Medical Discharges

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Atlas Data – Hospital Discharges and Post-Acute Care – Selected Medical Discharge Rates

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For patients with medical conditions, geography matters; patients with medical conditions receive very different care depending upon where they live. Why does care vary so much? The most obvious explanation might seem to be regional differences in how sick patients are. But the prevalence and severity of illness accounts for remarkably little of the variation in care.

Denominator Definition
100% of Medicare enrollees age 65-99 with full Part A entitlement and no HMO enrollment during the measurement period. Age, gender, race, and eligibility are determined using the Denominator file.

Numerator Definition
Number of medical discharges
DRGs classified as “medical” according to Medicare DRG definitions (CMS-DRG & MS-DRG).

Ambulatory Care-Sensitive (ACS) Conditions
Numerator counts are based on ICD-9-CM diagnosis codes. Surgical codes are usually excluded to ensure that the admission was for a medical condition. Conditions: Convulsions (780.3x): Chronic Obstructive Pulmonary Disease (COPD) (491xx, 492xx, 494xx, 496xx, 466.0x: 466.0x only w/secondary dx 491xx, 492xx, 494xx, 496xx): Bacterial Pneumonia (481xx, 482.2x, 482.3x, 482.9x, 483xx, 485xx, 486xx: excl. secondary dx 282.6x): Asthma (493xx): Congestive Heart Failure (CHF) (428xx, 402.01, 402.11, 402.91, 518.4x: excl. sx 36.01, 36.02, 36.05, 36.1x,37.5x, or 37.7x): Hypertension (401.0x, 401.9x, 402.00, 402.10, 402.90: excl. sx 36.01, 36.02, 36.05, 36.1x,37.5x, or 37.7x): Angina (411.1x, 411.8x, 413xx: excl. sx 01-86.99): Cellulitis (681xx, 682xx, 683xx, 686xx: excl. sx 01-86.99, unless 86.0x is the first and only sx code): Diabetes (250.0x, 250.1x, 250.2x, 250.3x, 250.8x, 250.9x): Gastroenteritis (558.9x): Kidney/Urinary Infection (590xx, 599.0x, 599.9x): Dehydration (276.5x).

Adjustments
Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard.