DISEASE CATEGORY ANALYSIS
RESPIRATORY DISEASE
IV.
DISEASE CATEGORY ANALYSIS
A.
•
•
•
•
Rates of respiratory disease are higher in Delaware relative to national rates.
-
Delaware has an eight percent to 21 percent higher trachea, bronchus, and lung
cancer death rate than all benchmark communities1.
-
Delaware’s lung and bronchus cancer incidence rate of 77.3 per 100,000 persons is
43 percent higher than the national rate.
The rate of infectious diseases affecting the respiratory system in Delaware has
decreased, but is still higher than some benchmark communities.
-
There were 31.0 deaths per 100,000 persons due to pneumonia and influenza in 1997,
which is higher than the rates in Maryland, New Jersey and Washington State, but
fifteen percent lower than Pennsylvania’s rate and four percent below the nation’s rate.
-
Delaware tuberculosis cases per 100,000 persons declined from 7.8 per 100,000
persons in 1995 to 5.3 per 100,000 persons in 1997. The rate of new cases of
tuberculosis in Delaware (5.3 per 100,000 persons in 1997) is lower than most
benchmarks, but remains above the Healthy People 2000 objective of 3.5 per 100,000
persons.
Delaware residents receive the vast majority of their physician and inpatient care for
respiratory conditions from Delaware providers.
-
Ninety-three percent of all inpatient admissions for respiratory conditions are in-area
admissions, the majority of which occur in New Castle County. When Delaware
residents leave the state for respiratory care, they generally seek treatment in Maryland.
-
Delaware had 16 physicians specializing in treating pulmonary conditions in 1997
(0.85 percent of all physicians), which is comparable to the national distribution.
Delaware residents utilize inpatient services at higher rates for respiratory diseases
than most benchmark communities.
-
1
RESPIRATORY DISEASE
Respiratory system diagnoses account for a substantial portion of Delaware’s inpatient
utilization, representing 10.3 percent of total inpatient days (the second highest of all
Major Disease Categories [MDCs]) and 9.4 percent of total admissions (the fourth
highest of all MDCs).
The five-year average mortality rate for trachea, lung, and bronchus cancer in Delaware was 48.5
550
THE LEWIN GROUP, INC .
DISEASE CATEGORY ANALYSIS
RESPIRATORY DISEASE
Ø Delaware residents were admitted more often in 1997 to inpatient facilities for
respiratory diseases relative to most benchmark communities. The admission rate
for Delaware is between one percent and 57 percent higher in four benchmark
communities, but lower than the national rate.
ISSUE FOR FUTURE STUDY
•
-
Delaware residents’ inpatient admission rate for
pneumonia/pleurisy is slightly higher than that of
benchmark communities.
-
Delaware residents are admitted for
tracheostomy procedures at a rate 14 percent to
242 percent higher than all benchmark
communities.
Delaware residents experience higher than average asthma rates.
-
Estimated prevalence rates for asthma based on self-reported survey information for
Delaware residents are higher than the national estimate of prevalence rates for this
disease. The difference in prevalence rates is greatest for Delaware residents under
age 45.
-
The pediatric asthma hospital admission rate
(5.47 per 1,000 persons) is 12 percent to 75
percent higher than comparison community rates,
but comparable to the national rate.
-
•
2
To better understand the significance
of Delaware’s higher rate of hospital
admissions for tracheostomy
procedures, research and data
analysis is needed in a number of
areas, including the underlying
diagnosis, precipitating cause of the
procedure, age distribution and
clinical practice patterns.
The majority of asthma patients in Delaware may
need additional counseling and resources to
manage their asthma. The Delaware Health
Assessment Survey found that 58 percent of
asthma patients are counseled on what to do if
they have a severe flare up, 50 percent are taught
how to adjust their medication when their asthma
gets worse and 55 percent are educated on
common allergens and irritants and how to avoid
them.
ISSUE FOR FUTURE STUDY
The NAEP guidelines specify that
health care providers should educate
all asthmatic patients about what to
do if a severe episode of asthma
occurs, how to adjust medications
when asthma worsens and what
environmental precipitants or
exposures can make asthma worse
and how to avoid them. Delaware
residents are experiencing higher
than average rates of asthma and
admissions for the disease, but only
slightly more than half are receiving
education consistent with NAEP
guidelines.
Admission rates for two “high volume” respiratory system diagnoses pose particular
concern for Delaware residents.
-
Chronic Obstructive Pulmonary Disease (COPD) accounts for 1.7 percent of total
inpatient days in Delaware. The admission rate per 1,000 persons for COPD is between
four percent and 83 percent higher than most benchmark communities, yet slightly lower
than the national rate.
-
The COPD mortality rate of 21.2 deaths per 100,000 persons is six percent to 29
percent higher than Maryland, New Jersey and Pennsylvania, comparable to the
national rate but below the Healthy People 2000 objective 2. The Kent County COPD
The five-year average mortality rate for COPD in Delaware was 21.4.
551
THE LEWIN GROUP, INC .
DISEASE CATEGORY ANALYSIS
RESPIRATORY DISEASE
mortality rate of 29.7 per 100,000 persons is twice that of Sussex County and slightly
higher than New Castle County.
-
•
Simple pneumonia and pleurisy with complicating conditions account for 1.9
percent of total admissions and 2.2 percent of total inpatient days in Delaware.
Delaware residents experience a high admission rate for simple pneumonia compared to
Seattle, WA and Washington State but a comparable admission rate to all other
benchmark communities.
Average charges for respiratory system disorder admissions and tracheostomy are
within the range of benchmark communities.
-
Average charges for respiratory system disorders per admission in Delaware is 22
percent to 28 percent higher than Maryland, Washington State and Seattle, WA but
lower than the rates of Pennsylvania and San Joaquin, CA.
-
Tracheostomy charges per admission are 24 percent to 59 percent higher than
Washington State, Maryland and Seattle, WA but lower than the rates for Pennsylvania
and San Joaquin, CA.
552
THE LEWIN GROUP, INC .
Exhibit IV-A-1:
Delaware experienced a higher trachea, bronchus, and lung cancer death rate
compared to benchmarks.
Trachea, Bronchus, and Lung Cancer Deaths per 100,000 Persons(a) 1997
% Over/(Under)
Benchmark
Delaware
57.3
U.S.
Norms
50.0
Maryland
53.0
New Jersey
15%
8%
20%
47.7
Comparison
Communities
Pennsylvania
50.3
47.3
Washington State
Consensusbased
Standard
Healthy People 2000
14%
21%
53.0
8%
Sources:
1-6) 1997 data, U.S. National Center for Health Statistics; CDC, CDC Wonder Data Extraction Software; 7) Healthy People 2000 Objectives.
Notes:
(a) Death rates are age-adjusted to the 1970 U.S. national population.
(b) Although Delaware uses five-year averages to compensate for small sample size, one-year rates are used here so that Delaware can be compared to benchmarks. The five-year average mortality rate for trachea, bronchus, and lung cancer in Delaware was
48.5.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
553
THE LEWIN GROUP, INC.
Exhibit IV-A-2:
The new case rate for lung and bronchus cancer experienced by Delaware
residents was 43 percent higher than the national rate.
Trachea, Bronchus, and Lung Cancer Incidence Rates per 100,000 Persons1993 - 1997 Pooled Data
% Over/(Under)
Benchmark
Delaware
77.3
U.S.(a)
Norms
54.2
Sources:
(1) 1993 - 1997 data, Delaware Division of Public Health, Epidemiology Branch; 2) 1995 data, National Cancer Institute, SEER Cancer Statistics Review 1973 - 1995.
Notes:
(a) Incidence rates are age-adjusted to the 1970 U.S. national population.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
554
Mental Health
43%
THE LEWIN GROUP, INC.
Exhibit IV-A-3:
Delaware’s pneumonia and influenza death rate was comparable to most
benchmarks.
Pneumonia and Influenza Deaths per 100,000 Persons(a) 1997
% Over/(Under)
Benchmark
31.0
Delaware
Norms
(4%)
32.3
U.S.
Maryland
28.5
9%
29.3
New Jersey
6%
Comparison
Communities
36.4
Pennsylvania
29.4
Washington State
Sources:
1997 data, U.S. National Center for Health Statistics, CDC Wonder Data Extraction Software.
Notes:
(a) Death rates are age-adjusted (except for U.S. rates which are age-sex adjusted) to the 1940 U.S.national population.
(15%)
5%
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
555
THE LEWIN GROUP, INC.
Exhibit IV-A-4:
From 1995 to 1997, Delaware experienced a decrease in tuberculosis cases
that paralleled the decrease in the U.S. tuberculosis case rate.
Tuberculosis Cases per 100,000 Persons 1995 to 1997
10
8.7
9
8.0
7.4
8
7
7.8
6
5
5.9
5.3
4
3
2
U.S.
1
Delaware
0
1995
Sources:
1996
1997
1995 - 1996 data, Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 1996; 1997 data Centers for Disease Control and Prevention, Tuberculosis Morbidity 1997, MMWR; 47(13) 1998.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
556
THE LEWIN GROUP, INC.
Exhibit IV-A-5:
The incidence of tuberculosis in Delaware was lower than most benchmarks
but above the Healthy People 2000 objective.
New Tuberculosis Cases per 100,000 Persons 1997
% Over/(Under)
Benchmark
Delaware
5.3
U.S.
Norms
(28%)
7.4
Maryland
6.7
New Jersey
(21%)
8.9
(40%)
Comparison
Communities
Pennsylvania
4.4
Washington State
Consensusbased
Standard
Sources:
20%
5.4
Healthy People 2000
3.5
(2%)
51%
1-6) 1997 data, U.S. National Centers for Disease Control and Prevention. Tuberculosis Morbidity - United States, 1997, MMWR; 47(13) 1998; 7) Healthy People 2000 Objective.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
557
THE LEWIN GROUP, INC.
Exhibit IV-A-6:
Ninety-three percent of all inpatient admissions for respiratory conditions are
in-area admissions, the majority of which occur in New Castle County.
Percent of Admissions to Selected Counties Respiratory System Disorders 1997
In-area Admissions
Out-of-area Admissions
Other MD Counties 6.6%
Sussex County
25.2%
Philadelphia
County, PA
13.9%
Worcester County, MD
9.2%
New Castle County
61.2%
Other
PA Counties
7.0%
Wicomico
County, MD
32.5%
Total = 7,926
93% of All Respiratory System
Disorders
Source:
Delaware
County, PA
15.1%
Cecil County, MD
9.2%
Kent County
13.6%
Baltimore City, MD
6.5%
Total = 610
7% of All Respiratory System
Disorders
1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
558
THE LEWIN GROUP, INC.
Exhibit IV-A-7:
The proportion of the physicians specializing in pulmonary care in Delaware is
comparable to the national norm.
Percent of Pulmonary Specialists Delaware and U.S. 1999
Delaware
Norms
Source:
0.85%
U.S.
0.88%
American Medical Association, Physician Characteristics and Distribution in the U.S., 1999.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
559
THE LEWIN GROUP, INC.
Exhibit IV-A-8:
Respiratory system diagnoses represent 10.3 percent of total inpatient days
and 9.4 percent of total admissions.
Top MDCs by Percent of Total Admissions and Days 1997
Rank
(Admissions)
Rank
(Days)
Percent
of Admissions
Percent
of Days
1
1
5: Circulatory System
17.3%
16.3%
2
8
14: Pregnancy and Childbirth
11.8%
5.8%
3
5
15: Newborns and Neonates
10.0%
6.8%
4
2
4: Respiratory System
9.4%
10.3%
5
3
6: Digestive System
8.0%
8.9%
6
6
8: Musculoskeletal System
7.5%
6.3%
7
7
1: Nervous System
5.7%
6.2%
8
4
19: Mental Diseases and Disorders
5.3%
8.8%
25.0%
30.6%
MDC Description
All Other MDCs
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group
Inc.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
560
THE LEWIN GROUP, INC.
Exhibit IV-A-9:
Utilization of inpatient days for Delaware residents for respiratory system
disorders was within the range of benchmarks.
Days per 1,000 Person MDC 4: Respiratory System 1997
Data Not Severity Adjusted
% Over/(Under)
Benchmark
Delaware
64.5
U.S.
Norms
81.5
Maryland
72.9
Washington State
38.2
San Joaquin, CA
62.1
Seattle, WA
36.0
Wichita, KS
37.5
4%
79%
62.7
M&R Moderate
(12%)
69%
Comparison
Communities
Consensusbased
Standard
5%
61.6
Pennsylvania
(21%)
3%
72%
Sources:
1) 1997 data, Delaware H ealth Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3)
1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6)
California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data; 9) 1997 data, Milliman & Robertson Healthcare Management Guidelines (Volume I: Inpatient and
Surgical Care, updated December 1997).
Notes:
(a) Days per 1,000 persons is calculated from the admissions per 1,000 persons and the average length of stay. Benchmark community rates are age/sex-adjusted to the Delaware population and case-mix adjusted to control for differences in types of hospital admissions.
However, M&R rates are age-adjusted only (gender-specific utilization data were not available). M&R rates are adjusted to control for differences in the inpatient experience of Delaware residents.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
561
THE LEWIN GROUP, INC.
Exhibit IV-A-10:
Over one-tenth of inpatient days provided to Delaware residents are for
respiratory system diagnoses.
Hospital Days by Top MDCs 1997
Data Not Severity Adjusted
Circulatory System 16.3%
Other MDCs
36.4%
Respiratory System 10.3%
Digestive System 8.9%
Neurological System 6.2%
Musculoskeletal System 6.3%
Sources:
Mental Diseases and Disorders 8.8%
Newborns/Neonates 6.8%
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group
Inc.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
562
THE LEWIN GROUP, INC.
Exhibit IV-A-11:
Delaware residents experienced an admission rate for respiratory system
disorders slightly lower than the national rate, but slightly higher than most
other benchmarks.
Admissions per 1,000 Persons MDC 4: Respiratory System 1997
% Over/(Under)
Benchmark
Delaware
11.6
U.S.
Norms
13.2
Maryland
11.5
12.3
Pennsylvania
Comparison
Communities
Washington State
8.2
San Joaquin, CA
Consensusbased
Standard
10.7
7.4
M&R Moderate
(6%)*
5%*
51%*
7.7
Wichita, KS
1%
41%*
11.0
Seattle, WA
(12%)
8%*
57%
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3)
1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6)
California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data; 9) 1997 data, Milliman & Robertson Healthcare Management Guidelines (Volume I: Inpatient and Surgical Care, updated
December 1997).
Notes:
(a) Benchmark community rates are age/sex-adjusted to the Delaware population. However, M&R rates are age-adjusted only (gender-specific utilization data were not available).
* = statistically significant at the 0.05 level. Statistical significance is not calculated for M&R Moderate.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
563
THE LEWIN GROUP, INC.
Exhibit IV-A-12:
The three Delaware counties had similar utilization rates of inpatient days for
respiratory system disorders.
Days per 1,000 Persons MDC 4: Respiratory System 1997
Data Not Severity Adjusted
New
Castle
62.5 Days/1,000
Kent
69.9 Days/1,000
N
Sussex
67.0 Days/1,000
W
E
S
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.
Notes:
(a) Days per 1,000 persons is calculated from the admissions per 1,000 persons and the average length of stay. County rates are age/sex-adjusted to the Delaware population. County-specific rates are also case-mix adjusted to Delaware to control for
differences in types of hospital admissions.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
564
THE LEWIN GROUP, INC.
Exhibit IV-A-13:
New Castle County residents experienced a lower admission rate for
respiratory system disorders than residents of other counties.
Admissions per 1,000 Persons MDC 4: Respiratory System 1997
New
Castle
10.8 Admissions/1,000
Kent
12.4 Admissions/1,000
N
Sussex
13.2 Admissions/1,000
W
E
S
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.
Notes:
(a) County-specific rates are age/sex-adjusted to the Delaware population.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
565
THE LEWIN GROUP, INC.
Exhibit IV-A-14:
Delaware’s inpatient admission rate for pneumonia/pleurisy was slightly higher
than those of benchmarks.
Pneumonia/Pleurisy Inpatient Admission Rate per 1,000 Persons 1997
Delaware
3.44
U.S. (a)
Norms
% Over/(Under)
Benchmark
3.93
5%
3.29
Maryland (a)
Pennsylvania (a)
2.67
29%*
2.72
Washington State (a)
(12%)*
26%*
Comparison
Communities
San Joaquin, CA (a)
9%*
3.17
Seattle, WA (a)
44%*
2.39
3.58
Wichita, KS (a)
(4%)
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3)
1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997
California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association.
Notes:
(a) Benchmarks were age-adjusted to the Delaware population.
* = statistically significant at the 0.05 level.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
566
THE LEWIN GROUP, INC.
Exhibit IV-A-15:
Delaware residents were admitted for tracheostomy procedures at a rate 14
percent to 242 percent higher than benchmarks.
Admissions per 1,000 Persons DRG 483: Tracheostomy Except for Face, Mouth and Neck Diagnoses 1997
% Over/(Under)
Benchmark
Delaware
0.41
U.S.
Norms
0.23
78%*
0.36
Pennsylvania
Washington State
Comparison
Communities
24%*
0.33
Maryland
242%*
0.12
San Joaquin, CA
0.29
0.13
Seattle, WA
Wichita, KS
14%*
41%*
215%*
0.14
193%*
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3)
1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1996 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997
California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data.
Notes:
(a) Benchmark community rates are age/sex adjusted to the Delaware population.
* = statistically significant at the 0.05 level.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
567
THE LEWIN GROUP, INC.
Exhibit IV-A-16:
Estimated asthma rates in Delaware are above the national prevalence
estimates.
Prevalence of Asthma Delaware and U.S.
Condition
Delaware
(2000)
U.S.
(1996)
Percent Above
U.S. Benchmark
13.2%
5.9%
124%
9.9%
4.9%
102%
10.2%
4.6%
122%
Asthma
< 45 Years of Age
45 – 64 Years of Age
> 65 Years of Age
Sources:
1) The Lewin Group, Inc., Delaware Community Assessment: Health Assessment Survey, 2000; 2) 1996 National Health Interview Survey.
Notes:
Delaware prevalence estimates do not include respondents for whom age could not be calculated because birth date was missing. The methodology used in the Health Assessment Survey to determine prevalence of disease in the Delaware community is
different from the methodology used to determine national prevalence. National prevalence estimates also predate survey estimates by several years. Four patients with no age reported having asthma. N/A denotes data is not available.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
568
THE LEWIN GROUP, INC.
Exhibit IV-A-17:
The inpatient admission rate for pediatric asthma in Delaware was significantly
higher than most benchmark communities but comparable to the nation.
Pediatric Asthma Inpatient Admission Rate per 1,000 Persons Age 0 to 17 1997
% Over/(Under)
Benchmark
Delaware
5.47
U.S. (a)
5.58
Norms
30%*
4.22
Maryland (a)
Pennsylvania (a)
4.88
Washington State (a)
(2%)
12%*
75%*
3.13
Comparison
Communities
San Joaquin, CA (a)
3.32
65%*
Seattle, WA (a)
3.50
56%*
Wichita, KS (a)
3.57
53%*
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3)
1997 Maryland hospital discharge data, Health Services Cost Review Commission; 4) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997
California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association.
Notes:
(a) Benchmarks were age-adjusted to the Delaware population, aged 0 to 17.
* = statistically significant at the 0.05 level.\
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
569
THE LEWIN GROUP, INC.
Exhibit IV-A-18:
COPD accounts for 1.7 percent of total inpatient days in Delaware.
Top DRGs by Number of Days 1997
DRG
Code
Percent
of Total Days
DRG Description
430
Psychoses
6.3%
462
Rehabilitation
5.1%
127
Heart Failure and Shock
3.2%
483
Tracheostomy Except for Face, Mouth and Neck Diagnoses
2.8%
373
Vaginal Delivery without Complicating Conditions, Age > 17
2.6%
148
Major Small and Large Bowel Procedures with Complicating Conditions
2.4%
391
Normal Newborn
2.3%
89
Simple Pneumonia and Pleurisy with Complicating Conditions, Age > 17
2.2%
14
Specific Cerebrovascular Disorders except TIA
2.1%
88
Chronic Obstructive Pulmonary Disease
1.7%
All Other DRGs
69.3%
Total Days = 460,396
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
570
THE LEWIN GROUP, INC.
Exhibit IV-A-19:
Delaware residents’ admission rate for COPD is slightly lower than
Pennsylvania and the nation, but higher than the majority of other benchmark
rates.
Admissions per 1,000 Persons DRG 88: Chronic Obstructive Pulmonary Disease 1997
Delaware
Norms
U.S.
2.22
Maryland
2.28
Washington State
San Joaquin, CA
1.93
4%
83%*
1.10
Wichita, KS
(12%)*
65%*
1.22
Seattle, WA
(9%)*
10%*
1.83
Pennsylvania
Comparison
Communities
% Over/(Under)
Benchmark
2.01
1.59
26%*
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital Discharge Survey; 3)
1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1996 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 6) 1997
California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data.
Notes:
(a) Benchmark community rates are age/sex adjusted to the Delaware population.
* = statistically significant at the 0.05 level.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
571
THE LEWIN GROUP, INC.
Exhibit IV-A-20:
In 1997, Delaware’s residents experienced a COPD mortality rate that fell
within the range of benchmarks.
Chronic Obstructive Pulmonary Diseases and Allied Conditions Deaths per 100,000 Persons(a) 1997
% Over/(Under)
Benchmark
Delaware
21.2
U.S.
Norms
21.1
Maryland
0%
20.0
New Jersey
6%
16.4
29%
Comparison
Communities
Pennsylvania
Washington State
Consensusbased
Standard
14%
18.6
(9%)
23.3
Healthy People 2000
Objective
25.0
(15%)
Sources:
1-6) 1997 data, U.S. National Center for Health Statistics; CDC, CDC Wonder Data Extraction Software; 7) Healthy People 2000 Objectives.
Notes:
(a) Death rates are age-adjusted to the 1940 U.S. national population.
(b) Although Delaware uses five-year averages to compensate for small sample size, one-year rates are used here so that Delaware can be compared to benchmarks. The five-year average mortality rate for COPD in Delaware was 21.4.
(c) Healthy People 2000 objective to slow the rising COPD death rate to no more than 25.0 deaths per 100,000 persons.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
572
THE LEWIN GROUP, INC.
Exhibit IV-A-21:
The Kent County COPD mortality rate was nearly twice that of Sussex County
in 1997.
Chronic Obstructive Pulmonary Diseases and Allied Conditions Deaths per 100,000 Persons by County(a) 1997
New
Castle
21.5 Deaths
29.7 Deaths
Kent
Sussex
N
15.3 Deaths
W
E
S
Sources:
1997 data, U.S. National Center for Health Statistics; CDC, CDC Wonder Data Extraction Software.
Note:
(a) Death rates are age-adjusted to the 1940 U.S. national population.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
573
THE LEWIN GROUP, INC.
Exhibit IV-A-22:
Simple pneumonia and pleurisy with complicating conditions account for 1.9
percent of admissions in Delaware.
Top DRGs by Number of Admissions 1997
DRG
Code
DRG Description
Percent of Total
Admissions
373
Vaginal Delivery without Complicating Conditions
6.9%
391
Normal Newborn
6.3%
430
Psychoses
3.5%
127
Heart Failure and Shock
3.0%
462
Rehabilitation
2.0%
Simple Pneumonia and Pleurisy with Complicating Conditions, Age > 17
1.9%
143
Chest Pain
1.8%
371
Cesarean Section without Complicating Conditions
1.7%
390
Neonate with Other Significant Problems
1.7%
209
Major Joint and Limb Reattachment Procedures of Lower Extremity
1.7%
89
All Other DRGs
69.5%
Total Admissions = 90,804
Sources:
Inc.
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
574
THE LEWIN GROUP, INC.
Exhibit IV-A-23:
Delaware residents experienced a high admission rate for simple pneumonia
compared to Seattle, WA and Washington State, but a comparable admission
rate compared to other benchmarks.
Admissions per 1,000 Persons DRG 89: Simple Pneumonia and Pleurisy with Complicating
Conditions, Age > 17 1997
Delaware
2.30
U.S.
2.45
% Over/(Under)
Benchmark
(6%)*
Norms
Maryland
2.29
0%
Pennsylvania
2.29
0%
1.83
Washington State
Comparison
Communities
San Joaquin, CA
26%*
7%
2.14
Seattle, WA
40%*
1.57
Wichita, KS
2.37
(3%)
Sources:
1) 1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 2) 1995 data, National Hospital
Discharge Survey; 3) 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group Inc.; 5,7) 1996 data, Comprehensive Hospital Abstract Reporting System
(CHARS) database; 6) 1997 California hospital discharge data, Office of Statewide Health Planning and Development (OSHPD); 8) 1997 data, Kansas Hospital Association data.
Notes:
(a) Benchmark community rates are age/sex adjusted to the Delaware population.
* = statistically significant at the 0.05 level.
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
575
THE LEWIN GROUP, INC.
Exhibit IV-A-24:
Average charges for respiratory system disorders in Delaware fell within the
range of benchmarks.
Charge per Admission (all payors) MDC 4: Respiratory System 1997
% Over/(Under)
Benchmark
Delaware
$9,672
Maryland
$18,222
Pennsylvania
Comparison
Communities
32%
$7,302
Washington State
22%
$7,932
San Joaquin, CA
$18,143
Seattle, WA
$7,570
(47%)
(47%)
28%
Sources:
1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 2) 1997 Maryland hospital discharge data, Health Services
Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 4,6) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 5) 1997 California hospital discharge data, Office of Statewide Health
Planning and Development (OSHPD).
Notes:
(a) All payors charges: figures include charges associated with hospital discharge records, regardless of payor or age of patient.
(b) Benchmarks were case mixed to control for differences in types of hospital admissions. Benchmarks were also adjusted to contr ol for geographic differences in operating costs using 1997 wage index data from the US Department of Health and Human Services (Federal
Register, v.62(168), August 29, 1997).
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
576
THE LEWIN GROUP, INC.
Exhibit IV-A-25:
Delaware’s tracheostomy charge per admission was within the range of
benchmarks.
Charge per Admission (all payors) DRG 483: Tracheostomy Except
Face, Mouth and Neck Diagnoses 1997
% Over/(Under)
Benchmark
Delaware
$156,937
Maryland
$98,776
Pennsylvania
Comparison
Communities
59%
$249,597
(37%)
24%
$126,671
Washington State
San Joaquin, CA
$264,376
Seattle, WA
$115,411
(41%)
36%
Sources:
1997 data, Delaware Health Statistics Center; 1997 Maryland hospital discharge data, Health Services Cost Review Commission; 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 2) 1997 Maryland hospital discharge data,
Health Services Cost Review Commission; 3) 1997 Pennsylvania Health Care Cost Containment data, SMG Marketing Group, Inc.; 4,6) 1997 data, Comprehensive Hospital Abstract Reporting System (CHARS) database; 5) 1997 California hospital discharge
data, Office of Statewide Health Planning and Development (OSHPD).
Notes:
(a) All payors charges: figures include charges associated with hospital discharge records, regardless of payor or age of patient.
(b) Benchmarks were adjusted to c ontrol for geographic differences in operating costs using 1997 wage index data from the US Department of Health and Human Services (Federal Register, v.62(168), August 29, 1997).
DISEASE CATEGORY ANALYSIS
Respiratory Disease
Cardiovascular Disease
Mental Health
577
THE LEWIN GROUP, INC.