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Med/Surg Bed Projections: Overview and Methodology in Delaware

This resource provides an overview of past med/surg bed projections in Delaware and explores the methodological details specific to Delaware that impact these projections. It also walks through the calculation steps and discusses the possibility of revising the projection procedures.

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Med/Surg Bed Projections: Overview and Methodology in Delaware

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  1. Med/Surg Bed Projections Delaware Health Resources Board April 25, 2013

  2. 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

  3. 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

  4. 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)

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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Med/Surg Calculation steps Examples: (1) Beebe Medical Center, 2011-2016 (2) Wilmington Hospital, 2011-2016

  11. 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

  12. 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

  13. Step 1:Calculate Average Daily Census (ADC) for Base Year Eliminate Pediatric Cases & Create the 15-64 Age Category

  14. Step 1:Calculate Average Daily Census (ADC) for Base Year Eliminate Pediatric Cases & Create the 15-64 Age Category

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

  16. 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

  17. 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

  18. 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

  19. 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

  20. Step 2: Calculate Projected Average Daily Census (ADC) • Calculate Projected Population Changes

  21. Step 2: Calculate Projected Average Daily Census (ADC) • Calculate Projected Population Changes

  22. Step 2: Calculate Projected Average Daily Census (ADC) • Calculate Population Change Factor (PCF)

  23. Step 2: Calculate Projected Average Daily Census (ADC) • Calculate Population Change Factor (PCF)

  24. 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).

  25. 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

  26. Step 2: Calculate Projected Average Daily Census (ADC) • Use PCF to Calculate Projected ADC

  27. 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

  28. 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?

  29. Step 3: Calculate Projected Bed Need

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

  31. A Few points for consideration

  32. 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

  33. 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.

  34. Point for Consideration: The Influence of Base Year ADC on Projections Med/Surg ADC by Hospital, 2003-2010

  35. Point for Consideration: The Influence of Base Year ADC on Projections Med/Surg ADC by Hospital, 2003-2010

  36. Point for Consideration: Excluding A.I. DuPont from NCC Bed Projections

  37. Point for Consideration: Excluding A.I. DuPont from NCC Bed Projections

  38. Point for Consideration: Excluding A.I. DuPont from NCC Bed Projections

  39. 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

  40. Point for Consideration: Excluding Med/Surg Pediatric Patient Days

  41. 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

  42. 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

  43. end

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