First 3 Chapters

Introduction to Health Statistics Learning Objectives At the conclusion of this chapter, you should be able to do the following: Recommend healthcare statistics e Assess sources of data o Compare and contrast between data and information, validity and reliability, descriptive and inferential statistics, and primary and secondary data sources ! Determine the users of healthcare statistics Key Terms Agency for Healthcare Research and Descriptive statistics Nursing facility _ Quality (AHRQ) Encounter Outpatient Ambulatory care facility Home health (HH) Primary data source Census Hospice Secondary data source Centers for Disease Control and Inferential statistics Visit Prevention (CDCQ) Inpatient Vital statistics Cenler§ for Medicare and Medicaid Inpatient census World Health Organization (WHO) Services (CMS) Managed care organization (MCO) :11: term statistics has two meanings. First, it is a number computed from a larger group of numbers, which collectively Stitute a sample of data—for instance, the average number of days that patients stay in the hospital overnight. Second, statistics i . f . . o o an;:;tzliCS lsd rr:ore broadly defined as a branch of mathematics concerned with collecting, organizing, summarizing, and - ng data, Statistics L ‘.\‘A‘P_‘ Originall .y Y, the term statistics referred to the collection of data about and for the “state.” The word comes from the Italian Word stato, meaning « ) ng “state.” One need only think of i istics- i izati 8s the Bureau of Labor Sl y our own government and its statistics-collecting organizations, such and Medicaid Services (CM stics, the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare S), for example.

m Chapter 1 Introduction to Health Statistics Health statistics provide information about the health of people and their use of healthcare services. Examples of healthcare statistics include average longevity; birth rates; death rates; number of people with a disease in a county, state, the US as a whole, or the world; and the frequency of usage of a particular type of service within a healthcare organization. Reasons for Studying Statistics Statistics is about using data for decision-making, which is required in every area of our lives. To make decisions, we must have information. In healthcare settings, information is often incomplete. As a result, we must learn to estimate the characteristics of a complete population using statistics based on a subset or sample of the population. Most organizations keep statistics to make decisions about their business. For example, an organization may use statistics to determine its markets; that is, to identify who is buying its products or using its services to decide how it can increase the availability and variety of products and services. Healthcare organizations use statistics to determine the use and cost of services as well as outcomes of patients. Many examples of healthcare data and statistics will be presented in this text. Healthcare Operations Needs In the healthcare industry, there are compelling reasons to collect and analyze data and compute statistics. For example, statistics kept on activities in the healthcare facility indicate why patients come to the facility and the costs of taking care of them. Patient care statistics and comparison of the values for different providers may be used to measure the quality of care provided. Many accrediting agencies require a data analysis system as part of accreditation, and many third-party payers require facilities to collect performance data. Organizational leadership also may use statistics for prioritizing needed services and to identify areas where efficiency and effectiveness might be increased. For example, laboratory data may show that most outpatients come in for blood work early in the day, so the lab may add more staff in the morning hours. Additionally, healthcare facilities are interested in the types of patients they have with respect to their diagnoses in order to maintain the optimum physician specialty and other professional staff mix they need to treat their patients. Public Health Needs Government agencies also need to maintain statistics on and about the population in order to provide services. For example, the CDC, a division of the Department of Health and Human Services (HHS), is recognized as the lead agency responsible for protecting the health of the US population by providing credible information to help individuals make the right healthcare decisions and promoting quality of life through the prevention and control of disease, injury, and disability (CDC 2019). The organization compiles and uses health statistics, such as birth and death statistics, to understand the conditions of life and health in our country. CMS is the division of HHS that is responsible for administering the Medicare program and the federal portion of the Medicaid program. CMS also publishes information on death rates among Medicare patients, and patients in diagnosis and procedure categories. Researchers use this information for studies, which may lead to improvement in patient care and services. The Agency for Healthcare Research and Quality (AHRQ), a part of HHS, tries to make healthcare safer; of higher quality; and more accessible, equitable, and affordable. For example, AHRQ publishes research-based fact sheets for patients and consumers on a variety of issues, such as patient safety and reducing errors when a patient is in the hospital. AHRQ also works within HHS and with other partners to make sure that the data and statistics are understood and used. AHRQ conducts research on the elderly, children, and various healthcare conditions to provide information to consumers and other HHS agencies so they may meet their objectives. For example, their work around how to reduce readmissions is intended to help hospitals by providing tools to identify causes of readmissions and aid in the development of prevention strategies (AHRQ 2017). g The World Health Organization (WHO), an international organization founded by the United Nations (UN), 18 the directing and coordinating authority on international health within the UN’s system. WHO provides leadership on critical health matters, works to support countries to ensure all of their citizens have accessible and safe healthcar® and helps prevent the spread of communicable diseases, especially vaccine-preventable diseases. They support gOOd health through the continuum of life and are working toward reducing quality of life disparities among countries: WHO supports healthcare research in maternal, child, and adolescent health; malaria; tuberculosis; HIV; Ebola; an Sources of Healthcare Statistics m other global healthcare issues (WHO 2019). For example, in 1988, WHO helped launch the Global Polio Eradication Initiative to help protect all children from polio. As a result of this immunization initiative, the number of polio cases has dropped by 99 percent. Today, 80 percent of the world’s population lives in polio-free regions (WHO 2019). importance of Data To obtain the knowledge they need to make decisions, organizations first must determine Wha:t data to gollect. Data are raw facts and figures that can pertain to a process or activity that an organization is interested in measuring. Inforn_uanon is derived from data for the purpose of making decisions. The data used to calculate these statistics must bc? .Vahd and reliable. Validity answers the question of whether one measured what one intended to measure, and rehab_111ty means that there is some consistency or ability to replicate results. For example, if a supervisor is checking the coding work of a new employee, the codes assigned should be the same for the supervisor as they were for the employee for the results to be considered reliable. Descriptive Statistics Versus Inferential Statistics e ———— The primary focus of descriptive statistics is to organize and describe the features of data in a study. Descriptive statistics describe what the data show about the characteristics of a group or population; in other words, they may be used to describe a particular population. For example, it might be necessary to know the average age of patients or which service is used most in a given facility. A database including the age of each patient may be useq to calculate the descriptive statistic average age. Inferential statistics, on the other hand, help organizations make inferences or decisions about a larger group of data by drawing conclusions from a small group of the population. The smaller group selected from the population is called a sample. The results obtained from the sample, if gathered carefully, are assumed to be representative of the entire population. Both types of statistics are used in healthcare. Sources of Healthcare Statistics e —————————— Healthcare data are derived from both primary and secondary data sources. It is important to understand the source of the data prior to using it to compute statistics for use in decision-making. Primary Data Sources In healthcare, primary data source refers to the record that was developed by healthcare professionals in the process of providing care or services to a patient. Health records are one of the most important primary sources of health statistics because they contain a systematic record of a patient’s medical history and care. The patient’s health record contains administrative data, such as admission and discharge dates, patient data, and billing data, as well as clinical data. Notes from physicians, such as orders, progress notes, operative reports, history and physical examination, and a discharge summary, may be included. Nurses’ documentation includes their notes and assessments on admission and throughout the hospital stay and medication records. Reports from clinical departments 1 the facility, such as laboratory, blood bank, radiology, pharmacy, rehabilitation services, and dietary services, may also be inf:luded in the health record. depal;{t?fiz::flmc;ep;nments also keep statistics on the activities they per'form for patients. For example, thfe: lllaboratfiry B o h')’ eep data on the_number of lab tests performed. The r?xd.lology department may keep track of the number decide wheth 1p X-rays. Th.e- physical t.herapy department may use statlstlc.al datg, such as thfe number of patient visits, to sed in tunn ;r l:;1 hire additional physical therapists or add ph-y§1cal therapist assistants to their staff. These reports may be produce y the managers of the departments for productivity measurement apd combined with other departments to areport of activity for the entire facility. The administration of a hospital might ask staff to keep data on the number of pati ) . o ‘5 1ents transferred to another hospital for procedures the facility does not offer in order to determine the need for that 1Ce at the facility. Another exam Of the Nationa] Ceple of a primary source of data is vital statistics. The National Vital Statistics System (NVSS) is part nter for Health Statistics (NCHS) of the CDC. These data are provided to the NCHS throughout the

m Chapter 1 Introduction to Health Statistics 50 states; Washington, DC; New York City; and the five territories of the US —Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. Vital statistics refers to a special group of statistics that record important events in our lives, such as birth, marriage, death, divorce, and fetal death (CDC 2019). Healthcare facilities are interested in births and deaths, fetal deaths, and induced terminations of pregnancy to drive quality improvement initiatives. Facilities generally are responsible for completing certificates for births, fetal deaths, abortions, and occasionally, death certificates. All states have laws that require this data. The certificates are reported to the individual state registrars and maintained permanently. State vital statistics registrars compile the data and report them to the NCHS. The NCHS has developed standard certificates and procedures that states and territories must use to facilitate the reliable collection of data. The standard certificates represent the minimum basic data set necessary for the collection and publication of comparable national, state, and local vital statistics data. The standard forms are revised about every 10 to 15 years, and the latest adoption to the 2003 revisions of the US Standards Certificate of Live Birth were completed in 2015. The NCHS is currently working on the development of an e-Vital Standards Initiative (NCHS 2015) that will provide support for the development of vital statistics standards to enable an exchange of data regarding births and deaths from a healthcare facility’s electronic health record system directly to the state registrar and then to the NCHS. Data from the states and territories provide important information for use in medical research and are extremely valuable in estimating population growth areas of the country and essential in planning and evaluating maternal and child health programs. The NCHS prepares and publishes national statistics based on vital statistics data because the figures are important in the fields of social welfare and public health. Because of their many uses, the data on these certificates must be complete, reliable, and accurate. Censuses Another primary source of health data is the census. A census is defined as a survey of a population. The US government conducts a population census; that is, a count of the people residing in the US and their location. The US Constitution requires that a population census be taken decennially (every 10 years), mainly to determine the number of congressional representatives in the states. Over the years, Congress has authorized gathering more information about each person. The census now is used in many ways. For instance, the amount of government money given to school districts is based partly on the number of children in a district. Congress also has requested that other types of censuses be taken periodically. These include a census of the types of businesses and industries in the US; for example, farms and fisheries and construction, foreign trade, manufacturing, and energy companies. Aggregated census data, or data that have been clustered together, are available to the public. Healthcare researchers use the US census when they want to determine statistics about the population at large. For example, if resecarchers want to show the rate of maternal deaths in a population, they must know information about the size of the population, which the US census provides. Healthcare facilities also have a census, which is the count of patients present at a specific time and place. A hospital inpatient is a patient who is provided with room, board, and continuous general nursing services in an area of an acute- care facility where patients generally stay at least overnight. In hospitals, this census is referred to as the inpatient census. The hospital census is a source of primary data. Ambulatory care facilities also may keep a census. An ambulatory care facility is a healthcare facility that provides preventive or corrective healthcare services on a nonresident basis in a provider’s office, clinic setting, or outpatient setting. Patients treated in a hospital setting such as the emergency department or clinic are classified as outpatient. The census for this setting usually represents the number of visits or encounters during a specified period, usually one day. A visit is a single encounter with a healthcare professional that includes all the services supplied during the encounter. An encounter is defined as the direct personal contact between 2 patient and a physician or other person authorized by state licensure and, if applicable, by medical staff bylaws to order or furnish healthcare services for the diagnosis or treatment of the patient. Secondary Data Sources Secondary data sources are data derived from primary sources and may be reported by someone other than the primary user. For example, the disease and operation index is a secondary source of data. The disease index is a listing © patients discharged with a specific diagnosis code, and an operation index is similar to the disease index, but the patients are listed by the operation or procedure code. All data in the index comes f_ro.m a prim;}ry data source, the health Registries are also considered secondary data sources. A registry is a listing of patients who share‘a common characteristic. For example, data from patients’ health records may be used to f:re'ate a cancer or trauma Feglstry.’l_‘l'us is a listing of patients in the facility who have been diagnosed with cancer and will include their treatment information as well as follow-up information. record. Users of Health Statistics n e Exercise 1.1 Identify the following as either a primary or a secondary data source: Type of Healthcare Data il 2. 3. 4. 5. 6. 7. Type of Data Source Productivity reports pulled from patient visit report Tumor registry State vital statistics Hospital census Hospital disease index Patient health record Health insurance data pulled from national census Users of Health Statistics All healthcare entities and third-party payers collect and use statistics. Following are examples of individuals and organizations that collect statistics and how they use statistics: o Hospital leadership: Inpatient facilities use health statistics to help address staffing issues and to determine the types of services to provide. For example, if the number of patients in the intensive care unit is increasing, .the hospital administration may want to consider adding beds and staff to meet the growing need. Conver§ely, if a request is made to the hospital administration for new facilities and equipment that cannot be substamlatt':c.l _by the statistics, it is unlikely the request will be granted. Quality management departments in healtlgcare facnhtu?s collect data to determine how the facility is performing regarding patient care and how it can improve _thenr patient care services. Leaders also use statistics to determine if they have the correct mix of medical specialties to treat the citizens in their communities. Healthcare department managers: Individual department managers in healthcare organizations use statistics to implement their department goals. For example, a manager needs to know if he or she is staying within budget. If not, the manager will need to investigate. Cancer registries: A cancer registry may be maintained by a separate department or may be a functiop of the health information department. States may also have a state cancer registry that is responsible for collectmg.data about cancer. A cancer registry collects data about the diagnosis, treatment, and follow-up of cancer pgtlepts. These statistics are important in tracking cancer survival rates. Facilities may choose to undergo accred.ltatlon through the American College of Surgeons Commission on Cancer (ACS 2019). This is an evaluation by an independent team to determine whether the facility’s cancer registry meets their standards, which guide treatment and ensure patient-centered care. Statistics must show the facility is providing high-quality care and f°"°w"~}P to its cancer patients. Physicians and researchers conduct research studies to learn about the biology of eancer, investigate new treatments and tests, and learn how to prevent cancers from occurring. ':I‘“_'Sing i:acililies: Long-term care (LTC) or nursing facilities may use statistics to determine the types of payers CIr patients have. These statistics also are helpful in demonstrating to the public the types of patients being

m Chapter 1 Introduction to Health Statistics cared for and the quality of care given. For example, an LTC facility will collect data on the number of patients who are incontinent. This will tell the facility if protocols need to be established for patients in order to help them void. The American Health Care Association, a nonprofit association of LTC associations, publishes statistics on the trends in nursing home care. e Home health (HH): HH agencies provide care to elderly, disabled, and convalescent patients in their homes. This is also called home care. These agencies keep statistics to determine the types of services used by their patients and their outcomes. For example, a HH agency would need to know the number of nursing visits, HH aide visits, physical therapy treatments, and patients using various types of equipment, such as oxygen machines or other respiratory aids. Additionally, agencies will report patient outcomes, such as the number of patients who have improved, the number of patients who were compliant with taking their medications, or the number of patients who had to be readmitted to a hospital. e Hospice: Hospice programs provide interdisciplinary programs of palliative care and supportive services that address the physical, spiritual, social, and economic needs of terminally ill patients and their families. These services may be given in either the home or an inpatient setting. A hospice needs to know types of illnesses in order to match the appropriate caregiver with each patient. e Mental health facilities: These may be inpatient or outpatient facilities. These facilities use health statistics to determine whether they are providing the proper services for patients in the community. Because the economic burden of psychiatric illness is great, the CDC collects data about mental illness and its impact on the country. e Drug and alcohol facilities: These programs may be inpatient, ambulatory, or a combination of the two. Statistics are important in this area to show the success rates of these facilities’ clients. The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism are centers in the National Institutes of Health that each collect statistics to conduct research. e Qutpatient facilities: These include physician clinics, surgery centers, emergency centers, and the like. Outpatient facilities often use statistics to determine whether they are providing the proper level of care to the community. e Managed care organizations (MCOs): An MCO is a type of healthcare organization that delivers medical care and manages all aspects of care or payment for care by controlling access to providers of care and negotiating discounted payment rates to providers of care. MCOs use statistics to determine whether they are providing an appropriate level of care and preventive services to their members. Additionally, MCOs contract with healthcare facilities to provide specific services to their members at a prenegotiated rate. The MCO pays the agreed-upon amount each time a member uses the service. e Healthcare researchers: Researchers depend on healthcare statistics to conduct research and help develop solutions to healthcare problems. Some examples include research in managed care, health law and regulations, mergers and acquisitions of healthcare facilities, physician practice issues, different types of illness and risk factors, telehealth issues, pharmaceutical research, drug and alcohol research, and so on. Healthcare statistics can also help researchers understand our quality of life. e Accreditation agencies: These organizations use healthcare statistics to determine the most common diagnoses and procedures and whether the resources are available to treat patients with those diagnoses. ¢ Federal government: The US government collects data for public health issues. For example, the CDC reports data on births, deaths, birth defects, cancer, and HIV/AIDS, just to name a few of the categories of data. CMS uses data collected by quality improvement organizations for its quality improvement projects. Legislators and other policymakers use healthcare statistics when working on new laws, conducting program oversight, and considering the amount of the budget that should be allotted to federal health agencies. Because health information management (HIM) professionals have a broad knowledge of healthcare facilities as well as immediate access to a wide range of clinical data, they are in the best position to collect, prepare analyze, and interpret healthcare data. HIM professionals must learn acceptable terminology, definitions, an computational methodology if they are to provide the basic and most frequently used health statistics. One important point to remember is that health statistics are dependent upon accurate reporting by those individuals responsible for the task. Chapter 1 Review n Chaptel' 1 MatChing QUiZ e — Match the definitions with the terms. pefinitions: b. A type of healthcare organization that delivers medical care and manages all aspects of care or payment for care by controlling access to providers of care and negotiating discounted payment rates to providers of care A comprehensive term for facilities that provide nursing care and related services for residents requiring medical, nursing, or rehabilitative care The direct personal contact between a patient and a physician or other person authorized by state licensure law and, if applicable, by medical staff bylaws to order or furnish healthcare services for the diagnosis or treatment of the patient . A group of federal agencies that oversecs health promotion and disease control and prevention activities in the US An interdisciplinary program of palliative care and supportive services that addresses the physical, spiritual, social, and economic needs of terminally ill patients and their families Data related to births, deaths, marriages, and fetal deaths An umbrella term that refers to the medical and nonmedical services provided to patients and their families in their places of residence . Record developed by healthcare professionals in the process of providing patient care The UN’s specialized agency created to ensure the attainment or the highest possible levels of health by all peoples Data derived from the primary patient record, such as an index or registry Terms: Secondary data source Encounter __ Nursing facility WHO Home health Hospice Vital statistics MCO 1 R R S ©v ® N o Health record Chapter 1 Review e e — L) Select the best answer to the following questions: 1. The CDC is the lead agency that . a. Accredits and licenses acute hospital facilities in the US b. Is responsible for providing vital statistics to various agencies, such as the NCHS C. Develops and updates ICD-10 for the world d. Isresponsible for protecting the health of the people of the US The type of statistics that make conclusions about a population by drawing conclusions from a sample 1s called a. Descriptive statistics - Inferential statistics Generalized statistics - Mathematical statistics an o

m Chapter 1 Introduction to Health Statistics 10. - Which of the following is a primary source of data? Inpatient census Vital statistics collected by the NCHS Health record a, b,and c P AN b and c only - The division of HHS that is responsible for administering the Medicare program is the a. CDC b. CMS ¢. AHRQ d. WHO . A secondary data source includes a. Vital statistics b. The health record €. The physician’s index d. A videotape of a counseling session - Which user of statistics has the primary job of supporting terminally ill patients and their families? a. Home health agencies b. Nursing facilities €. Hospice d. MCOs . The NCHS keeps statistics on a. The licensing information on all healthcare providers in the 50 states b. Cancer and other deadly diseases in the 50 states and the US-owned territories €. Vital statistics, such as births, deaths, and fetal deaths, in North America d. Vital statistics, such as births, deaths, and fetal deaths, in the 50 states and US territories Which of the following is not a primary source of data? a. Health record b. Vital statistics €. Hospital census d. Disease and operation index To be useful, the data used to calculate statistics must be a. Fair and exact b. Valid and reliable €. Honest and justified d. Simple and clear To be reliable, statistical data must a. Be reproducible b. Be applicable to what is being measured ¢. Be collected from one source only d. Have multiple meanings 11. 12. 13. 14. 15. Chapter 1 Review n Which of the following is a secondary use of a patient health record? a. Determining the results of a diagnostic test b. Identifying patients that have a cancer diagnosis ¢. Recording the health and physician information during an office visit d. Submitting diagnoses and procedures for claim submission Facilities may choose to pursue accreditation for their cancer registry with the a. American College of Physicians b. American Cancer Society c¢. American College of Surgeons d. National Institutes of Health The type of patient who receives care in a hospital-based clinic or department is called a(n) a. Inpatient b. Outpatient c. Hospice patient d. MCO patient The number of inpatients present in a healthcare facility at any given time is called a(n) a. Survey b. Census ¢. Sample d. Enumeration ' An international organization founded by the UN that is the directing and coordinating authority on international heath is called the a. CDC b. AHRQ c¢. NCHS d. WHO