are calculated annually and on-time, the base year will typically represent the most recently-available year of data

Eliminate Pediatric Cases & Create the 15-64 Age Category

Eliminate Pediatric Cases & Create the 15-64 Age Category

Step 1: Calculate Average Daily Census (ADC) for Base Year

Step 2:Calculate Projected Average Daily Census (ADC)

Step 3: Calculate Projected Bed Need

- Essentially, Step 2 is comprised of three sub-steps:
- Calculate population changes…
- Use population data to calculate Population Change Factor (PCF)…
- Use PCF to calculate Projected ADC

- Calculate Projected Population Changes
- Use Delaware Population Consortium Data (available online)
- Calculate projected population change by dividing the population for the last year of the projected time period by the population for the first year of the projected time period

- Calculate Projected Population Changes
- Hospital-specific med/surg projections are calculated using population statistics from the following geographic areas:
- Christiana Hospital:New Castle County
- St. Francis Hospital: New Castle County
- Wilmington Hospital: New Castle County
- Kent General Hospital:Kent County
- Milford Memorial Hospital:Kent and Sussex Counties*
- Beebe Medical Center:Sussex County
- Nanticoke Hospital:Sussex County

- Hospital-specific med/surg projections are calculated using population statistics from the following geographic areas:

- Calculate Projected Population Changes

- Calculate Projected Population Changes

- Calculate Population Change Factor (PCF)

- Calculate Population Change Factor (PCF)

- Calculate Population Change Factor (PCF)
- Important Note:
If the base year ADC (calculated in Step 1) is < 95% of the prior year ADC (also calculated in Step 1), a PCF of 1.0 will be used to calculate the hospital’s projected ADC…

(Unless the PCF as calculated is < 1.0, in which case the lesser figure will be used).

- Important Note:

- Calculate Population Change Factor (PCF)
- Is the base year ADC > or < 95% of the prior year ADC? Let’s see...
Base year = 2010 Prior year = 2009

- Use PCF to Calculate Projected ADC

Step 1: Calculate Average Daily Census (ADC) for Base Year

Step 2:Calculate Projected Average Daily Census (ADC)

Step 3: Calculate Projected Bed Need

- New Castle County: Occupancy Factor = 0.850
- Kent and Sussex Counties:Occupancy Factor = 0.875
- By setting the ideal occupancy rate for New Castle County hospitals to 85%, the med/surg bed need projections for NCC and the three NCC hospitals will be slightly more conservative
- Allow for more surge capacity in NCC hospitals?

A Few points for consideration

Point for Consideration:

The Influence of Base Year ADC on Projections

- What are the main driving forces of year-to-year fluctuations in bed need projections?
- Population Change
- Base Year ADC

Point for Consideration:

The Influence of Base Year ADC on Projections

- What are the main driving forces of year-to-year fluctuations in bed need projections?
- Population Change
- Base Year ADC

- Base Year ADC is the strongest factor in determining if a hospital’s med/surg bed needs will increase or decrease across projection periods.

Point for Consideration:

The Influence of Base Year ADC on Projections

Med/Surg ADC by Hospital, 2003-2010

Point for Consideration:

The Influence of Base Year ADC on Projections

Med/Surg ADC by Hospital, 2003-2010

Point for Consideration:

Excluding A.I. DuPont from NCC Bed Projections

Point for Consideration:

Excluding A.I. DuPont from NCC Bed Projections

Point for Consideration:

Excluding A.I. DuPont from NCC Bed Projections

Med/Surg Bed Projections: Points for Consideration

- Med/surg projections are calculated from patient day data for two age groups only:
- 15-64 year olds
- 65+ year olds

- Pediatric med/surg data (<15 year olds) are excluded from each hospital’s calculations
- However, as the next slide shows, most hospitals are treating a large number of pediatric med/surg cases

Point for Consideration:

Excluding Med/Surg Pediatric Patient Days

Point for Consideration:

Excluding Med/Surg Pediatric Patient Days

- Unlike the previous issue of excluding A.I. DuPont from med/surg projections, the decision to exclude pediatric med/surg patient days not only impacts New Castle County, but all individual hospitals.
- This methodological step will disproportionately affect hospitals with relatively large pediatric med/surg loads
- The larger a hospital’s pediatric med/surg load, the more artificially low its bed need projections will be by the exclusion of pediatric med/surg patient day data

Point for Consideration: Summarized

- The strong influence of base year ADC on resulting bed projections
- Statistical methods to smooth out year-to-year variability?

- Exclusion of A.I. DuPont from NCC med/surg patient day totals
- Even among the 15-64 age group

- Exclusion of pediatric med/surg data from all hospitals
- Results in artificially low ADCs and bed projections

end