Med surg bed projections
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Med/Surg Bed Projections. Delaware Health Resources Board April 25, 2013. Med/Surg Bed Projections: Overview. 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

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Med/Surg Bed Projections

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Med surg bed projections

Med/Surg Bed Projections

Delaware Health Resources Board

April 25, 2013


Med surg bed projections overview

Med/Surg Bed Projections: Overview

  • 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


Past med surg bed projections

Past Med/Surg Bed Projections

  • 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


Past med surg bed projections1

Past Med/Surg Bed Projections

  • 2005-2010(calculated in 2008)

  • 2006-2011

  • 2007-2012

  • 2008-2013

  • 2009-2014

  • 2010-2015(available today)

  • 2011-2016(available today)


Med surg bed projections 2005 2010 vs 2010 2015 vs 2011 2016

Med/Surg Bed Projections: 2005-2010 vs. 2010-2015 vs.2011-2016


Licensed bed supply

Licensed Bed Supply

  • 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


Med surg bed projections the basics to get us started

Med/Surg Bed Projections: The Basics to Get Us Started

  • 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


Med surg bed projections the basics to get us started1

Med/Surg Bed Projections: The Basics to Get Us Started

  • 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 bed projections the basics to get us started2

Med/Surg Bed Projections: The Basics to Get Us Started

  • 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

Med/Surg Calculation steps

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

(2) Wilmington Hospital, 2011-2016


Med surg calculation steps a summary

Med/Surg Calculation Steps: A Summary

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

Step 2:Calculate Projected Average Daily Census (ADC)

Step 3: Calculate Projected Bed Need


Step 1 calculate average daily census adc for base year

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

  • 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


Step 1 calculate average daily census adc for base year1

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

Eliminate Pediatric Cases & Create the 15-64 Age Category


Step 1 calculate average daily census adc for base year2

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

Eliminate Pediatric Cases & Create the 15-64 Age Category


Step 1 calculate average daily census adc for base year3

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


Med surg calculation steps a summary1

Med/Surg Calculation Steps: A Summary

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

Step 2:Calculate Projected Average Daily Census (ADC)

Step 3: Calculate Projected Bed Need


Step 2 calculate projected average daily census adc

Step 2: Calculate Projected Average Daily Census (ADC)

  • 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


Step 2 calculate projected average daily census adc1

Step 2: Calculate Projected Average Daily Census (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


Step 2 calculate projected average daily census adc2

Step 2: Calculate Projected Average Daily Census (ADC)

  • 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


Step 2 calculate projected average daily census adc3

Step 2: Calculate Projected Average Daily Census (ADC)

  • Calculate Projected Population Changes


Step 2 calculate projected average daily census adc4

Step 2: Calculate Projected Average Daily Census (ADC)

  • Calculate Projected Population Changes


Step 2 calculate projected average daily census adc5

Step 2: Calculate Projected Average Daily Census (ADC)

  • Calculate Population Change Factor (PCF)


Step 2 calculate projected average daily census adc6

Step 2: Calculate Projected Average Daily Census (ADC)

  • Calculate Population Change Factor (PCF)


Step 2 calculate projected average daily census adc7

Step 2: Calculate Projected Average Daily Census (ADC)

  • 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).


Step 2 calculate projected average daily census adc8

Step 2: Calculate Projected Average Daily Census (ADC)

  • 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


Step 2 calculate projected average daily census adc9

Step 2: Calculate Projected Average Daily Census (ADC)

  • Use PCF to Calculate Projected ADC


Med surg calculation steps a summary2

Med/Surg Calculation Steps: A Summary

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

Step 2:Calculate Projected Average Daily Census (ADC)

Step 3: Calculate Projected Bed Need


Step 3 calculate projected bed need

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?


Step 3 calculate projected bed need1

Step 3: Calculate Projected Bed Need


Med surg bed projections 2005 2010 vs 2010 2015 vs 2011 20161

Med/Surg Bed Projections: 2005-2010 vs. 2010-2015 vs.2011-2016


A few points for consideration

A Few points for consideration


Med surg bed projections

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

  • But, because population projections for the 15-64 and 65+ age categories typically only INCREASE over time, population changes should always work to increase med/surg bed need


  • Med surg bed projections

    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

  • So, what causes the “up and down” med/surg bed need projections for some hospitals?

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


  • Med surg bed projections

    Point for Consideration:

    The Influence of Base Year ADC on Projections

    Med/Surg ADC by Hospital, 2003-2010


    Med surg bed projections

    Point for Consideration:

    The Influence of Base Year ADC on Projections

    Med/Surg ADC by Hospital, 2003-2010


    Med surg bed projections

    Point for Consideration:

    Excluding A.I. DuPont from NCC Bed Projections


    Med surg bed projections

    Point for Consideration:

    Excluding A.I. DuPont from NCC Bed Projections


    Med surg bed projections

    Point for Consideration:

    Excluding A.I. DuPont from NCC Bed Projections


    Med surg 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


    Med surg bed projections

    Point for Consideration:

    Excluding Med/Surg Pediatric Patient Days


    Med surg bed projections

    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


    Med surg bed projections

    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


    Med surg bed projections

    end


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