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The data collected for this website by the Florida Agency for Health Care Administration (AHCA) comes from information hospitals record primarily for billing purposes. This type of record, referred to as "administrative data," consists of diagnoses and procedures along with information about the patient's age, gender, and discharge status. Inpatient data consists of those patients admitted to a hospital who require at least one overnight stay. The inpatient data reflects only the care provided to patients who were discharged from the hospital in a 12 month (1 year) time period. Due to low volume, pediatric inpatient data represents 3 years of data. When less than 30 patients in a facility had a specific procedure no data is included for charges and length of stay due to statistical significance, and an X is inserted. When there are less than 5 patients, total hospitalizations (volume), charges, length of stay and readmissions are denoted by ‘Too few cases’. This is to protect confidential patient information, as well as ensure the validity of the data.

Ambulatory Surgery (Outpatient) Data

The Ambulatory (Outpatient) Surgery data collected by the Florida Agency for Health Care Administration (AHCA) comes from information on outpatient facilities, including hospitals, freestanding ambulatory surgery centers and treatment centers record primarily for billing purposes. Ambulatory Surgery is an operative procedure, performed either in a hospital or in a freestanding facility, which does not require an overnight stay in a hospital. This type of record, referred to as "outpatient administrative data," consists of diagnoses and procedures along with information about the patient's age, gender, and discharge status. The ambulatory surgery data reflects only the care provided to patients on an outpatient basis in a 12 month (1 year) time period. When there are less than 5 patients, total visits (volume) and charges are denoted by ‘Too few cases’. When less than 30 patients in a facility had a specific procedure no data is included due to statistical significance, and (an X is inserted) as a further step to protect confidential patient information, as well as ensure the validity of the data.

Selecting cases to include in data reporting

All cases reported to the Agency for Health Care Administration (AHCA) for short-term acute care hospitals and ambulatory (outpatient) surgery centers were used in this analysis. A small number of cases could not be categorized (not enough information to determine in which category they should be included), but these cases were negligible.

Ambulatory (Outpatient) Surgery Center Facility Types

Cardiac Catheterization Facility

A freestanding facility employing or contracting licensed health care professionals to provide diagnostic services for cardiac conditions such as cardiac catheterization or balloon angioplasty. Cardiac catheterization facilities located in certain hospitals may also provide therapeutic services such as insertion of stents or balloon angioplasty.

Cardiac catheterization involves passing a catheter (a thin flexible tube) into the right or left side of the heart. In general, this procedure is performed to obtain diagnostic information about the heart or its blood vessels or to provide treatment in certain types of heart conditions.
Angioplasty (also known as percutaneous cardiovascular intervention) is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart (coronary arteries).
Stents are small spring-like objects placed in the vessels of the heart designed for the purpose of opening narrowed or blocked blood vessels of the heart.

Freestanding Ambulatory Surgery Center (FASC)

A facility dedicated solely to the provision of surgery on an outpatient basis. FASCs are usually operated independently of a hospital.

Hospital Based Ambulatory Surgery Centers

The unit in a hospital that provides surgery on an outpatient basis. The surgical procedure may be provided in the hospital's main operating rooms, or the hospital may have a separate location within the facility used explicitly for outpatient surgery.

Lithotripsy Facility

A freestanding facility that employs or contracts with licensed health care professionals to provide diagnosis or treatment services using electro-hydraulic shock waves. Lithotripsy is a technique that uses shock waves to break down stones forming in the kidney, bladder, ureters, or gallbladder.

Inpatient Mortality Indicators - General Overview

What do the mortality indicators mean?

For many years, the federal government has supported research into what factors affect quality of health care services, including care delivered in hospitals. The United States Agency for Healthcare Research and Quality (AHRQ, www.qualityindicators.ahrq.gov) has conducted extensive research and developed software that analyzes administrative data and assesses performance on certain indicators which studies have shown correlation to higher quality of care. Research can predict an expected range of patient deaths for a given procedure or condition. Mortality rates above or below the expected range may have quality implications.

AHRQ has developed these inpatient mortality indicators with the intention they would be used for researching national, statewide, regional and hospital-specific performance. They represent the current state-of-the-art in assessing quality of care using administrative data. As noted by the Centers for Medicare and Medicaid services, these indicators must be used 'cautiously' for public reporting.

Important: This data is based on administrative data. Recording administrative data - or coding - varies among hospitals. Codes do not provide specific details about a patient's condition at the time of admission, nor capture everything that occurs during the hospital stay. Especially when reviewing mortality rates, remember that medicine is not an exact science and death may occur even when all standards of care are followed. These reports provide some information about hospital performance, but consider the limitations of the data in your decision-making process. AHCA recommends that consumers discuss these data with their physician.

Inpatient Mortality Indicators - Definitions

Mortality Inpatient Procedures

Abdominal Aortic Aneurysm Repair (AAA) Mortality

The abdominal aorta is the major blood vessel from the heart that supplies blood to most of the major organs and the legs. Surgery is usually performed to prevent rupture of a ballooning vessel (aneurysm). Patients requiring this procedure usually have disease of other major vessels as well, which may lead to stroke or heart attack during or after the major surgery required to repair the abdominal aorta. This surgery usually is performed by surgeons who specialize in repair of blood vessels, and at hospitals where other specialists are available to deal with the expected complications. The type of aneurysm and other patient-related factors greatly affect the mortality rate for this procedure. It is not certain that administrative data always contain enough information to account for these factors. See Methodology.

Carotid Endarterectomy Mortality (Surgical Removal of the Lining of Carotid Artery)

Carotid Endarterectomy or carotid artery surgery is a procedure to restore proper blood flow to the brain. The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). A blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood. This is a fairly common procedure that requires proficiency with the use of complex equipment; and technical errors may lead to clinically significant complications, such as abrupt carotid occlusion with or without stroke, myocardial infarction, and death. As noted in the literature, higher volume hospitals have lower mortality and postoperative stroke rates than lower volume hospitals. See Methodology.

Coronary Artery Bypass Graft (CABG) Mortality

Coronary artery bypass graft (CABG) surgery reroutes or 'bypasses' blood around clogged arteries to improve the supply of oxygenated blood to the heart. Thousands of bypass surgeries are performed each year and the death rate is relatively low. However, this relatively common procedure requires a high level of skill. Studies have shown that physicians and hospitals performing higher volumes of these procedures, thus having more experience, are more likely to have better outcomes. The experience level of the physician and staff are important questions a consumer should consider. See Methodology.

Craniotomy Mortality (Surgical opening of the skull)

Craniotomy (surgical opening of the skull) for repair of aneurysms (ballooning or bursting of blood vessels) is a demanding operation that is almost always associated with high risk of disability or death. Nevertheless, it may be the only option available when a blood vessel ruptures deep in the brain. The mortality rate for this operation may be high even in the hands of an extremely experienced neurosurgeon and neurosurgical team, who are likely receiving the more difficult cases by referral. The adjustments used in this report to equalize 'risk' may not fully reflect the many types of risk associated with this complex surgery, which often is performed on an emergency basis. See Methodology.

Esophageal Resection Mortality (Surgical Removal of the Throat)

Surgery on the esophagus (the tube that carries food from the mouth to the stomach) is difficult, and requires an experienced surgeon and surgical team. The removal of the esophagus (usually for cancer) involves manipulation of vital organs in both the chest and the abdomen, together with reconstruction of a way to replace the function of the esophagus. This procedure is rarely done and few hospitals do even one such operation in a year. See Methodology.

Hip Replacement Mortality

Planned replacement of a diseased hip joint with an artificial joint is a common procedure to treat disabling pain or improve hip function. The mortality rate is low for this procedure, as would be expected in a procedure designed to improve function rather than extend life. The patients are often elderly, and many have multiple medical conditions. See Methodology.

Pancreatic Resection Mortality (Surgical Removal of the Pancreas)

Surgical removal of the pancreas, the organ in the abdomen that supplies insulin and digestive enzymes, is a demanding operation in which complications and death occur even in the most experienced of hands. This may be the only treatment option for those with cancer of the pancreas. This procedure is rarely done and few hospitals do even one such operation in a year. See Methodology.

PTCA Mortality

Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. It is a relatively common procedure that requires proficiency with the use of complex equipment, and technical errors may lead to clinically significant complications. As noted in the literature, higher volumes of PTCA have been associated with fewer deaths and post-procedural coronary artery bypass grafts (CABG). See Methodology.

Mortality Inpatient Conditions

Acute Myocardial Infarction (Heart Attack)

A myocardial infarction is a heart attack. The word 'myocardial' refers to the heart muscle. Infarction refers to tissue death caused by the lack of blood supply. Most heart attacks are caused by a clot that blocks one of the coronary arteries (the blood vessels that bring blood and oxygen to the heart muscle) and an area of the heart muscle becomes damaged. The damaged heart muscle loses its ability to contract, and the remaining heart muscle needs to compensate for that weakened area. It is estimated that approximately 1 million patients visit the hospital each year with a heart attack.

A heart attack is a life-and-death emergency. According to the American Heart Association, if a heart attack victim gets to an emergency room fast enough, prompt care dramatically reduces heart damage. Research findings have resulted in detailed practice guidelines covering all phases of heart attack management. However, administrative data do not indicate how quickly the patient began receiving medical treatment.

This measure excludes any patients that were transferred to another short-term hospital. See Methodology.

Acute Myocardial Infarction (Heart Attack), Without Cases Transferred to or from other Hospitals

This measure excludes any patients who were transferred from a short-term hospital with AMI as well as patients who were transferred to another short-term hospital. Since many hospitals are more specialized, such as teaching hospitals or larger regional hospitals, they receive a disproportionate number of transfers from other hospitals. These cases may be more difficult to manage. For the purpose of providing a more reasonable measure of performance, this particular measure excludes patients who were transferred to, or from, the hospital being measured. See Methodology.

Acute Stroke Mortality

A stroke is a disruption in the blood supply to the brain. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts, or is clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain doesn't get the flow of blood it needs, and the nerve cells in the affected area of the brain cannot function. When nerve cells cannot function, neither can the part of the body they control.

A stroke is a medical emergency. Getting treatment immediately can save lives and reduce disability including paralysis. Treatment varies, depending on the severity and cause of the stroke. For virtually all strokes, hospitalization is required, possibly including intensive care and life support. Some advanced treatments may be helpful only in the first few minutes or hours following the onset of the stroke, but administrative data do not provide this information.

Mortality rates will vary based on the cause of the stroke, the severity of the stroke, other patient illnesses and speed of arrival at the hospital. See Methodology.

Congestive Heart Failure (CHF) Mortality

Congestive Heart Failure (CHF) is one of the most severe heart diseases affecting Americans, and one of the most common reasons for hospitalization. CHF is a disorder in which the heart loses its ability to pump blood efficiently. The term 'heart failure' should not be confused with cardiac arrest, a situation in which the heart actually stops beating. Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly. This condition may affect the right side, left side, or both sides of the heart. Congestion is the presence of an abnormal amount of fluid in the tissues, usually because of limitations in the body's ability to return the flow of blood from the arms or legs to the heart and lungs. With heart failure, many organs do not receive oxygen and nutrients, which damages them and reduces their ability to function properly. Most areas of the body can be affected when both sides of the heart fail.

Though CHF has many possible underlying causes, the end result is an inability of the heart muscle to function well enough to meet the demands of the rest of the body. CHF mortality is influenced greatly by other medical problems, including lung disease, high blood pressure, cancer and liver disease. See Methodology.

Gastrointestinal (GI) Hemorrhage Mortality

Gastrointestinal (GI) hemorrhage refers to the loss of blood from the esophagus, stomach, intestines or colon. While many cases are relatively minor, some are life-threatening or fatal. GI hemorrhage itself is rarely the cause of death. Mortality is more related to the reasons why the bleeding began, along with patient factors, such as age and other illnesses. The evidence for substantial variance in mortality rates due to provider performance is weak. This indicator should be interpreted with caution. See Methodology.

Hip Fracture Mortality

Hip fracture is a common cause for hospitalization in the elderly, and usually happens to individuals with several diseases or disabilities. Many people die in the first six months after hip fracture, and most of these deaths do not occur in the hospital. Older men admitted from nursing homes are the most likely to die of hip fracture in the hospital. The evidence for substantial variance in mortality rates due to provider performance is limited, and this indicator should be interpreted with caution. See Methodology.

Pneumonia Mortality

Pneumonia is a medical condition involving an infection in the lungs. An irritation to the lining of the lungs causes fluid to collect, often making breathing difficult. Pneumonia typically is treated with antibiotics, sometimes in an outpatient setting. Pneumonia can range from mild to severe, even fatal. The severity depends on the type of organism causing pneumonia as well your age and underlying health.

Many people contract pneumonia while staying in a hospital for other conditions. This tends to be more serious because the patient's immune system is often impaired due to the condition that initially required treatment. In addition, there is a greater possibility of infection with bacteria that are resistant to antibiotics. Death may occur even when the patient is in the hospital, especially in patients with weakened respiratory systems or other chronic health problems. See Methodology.

Patient Safety Indicators -Complication and Infection - General Overview

What do the Patient Safety Indicators - Complication and Infection mean?

These are a set of measures that can be used with hospital inpatient discharge data to provide a perspective on patient safety. Specifically, Patient Safety Indicators (PSIs) screen for problems that patients experience as a result of exposure to the healthcare system and that are likely amenable to prevention by changes at the system or provider level. These are referred to as complications or adverse events. The indicators provide a measure of the potentially preventable complications for patients who received their initial care and the complication of care within the same hospitalization. These indicators include only those cases where a secondary diagnosis code flags a potentially preventable complication.

Widespread consensus exists that health care organizations can reduce patient injuries by improving the environment for safety. This may be achieved by implementing technical changes, such as electronic medical record systems, electronic order-entry or improving staff awareness of patient safety risks. Clinical process interventions also have strong evidence for reducing the risk of adverse events related to a patient's exposure to hospital care.

Patient Safety Indicators - Complication and Infection - Definitions

These are a set of measures that can provide one view on patient safety. They provide a measure of complications that patients experienced that might have been potentially preventable for patients who received their initial care and experienced a complication within the same hospitalization.

This training tool can help you learn more about infection control practices and how you can help prevent infections in a hospital setting.

Why is the "risk adjusted rate" important?

This is the rate of problems that patients experienced while in the hospital that might have been able to be prevented. These are called complications or adverse events. The results are described as "lower than expected," "as expected" or "higher than expected".

What the Complication/Infection rate means:

Lower than Expected - Fewer complications/infections than expected given how sick patients were
As Expected - Expected number of complications/infections given how sick patients were
Higher than Expected - More complications/infections than expected given how sick patients were

Pressure Ulcer

A pressure ulcer is commonly called a bed sore or a pressure sore. This type of ulcer can appear when a person stays in one position for a long time without moving. The pressure of the person's weight, especially on bony areas, reduces the blood supply to that area and can cause the tissues beneath it to die. People such as the elderly, who are bedridden, or limited to wheel chairs or with poor circulation are most at risk of developing these pressure sores. The ulcer starts as reddened skin that gets progressively worse.

Two thirds of pressure sores occur in patients older than 70 years, with the most commonly affected sites being the hips and heels. Many of these ulcers can be prevented if detected promptly and treated at an early stage. Health care professionals have identified four stages of bed sores, each one progressively worse. Catching the sore early is vital. You can prevent bed sores by having the proper support, such as a foam or gel pad or mattress. Change position often and avoid lying directly on your hipbones. Cleaning the sore area is also important.

This measure for pressure ulcers shows the rate of pressure or bed sores acquired in the hospital, and is an important indicator of the level of care provided in the hospital, especially to elderly patients. Facilities with a high incidence of bed sores may not be turning patients as often as they should, may be allowing patients to sit up for longer periods than are good for them, or may need an improved system of surveillance for skin breakdown. See Methodology.

Iatrogenic Pneumothorax

An iatrogenic pneumothorax is a collection of air or gas in the pleural space (the space surrounding the lungs). This measure indicates the occurrence of a collapsed lung was possibly due to medical treatment or surgery in or around the chest. Symptoms, which can occur when one is asleep, often begin suddenly and can take the form of chest pain, shortness of breath and abnormal breathing.

Many procedures performed in an intensive care or emergency setting can result in an iatrogenic pneumothorax. These procedures include mechanical ventilation therapy, cardiopulmonary resuscitation and neck surgery. Treatment of pneumothorax is generally with a chest tube.

This measure is intended to flag cases of pneumothorax caused by medical care. The indicator is used to show complications that can result from interventional treatment in the chest area. See Methodology.

Central Venous Catheter-related Bloodstream Infections - PSI 7

This measure indicates the occurrence of serious infection, primarily related to intravenous (IV) lines and catheters. Intravenous line infections are a frequent cause of fever, and less frequently cause a local infection around the insertion site. The longer the IV is in place, the more likely there will be an infection. Catheter infections can be systemic, that is, affecting the whole body, or can be a local infection. They are caused by germs on the skin that enter the body through the catheter tip.

This patient safety measure is important because it indicates the quality of care provided to prevent infections in patients, and also is an indicator of overall hospital and physician cleanliness practices. This indicator is intended to flag cases of infections due to medical care, primarily those related to intravenous (IV) lines and catheters. Patients with potential immunocomprised states, such as AIDS, cancer and transplant, are excluded as they may be more susceptible to such infection. Hospitals following the appropriate procedures, such as washing hands before working with a patient or proper cleaning of the area around the catheter insertion site should show a lower level of infections due to medical care. Care must be taken to exclude patients from this measure who have infections when they enter the hospital, as this does not reflect quality of care delivered at the facility. See Methodology.

Postoperative Hip Fracture

The postoperative hip fracture refers to fractures of the hip that occur following surgery. A break or crack of any size is called a fracture. This measure includes all persons ages 18 and older who broke their hip(s) following a surgical procedure. Hip fractures usually occur in the elderly, with fewer than half of those who suffer a hip fracture returning to their former level of activity.

A hip fracture following surgery is a complication factor that can be used as an indicator of hospital care and oversight. Patients, particularly the elderly, can fracture their hip by falling while trying to move about too soon after surgery. This type of accident should be minimized in hospitals exercising appropriate protocols for patients who are high risk for falls.

This measure is limited to patients who enter the hospital for procedures other than fractures of the hip. Patients with diseases of the bone, cancer, trauma and other conditions are not included. See Methodology.

Postoperative Pulmonary Embolism or Deep Vein Thrombosis

An 'embolism' is an obstruction in the flow of blood in a vessel, and 'pulmonary' refers to the lungs. Therefore, a 'pulmonary embolism' is a blood clot in an artery of the lungs. It is usually produced by foreign matter in the bloodstream, most often a blood clot originating in a vein of the leg or pelvis. It may occur after an operation or confinement to bed. Pulmonary embolism is one of the most common causes of death in hospitalized people who must remain in bed for a long time.

Deep vein thrombosis is a condition marked by the formation of a blood clot ('thrombus') within a deep vein, usually in the leg or pelvis. These clots may then travel through blood vessels and then cause an obstruction in blood flow to a body organ. For example, when the blood flow to the heart is interrupted, a heart attack may occur.

This patient safety indicator is intended to identify deep blood clots in the lungs or legs following surgery. The indicator is used to reveal complications of surgery or other invasive procedures. Hospitals displaying a 'lower than expected', or 'as expected' rate on this measure likely have employed effective techniques for prevention of this complication. Patients who have these conditions upon admission to a hospital are excluded from the counts, since the indicator seeks to find these blood clots when they occur after surgery in a hospital. See Methodology.

Postoperative Sepsis

A serious infection of the bloodstream caused by toxin-producing bacteria, known as sepsis, can occur after surgery. This measure indicates the occurrence of infections acquired during a stay at a hospital. There are protocols developed intending to prevent postoperative sepsis, among them the Surgical Infection Prevention system (SIP). This process ensures that the appropriate antibiotic is given to the patient one hour before surgery, and that the antibiotic is discontinued within 24 hours following surgery. Other protocols published by the Centers for Disease Control also intend to reduce the chance of infection after surgery.

This patient safety measure is important because it indicates the level of care provided to prevent infections in patients. Analysis of these infections may provide a screen for potential medical errors and a method for monitoring trends in infections over time. Hospitals following the appropriate protocols, (such as SIP, or patterns of cleanliness, such as washing hands before working with a patient), should see improvement in the trend of post-operative sepsis or other infections over time. Care must be taken to exclude patients from this measure who have infections when they enter the hospital, as this does not reflect quality of care delivered at the facility. See Methodology.

Pediatric Quality Measures – Complication, Infection and Mortality

Accidental Puncture or Laceration

Surgeries in pediatric patients, because of their smaller anatomy, can be technically more complex and can carry a high risk of accidental puncture or laceration. This indicator is intended to track injuries occurring during a procedure, specifically accidental cut, puncture, perforation or laceration. These procedures may be prevented through proper technique during procedures. See Methodology.

Central Venous Catheter-related Bloodstream Infections

This measure is important because it indicates the quality of care provided to prevent infections in patients, and also is an indicator of overall hospital and physician cleanliness practices. This indicator is intended to flag cases of infections due to medical care, primarily those related to intravenous (IV) lines and catheters. Hospitals following the appropriate procedures, such as washing hands before working with a patient or proper cleaning of the area around the catheter insertion site should show a lower level of infections due to medical care. Care must be taken to exclude patients from this measure who have infections when they enter the hospital, as this does not reflect quality of care delivered at the facility. See Methodology.

Pediatric Heart Surgery Volume and Mortality

These measures represent the number of patients undergoing surgery for congenital heart disease and the number of in-hospital deaths. Pediatric cardiac surgery requires technical proficiency with the use of complex equipment. Technical errors may lead to clinically significant complications, such as arrhythmias, congestive heart failure and death.

Studies have shown that physicians and hospitals performing higher volumes of these procedures, thus having more experience, are more likely to have better outcomes. The experience level of the physician and staff are important questions a consumer should consider. See Methodology.

Postoperative Sepsis

Risk Adjustment

In simpler terms, risk adjustment is a method to take a complex set of data and put it into terms where you can compare apples to apples.

Are the comparisons between facilities appropriate? What is risk adjustment?

Because of their expertise, some hospitals treat more high-risk patients, and some patients arrive at hospitals sicker than others and often sicker patients are transferred to specialty hospitals. That makes comparing hospitals for patients with the same condition but different health status difficult. To compensate for this fact, the data is risk adjusted to reflect the score the facility would have had if it had provided services to the average mix of sick, complicated patients utilizing 3M All Patient Refined-Diagnosis Related Groups (APR-DRGs). Ambulatory surgery is adjusted utilizing 3M Enhanced Ambulatory Patient Groups (EAPGs).

Risk adjusting the Average Length of Stay (ALOS) data:

A risk adjustment methodology was used that was developed by 3M Corporation. For hospitals, this is called All Patient Refined Diagnostic Related Groups (APR-DRGs, www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml). This is a widely accepted industry standard tool for risk adjusting. This adjustment is done for each hospital and each medical condition or procedure category according to the severity of illness of the patients. This means that a hospital with more severely ill patients (as determined by the APR-DRG method) has had its actual length of stay, and a hospital with less severely ill patients has had its rates increased. This adjustment should allow comparisons between hospitals that reflect the differences in care delivered, rather than the differences in the patients. For outpatient procedures, the data is risk adjusted by Enhanced Ambulatory Patient Groups (EAPGs). See below for further information.

Risk adjusting the Inpatient Mortality Indicators and Patient Safety Indicators / Complication and Infection data:

The methods used here have been developed by the United States Agency for Healthcare Research and Quality (AHRQ, www.qualityindicators.ahrq.gov) with the intention that they would be used for researching national, statewide, regional and hospital-specific performance. To calculate the risk adjusted rate, adjustments were made to the data based on national patient demographics such as age, gender and medical codes (diagnostic groups) for a specific condition or procedure. The risk-adjusted rate is the best estimate of what the hospital's rate would have been if the hospital had a mix of patients identical to a national-average patient mix for that year. Because of their expertise, some hospitals treat more high-risk patients and some patients arrive at hospitals sicker than others, which makes comparing mortality by hospital difficult. To compensate for this fact, AHRQ has risk adjusted each hospital's data to reflect the score the hospital would have had if it had provided services to the average patient. This adjustment should allow comparisons between hospitals that reflect the differences in care delivered, rather than the differences in the patients.

All Patient Refined - Diagnosis Related Groups (APR-DRGs)

APR-DRGs feature four severity of illness levels and four risk of mortality levels. A different model, or set of logic, is used to assign each APR-DRG and subclass. Subclasses are assigned according to sophisticated clinical logic that simultaneously evaluates multiple comorbidities (A concurrently existing but unrelated pathological or disease process), age, procedures, and principal diagnosis. Patients with clinically similar characteristics and similar resource consumption are assigned to one descriptive subclass for both severity of illness and risk of mortality: minor, moderate, major, or extreme. For more information please visit the 3M Health Information Systems website at: www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml

Enhanced Ambulatory Patient Groups (EAPGs)

Enhanced Ambulatory Patient Groups (EAPGs), also developed by 3M Health Information Systems (www.3m.com/us/healthcare/his/index.jhtml), are a patient classification system designed to explain the amount and type of resources used in an ambulatory visit. Patients in each EAPG have similar clinical characteristic and similar resource use and cost. Similar resource use means that the resources used are relatively constant across the patients within each EAPG. However, some variation in resource use will remain among the patients in each EAPG. In other words, the definition of the EAPG will not be so specific that every patient is identical, but the level of variation in resource use is known and predictable. Thus, while the precise resource use of a particular patient cannot be predicted by knowing the EAPG of the patient, the average pattern of resource use of a group of patients in an EAPG can be accurately predicted.

Enhanced Ambulatory Patient Groups (EAPGs) – Explanation of Designation as Levels I - IV

EAPGs simplify ambulatory visits for analysis and reporting. This is achieved by identifying key diagnoses and procedures, both diagnostic and therapeutic, performed during an ambulatory visit. Once identified, these diagnoses and procedures are used to classify outpatient visits into categories, called EAPGs, that are both clinically and financial meaningful.

Once the EAPGs are assigned, a second step is taken that assigns a level of complexity to each respective EAPG. Levels I through IV may be assigned to each EAPG. The complexity of an EAPG is defined by the following criteria: clinical similarity within an EAPG, the type (e.g. incision vs excision) of procedures in a particular EAPG, the amount of resources needed for the procedures in an EAPG, and the likelihood that other ancillaries (e.g. diagnostic vs therapeutic procedures involving different types of surgical and other types of surgical pathology) will be performed for the procedure in that EAPG.

Levels of complexity are characterized as follows:

Level I – Short treatment time in the operating room. Few laboratory tests or radiology procedures ordered. Few expensive disposable devices used, if any.

Level II - Laboratory tests and radiology procedures typically ordered as part of procedure. Disposable devices may consume significant resources. Increased length of time in the operating room.

Level III - Laboratory tests and radiology procedures ordered as part of a procedure. Disposable devices consume significant resources. Longer stay in the operating room than levels I and II.

Level IV – Procedure of major complexity. Treatment and resources used are extensive. Thus, Level IV EAPGs are frequently performed in an inpatient setting, not in an outpatient setting.

Explanation of Results Pages

Hospital Performance Measures

Patient Safety Indicators (PSI), Pediatric Quality Indicators (PDI) - Complications and Infections

Why is the "risk adjusted rate" important?

This is the rate of problems that patients experienced while in the hospital that might have been able to be prevented. These are called complications or adverse events. While the percentages vary, results are described as "lower than expected," "as expected" or "higher than expected," as compared to the statewide average.

Ranges for Charges

The range of charges is the set of charges specified by a maximum and minimum value that a hospital has billed for a particular condition or procedure. Any charge that is between these two values is said to be within the range. The hospital charge does not include physician fees nor does it reflect the actual cost or the amount paid for the care. The amount that a patient pays depends on the type of insurance coverage, co-payments and/or deductibles, if a patient is uninsured, or whether that patient qualifies for discounts under the hospital’s discount or charity policies.

The minimum value is represented by the 25th percentile and the maximum value is represented by the 75th percentile. 50 percent of the charges billed are between the 25th and 75th percentile.

Why are "charges" important?

In selecting a hospital, look at the ranges for charges for the hospital you are considering as compared to others. Keep in mind that only large differences are significant, so do not be concerned with slight differences. Use this measure to learn the typical charges for a condition or procedure. Hospital charges can affect your costs so lower charges can possibly save you money. NOTE: If you need more specific pricing information, Florida law, upon written request, requires each licensed facility (not operated by the state) to provide a written good faith estimate of reasonably anticipated charges for the facility to treat the patient’s condition. The estimate shall be provided within 7 business days after the receipt of the request.

Average Length of Stay

The average length of stay is the typical number of days a patient stayed in the hospital for a particular condition or procedure. For a fair comparison between hospitals, the information has been risk adjusted (See Risk Adjustment) to take into account that some hospitals take care of patients who are sicker and require more treatment or resources than the "average" patient.

Why is "length of stay" important?

Average length of stay provides an idea of how long you might expect to stay in the hospital as determined by your attending physician. The average length of stay might show the efficiency of care provided by a hospital. Typically, a shorter average length of stay decreases the chance of getting an in-hospital infection or experiencing a complication, and can be an indicator of improved outcomes. However, if a length of stay is too short, it could result in a readmission. To learn the typical length of stay for a particular condition or procedure look at the average length of stay for the state as whole and compare it to the hospital you are considering. Keep in mind that only large differences are significant, so do not be concerned with slight differences.

Mortality Rate

These results show patients who died at a hospital after undergoing a specific type of surgery or while being treated for a specific condition. It can be difficult to compare hospitals for mortality rates because some hospitals have special programs or services that treat more high-risk patients or because some patients arrive at hospitals sicker than others. To factor out these patient differences, the mortality rates were risk adjusted (See Risk Adjustment). The mortality rates provided here are based on the Inpatient Quality Indicators developed by the U.S. Dept. of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). These mortality indicators were chosen for those procedures or conditions which have been shown to vary greatly across hospitals, and for which evidence suggests that high mortality may be associated with deficiencies in the quality of care.

Why is ‘total volume’ for mortality important?

Volume can be a measure of quality. This is based on evidence suggesting that hospitals performing more of certain intensive, high-technology, or highly complex procedures may have better outcomes for those procedures. Volume indicators simply represent counts of admissions (including deaths and non-deaths) in which these conditions/procedures were performed with various exclusions according to AHRQ guidelines.

Why is the "mortality rate" important?

Research has shown that the rate of patient deaths for certain procedures and conditions may be related to quality of care. While research can predict an expected range of patient deaths for a given procedure or condition, mortality rates above the expected range may show possible concerns with quality of care. The results listed are described as "lower than expected," "as expected" or "higher than expected”.

What the mortality rate means:

Lower than Expected - Fewer deaths than expected given how sick patients were
As Expected - Expected number of deaths given how sick patients were
Higher than Expected - More deaths than expected given how sick patients were

Readmission Rate

The Readmission Rate is the percentage of patients who were readmitted to the same hospital or another short term acute care hospital for the same or related condition within 15 days of the initial discharge.

This rate is assigned to the hospital that first admitted the patient regardless of where the patient is readmitted.

Since sicker patients are more likely to be readmitted, the readmission rate is adjusted for the severity of patients’ illness.¹ A rate that is “lower than expected” indicates the hospital had fewer readmissions compared to other hospitals with similar patients. A rate that is “higher than expected” indicates the hospital had more readmissions compared to other hospitals with similar patients.

Why is this important?

Readmissions are costly and may indicate an opportunity to improve quality of care. Readmissions may reflect health care challenges such as:

poor coordination between the inpatient and outpatient healthcare team,
the patient not being able to get the prescription drugs or treatment needed following hospitalization,
the patient may have had an underlying health condition that was not treated,
the patient may have developed a complication after discharge,
the medical care following discharge may not have been adequate,
the patient may not have had an adequate support system after discharge
the patient may not have followed the doctor’s instructions following discharge.

Patients can reduce their chances of being readmitted by being engaged and informed about health care decisions. For example:

When you are being discharged from the hospital…

ask your doctor to explain the treatment plan you will use at home and get a written copy.
Inform your doctor of all the medications including prescriptions and over the counter medicines that you take at home.
Schedule your follow-up doctor’s appointments before you leave the hospital and make sure you have a transportation plan.
Get your doctor’s name and phone number for regular working hours and who to contact in case of an emergency after hours.
Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
Ask about potential side effects of each medication and what to do if a side effect occurs.
Make sure that any new medications the hospital doctor prescribes is covered by your insurance plan. If you do not have insurance, work with hospital staff to find out about low cost or no cost ways of paying for your medications and doctor visits.
Learn about your condition and ask what symptoms might signal a change in health and for which you should contact your doctor.
Request printed information to help you manage your health and any symptoms
Make sure your doctor or nurse has answered your most important questions.

¹ Severity adjusted readmission benchmarks calculated using 3M APR DRGs. Readmission rates computed using 3M Potentially Preventable Readmissions (PPR) software.

Source: Institute for Healthcare Improvement, University of Colorado Health Sciences Center

Total Hospitalizations

Total hospitalizations is the total number of patients treated at that hospital for a particular condition or procedure, or if one is not selected, then the total number of hospitalizations at the facility.

Why is a hospital's "total hospitalizations" important?

While volume of hospitalizations is not a direct measure of quality of care, it is useful in seeing how much experience a hospital has for a given procedure or condition. Generally, the higher the volume the better. If you have a condition that is not very common or involves complex procedures, you should consider the volume of similar cases your hospital handles, or find a facility with more experience with treating your condition.

Ambulatory (Outpatient) Surgery Center Performance Measures

Outpatient Range of Charges

The range of charges is the set of charges specified by a maximum and minimum value that a hospital has billed for particular condition or procedure. Any charge that is between these two values is said to be within the range. The charge does not include physician fees nor does it reflect the actual cost or the amount paid for the care. The amount that a patient pays depends on the type of insurance coverage, co-payments and/or deductibles.

The minimum value is represented by the 25th percentile and the maximum value is represented by the 75th percentile. 50 percent of the charges billed are between the 25th and 75th percentile.

Why are "charges" important?

In selecting a facility, look at the ranges for charges for the facility you are considering as compared to others. Keep in mind that only large differences are significant, so do not be concerned with slight differences. Use this measure to learn the typical charges for a condition or procedure. Facility charges can affect your costs so lower charges can possibly save you money. NOTE: If you need more specific pricing information, Florida law, upon written request, requires each licensed facility (not operated by the state) to provide a written good faith estimate of reasonably anticipated charges for the facility to treat the patient’s condition. The estimate shall be provided within 7 business days after the receipt of the request.

Total Visits

Total visits are the count of ambulatory (outpatient) procedures a facility performs within each procedure category, or if you do not choose a category then the total number at the facility. This data includes all ages.

Why is an ambulatory surgery center's "total visits" important?

Total visits or volume is an indication of the experience a facility has with a condition or procedure. Generally, the higher the volume the better. In addition, many ambulatory surgery centers specialize in a certain area which may explain their higher volume.

Physicians

Physician Volume

Why is physician volume important?

There is no consensus about the minimum procedure volume for the procedures listed. It is best to consider the surgical volume listed on this website as just one component of the information you should gather to make the best decision for your care. You should also consult with your primary care physician and your health insurance provider whenever choosing a surgeon or hospital. See Data Disclaimer.

IMPORTANT: The physician volume methodology varies from the Compare Hospitals facility level information thus the totals are not comparable.

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