RHIA CH 13-health statistics and research

formula fetal autopsy rate

# of autopsies on intermediate and late featl deaths x 100 ----------------------------------------------------------------------------- total # of intermediate and late fetal deaths

formula community acquired infection rate

# of community acquired infections x 100 --------------------------------------------------------------- total # of D/C's

formula post-op death rate

# of deaths within 10 days of surgery x 100 --------------------------------------------------------------- totAL # OF PATIENT'S OPERATED ON

formula nosocomial infection rate

# of hospital acquired infections x 100 ------------------------------------------------------- total # of D/C's including deaths

formula post-op infection rate

# of post-op infections (within 10 days post-op) x 100 ---------------------------------------------------------------------------- total # of operations performed

formula readmission rate

# of readmissions x 100 ------------------------------------- # of total admissions (including the readmissions)

3. On average, the ROI section brings in $1,500 per month. What is the difference between cost and income?

$1,323.82 $2,823.82 - $1500.00 = $1,323.82

difference between what is charged and what is paid

contractual allowance

During the month of September, Superior Health Care Center had 1,382 inpatient discharges, including 48 deaths. There were 38 deaths over 48 hours. Statistics also show 4 fetal deaths, 3 DOAs, and 4 inpatient coroner's cases. Which of the following calculations is correct to figure the net death rate? a. (1,382 - 10) x 100 / (48 - 10) b. (48 x 100) / (1,382 - 10) c. (1,382 x 100) / (48 - 10) d. (48-10 x 100) / (1,382 - 10)

d. (48-10 x 100) / (1,382 - 10)

Your administrator is concerned about the snuff study. The administrator would like to consider using a case-control study model rather than the prospective one you are planning. One of the biggest reasons the administrator is promoting the case-control model is because case-control is

less expensive than prospective studies because it uses existing records.

early fetal death

less than 20 weeks of gestation and less then 500grams

The best form/graph for demonstrating trends over time would be

line graph.

technique used to explore and examine relationship among a large number of variables of different types

linkage analysis

Look at the graph below. It is an example of a

stacked bar chart; it is well constructed.

formula total I/P

sum of all inpatient service days for each of the days in the period (excluding newborns)

formula total LOS

sum of the days stay of any group of I/P D/C during a specific period

assigns a secret key to data. one key is used

symmetric encryption

Data that fall into groups or categories that are mutually exclusive and with no specific order (for example, patient demographics such as third-party payer, race, and sex); Also called categorical data

Nominal-level data

Looking more closely at the LOS for these patients, when you calculate the standard deviation on the data, you would expect

a large standard deviation because the dispersion is large.

all EHR components are from the same vendor so should fit well together, enabling smoother exchange of data.

best of fit

Length of stay : Patient was admitted on January 2 and discharged on January 10.

he length of stay for this was patient was 8 days (10 - 2 = 8).

Look at the graph grid displayed above. If you want to follow accepted principles for graph construction, you will follow the three-quarter-high rule. That means the

height of the graph should be three-fourths the length of the graph.

enacted legislation for funding to construct hospitals ad health centers

hill-burton act

The display below is a

histogram, which is commonly used to display continuous data

The graph below can best be described as

multimodal.

In statistics, the notation "ΣXY" means

multiplied each pair of the X and Y scores, then summed their values.

Total # of NB death in a period/ total # of NB discharges including death in same period

new born death rate

assessing a changing environment to create a vision of the future; determining how the organization fits into the future environment based on its mission,

strategic management

formula fetal death rate (stillbirth rate)

total # of intermediate and late fetal deaths x 100 ----------------------------------------------------------------------- total # of births +intermediate and late fetal deaths

formula maternal death rate

total # of maternal deaths for a period x 100 --------------------------------------------------------------- total # of obstetrical D/C's

formula % of medicare (or other insurance) discharge days

total # of medicare (other insurance) discharge days x 100 ------------------------------------------------------------------------------ total # of discharge days for adults and children

formula % of medicare patient (or other insurance)

total # of medicare (other insurance) discharges x 100 ------------------------------------------------------------------------------ total # of adult and child D/C's

formula daily I/P census

total # of pts during a 24hr period

Use the formula below as a resource to answer the question. Np (1-p) n = __________________ (N-1)B squared/4 + (p) (1-p) If population size (N) = 1,200 and the proportion of subjects needed (p) = 0.5 and the acceptable amount of error (B) = 0.05, then sample size (n) =

300

late fetal death

greater then 28 weeks and 1,001 gram and over

formula net hospital death rate

# of I/P deaths (including NB) -(minus) deaths <48hrs of admission x 100 ------------------------------------------------------------------------------- total D/C's (including deaths and NB, -(minus) deaths <48hrs)

Business sector

Healthcare Quality- Adopted from?

The data display below is a

normal distribution or curve.

I/P bed count day

(not including bassinets)counts the presents of 1 I/P bed (occupied or vacant) that is set up and staffed for use in a 24hr period

The statistics reported for a 300-bed hospital for 1 year were 20,932 discharges with 136,651 discharge days and 3,699 consultations performed. What was the consultation rate for the year?

17.7% (3,699 x 100) / 20,932 = 17.671%

The New Beginnings Maternity Center recorded the following statistics in December: FETAL DEATHS EARLY 240 INTERMEDIATE 40 LATE 32 BIRTHS 980 DELIVERIES 994 NB DISCHARGES 1,008 What was the fetal death rate at New Beginnings Maternity Center in December?

6.8% 72/(980 + 72) x 100 = 6.844

The chart above shows a normal distribution. What percentage of the cases fall within the two lines showing the standard distribution between -1 and +1 on either side of the mean?

68%

Sea Side Clinic (SSC) provides episode of care service for four insurance companies. Data on services provided and reimbursement received are provided below. It would be most profitable for Sea Side Clinic to increase episode of care service with

BeHealthy.

many different vendors, presumably the best for each type of application

Best of breed

The 97 function-related groups into which inpatient rehabilitation facility discharges are classified on the basis of the patient's level of

Case Mix Groups (CMGs)

A tool that permits the systematic recording of observations of a particular phenomenon so that trends or patterns can be identified

Checksheet

x2. it tests if there is a difference between the expected frequencies and the observed frequencies

Chi square

Provide step-by-step guidance for physicians and others in making decisions related directly to patient care.

Clinical Practice Standards

Ex: A new director of nursing has just been hired, and at the same time the nursing documentation component of the EHR has just been implemented. If nurse staffing satisfaction scores rise - you cannot attribute the increase to either the new director or the implementation of the system. A benefits realization study would have to be performed to understand the impact of the nursing component of the EHR.

Confounding Variables

Digital Imaging and Communication in Medicine

DICOM

to support the uniform collection of data in hospital-based emergency departments and to substantially reduce incompatibilities in emergency department records.

Data elements for emergency department systems (DEEDS)

one vendor for most financial and administrative applications and another vendor for clinical applications

Dual Core

Believes that awareness and use of feelings complement rational intelligence and experience, and it is the combination of these that is the key to success

Emotional Intelligence

Data used to describe health related issues or events. (Example: Statewide cancer data system)

Epidemiological Data

used to describe health-related issues or events, such as disease trends found in specific populations. Ex: Statewide Cancer data system.

Epidemiological Data

drawing conclusions based on a limited number of observations.

Inductive Reasoning

One that results while a patient is under care.

Healthcare-associated Infection

If the customer base (patients) in a hospital change significantly over a period of time, staffing changes may need to be made to accommodate patients who have religious and cultural differences. Your org. may need to offer a wider variety of dietary choices, ensure there are no language barriers, and ensure patient rights are considered through religious and cultural differences.

Hospital Profile

primary data source for healthcare statistics

Hospital census

Jason collected data on the length of stay (LOS) for 10 patients and then determined the median LOS as follows: 1 2 4 3 1 <------ Median 3 2 3 4 8 What is wrong with Jason's determination of the median?

Jason forgot to put the numbers in sequential order before determining the median.

_______________ refers to the flatness or peakedness of one distribution in relation to another distribution.

Kurtosis

A group process technique that involves the steps of silent listing, recording each participant's list, discussing, and rank ordering the priority or importance of items; allows groups to narrow the focus of discussion or to make decisions without becoming involved in extended, circular discussions

Nominal group technique

effect of care, treatment, or services on a customer. Ex: incidence of post-op infections in procedures where antibiotics were and were not used.

Outcome Measure

A bar graph that includes bars arranged in order of descending size to show decisions on the prioritization of issues, problems, or solutions

Pareto chart

Both the patient and provider to arrive at the desired outcome.

Quality Care- Primary Objective

Appropriateness, technical excellence, accessibility, and acceptability

Quality Components

the systematic investigation of both the clinical and administrative reasons for sentinal events.

Root-Cause Analysis

analysis, design, implementation, and maintenance and evaluation

System development life cycle (SDLC)

Looking at the data represented in the scatter diagram below, you would conclude that there is

a positive correlation between Variable A and Variable B.

Patients in the pediatrics ward were studied to determine their favorite color. The survey results are listed below. The results of the favorite color study are reported in a REPORTED FAVORITE COLOR OF PEDIATRIC PATIENTS AZURE TIDES HOSPITAL JANUARY 18, 2014 FAVORITE COLOR NUMBER OF RESPONDENTS RED 12 GREEN 14 BLUE 22 YELLOW 18 ORANGE 16

frequency distribution.

statements that exempt s the signer from incuring liabilities or penalties

indemnification

review audit logs, access reports and security incident reports

information system activity review

A fetal death occurring during the 21st week of pregnancy, weighing 1,000 g is considered to be a(n)

intermediate fetal death.

Englewood Health Center collected the following data on patients discharged on January 1, 2015. Which measure of central tendency would be most affected by Mallory's extremely long LOS? Patient Name Length of Stay Ben 1 Josh 2 Emma 3 Bryan 4 Mallory 29 Taylor 2 Matthew 3 Aiden 2 Trevor 4 Tyler 2

mean

strategic plan that takes into consideration the IT side and the policies and procedures as well

migration path

process of attempting to reduce or eliminate harmful effects of breach

mitigation

formula LOS

number of calandar days from admission to D/C

the proportion of ppl in a pop who have a particular disease at a specific point in time over a period of time.

prevalence

serves as a permanent index that providers can quickly check to review the status of previous or current problems

problem list

duplication of data, hardware or cables

redundancy

formula median

the mid point of an ordered series arranged in order from highest to lowest

mode

the most frequently occurring value in a set of numbers

If a constant is added to all measurements within a sample

the standard deviation remains the same.

The name given to the error committed when the null hypothesis is rejected and it is actually true is

type I error.

number of autopsies out of total number of deaths. 5 autopsies during a period of 25 deaths equals a 20% autopsy rate.

Gross Autopsy Rate

A review of planned services (intensity of service) and/or a patient's condition (severity of illness) to determine whether care must be delivered in an acute-care setting

Admission utilization review

A hospital with 210 available beds in June rendered 4,780 patient days and had 736 discharged/died patients. The turnover interval rate is

Available beds x days in the period - patient days for the period ----------------------------------- Number of discharges, including deaths, in the period 210 x 30 - 4780 = 1520 736 736 = 2.06 or 2.1 days

A legal term that means promoting good for others or providing services that benefit others, such as releasing health information that will help a patient receive care or will ensure payment for services received

Beneficence

designates the probability of making type II error

Beta (B)

all of the EHR component applications are implemented at once, although still usually by department, nursing unit, and others. A big bang approach has significant advantages in that it reduces the use of the hybrid record and end users learn and experience the entire process at once.

Big bang approach

formula NB autopsy rate

# of autopsies on NB deaths x 100 ------------------------------------------------- total # of NB deaths

Research instruments that are used to gather data and information from respondents in a uniform manner through the administration of a predefined and structured set of questions and possible responses

Survey tools

exposure status for each individual in the study is determined and the individual is then followed to determine the outcome

experimental study

limit access to where data and hardware and software are located

facility access control

process used to gather intact and validated evidence. Part of the security incident

forensics

positively skewed when shifted to the right, meaning large FD

frequency distribution

similar to hisotogram except that it uses a line instead of bars. it is intended for intervals and ratios. used for frequency distribution

frequency polygon

You want to construct a data display for a frequency distribution. You will use a

frequency polygon or histogram.

attempt or successful unauthorized access, use, disclosure or destruction of PHI within a system. security incident cannot be eliminated but they can be minimised and prevented

security incident

Sea Side Clinic (SSC) provides episode of care service for four insurance companies. Data on services provided and reimbursement received are provided below. scprrhia01q.13.076 The most profitable insurance company for the units of services Sea Side Clinic performs is

service B with BeHealthy.

formula I/P service day

services recvd by one I/P in one 24hr period

A distribution is said to be positively skewed when the mean is

shifted to the right.

users ability to access multiple application using one user name and password.

single sign on (SSO)

formula net autopsy rate

total inpatient autopsies for a period x 100 ------------------------------------------------------------- total inpatient deaths (-minus) unautopsied coroner's cases for the period

formula gross autopsy rate

total inpatient autopsies for a period x 100 -------------------------------------------------------------- total inpatient deaths for the period

A data set developed by the National Committee on Vital and Health Statistics consisting of a minimum set of patient/client-specific data elements to be collected in ambulatory care settings

uniform ambulatory care data set (UACDS)

A core set of data elements adopted by the US Department of Health, Education, and Welfare in 1974 that are collected by hospitals on all discharges and all discharge abstract systems

uniform hospital discharge data set (UHDDS)

You have just constructed the chart displayed below. CH13-UNF-06 The names of the hospital services are hard to read. The best way to deal with this problem would be to

use a column chart instead of a bar chart.

formula bed turn over rate: indirect formula (when is it used?)

used in cases where bed count changes during the period in question % of occupancy x days in period x 100 -------------------------------------------------------- average LOS

uses a secure tunnel through the public network or the internet to connect remote sites or users

virtual private network (VPN)

Look again at the graph you used for the last question. From this graph, you can assume that more people

were admitted to the facility with infections than acquired infections in the hospital

determine that the access of an associate i appropriate

workforce clearance procedure

The American Health Information Management Association conducted a study on job stress and job satisfaction in HIM professionals with more than 5 years of experience. The data they collected are displayed below. CH13-UNF-18 Based on the data displayed in the graph AHIMA created,

you can assume there is a positive relationship between variable A and variable B.

break the glass. accessing data when required, bypassing a computer password or a log in

emergency access procedure

the analysis of the original work of another person or organization

secondary analysis

security incident that have not led to harm. Security incident is an event that have led to harm

security event

itermediate fetal death

20 completed weeks but less then 28 weeks and 501-1,000 grams

core set of screening, clinical and functional status of residents. more extensive than UHDDS and UACDS. its data is used to classify residents into RUGs

MDS

Data with inherent order and with higher numbers usually associated with higher values; Also called ordinal data; ranked data

Ordinal-level data

An inherent weakness or absence of a safeguard that could be exploited by a threat

Vulnerability

2. What is the monthly cost for the ROI services?

$2,823.82 $0.84 + $0.40 + $0.25 + $0.20 + $3.52 = $5.21 per request x 542 requests = $2,823.82

Exercise 9.10 1. In deciding whether to purchase or lease a new dictation system, the HIM supervisor calculates the payback period. The hospital's required payback period is three years. If the equipment costs $28,000 and generates $3,500 per year in savings, what would be the payback period for this equipment? Should the department purchase this equipment? 2. The coding section in the HIM department shows its first-quarter budget analysis as having an expected cost of operation of $62,000. However, the actual cost of operation was $76,000. Calculate the budget variance. Round to one decimal place.

1 8 years The department should purchase the equipment if it will pay back its cost in savings within three years. To find the number of years it will take to pay back the cost, divide the cost by the annual savings. $28,000/$3,500 = 8 In this case, the department should not purchase this equipment because the savings do not justify its purchase. 2.22.6% The budget variance is the difference between actual cost and expected cost, multiplied by 100 and then divided by the expected cost $76,000 - $62,000 = $14,000 ($14,000 x 100)/$62,000 = 22.58 = 22.6

Exercise 9.11 1. The report in figure 9.1 gives the gross death rate (hospital death rate) as .01 percent. Recalculate this rate and round to the second decimal place. 2. Recalculate the gross autopsy rate in figure 9.1. Round your answer to the second decimal place. 3. In figure 9.2 which Medicare severity diagnosis-related group (MS-DRG) has the greatest ALOS? 4. Recalculate the readmission rates for the medical services and the overall rate in figure 9.3 to verify their accuracy. Which readmission rates were not accurate? Round your answers to two decimal points .5. Recalculate the rates in figure 9.4 to verify their accuracy. Are there any that were calculated incorrectly? If so, which ones? How many Medicare patients were discharged during the fiscal year to date? What month end was this report calculated?

1. 1.38% The gross death rate is calculated by dividing the total number of deaths by the total number of discharges. [(7 + 2) x 100]/650 = 1.38% 2.22.22% (2 x 100)/9 = 22.22% Note that, according to this computerized statistical report, the net autopsy rate is the same as the gross autopsy rate. The reason for this is that no coroner's cases are listed. 3. MS-DRG 844, Other myeloprolific disorder or poorly differentiated neoplasm diagnosis with complication or comorbidity has an ALOS of 23 days. Note that this category has only one discharge. MS-DRG 208, Respiratory system diagnosis with ventilator support less than 96 hours has the greatest ALOS with more than one patient. 4 .FRP: (5 x 100)/75 = 6.67% GI: (5 x 100)/27 = 18.52% MED: (59 x 100)/511 = 11.55% MON: (26 100)/67 = 38.81% NB: (1 x 100)/129 = 0.78% NPH: (42 x 100)/162 = 25.93% ORS: (2 x 100)/14 = 14.29% PED (1 x 100)/55 = 1.82% THS: (3 x 100)/37 = 8.11% VSS: (1 x 100)/26 = 3.85% Overall rate: (188 x 100)/2,046 = 9.19% 5.6831.0912/3,230 = 2.1149 Case-mix - All financial classes for Month End 10/20XX: 3396.8017/1,626 = 2.0891 Case-mix - Medicare only for Month End 10/20XX: 1364.1506/658 = 2.0732 There were 1,367 Medicare discharges year-to-date. This report was calculated for month end October.

based on observed and validated evidence

empiricism

In 200xx hospital had 150 beds for adults and children from January through June 30. On July 1 the hospital increased its beds to 200 and the number remained 200 through December 31. During the first six months 27,813 patients days of service were provided to the hospital's adults and children . During the last 6 months 35,873 days of service were provided. Answer the following questions 1. What was the average daily inpatient census for the first six months: 153, 154,155, or 156? 2. What was the average daily impatient census for the entire year 173,174,175, or 193

1. What was the average daily inpatient census for the first six months: 153, 154,155, or 156? if it is not a leap year: average daily inpatient census = (27,813 patients days of service)/(181 days) = 153.6629834, or 154 if it is a leap year, the arithmetic would be (27,813 patients days of service)/(182 days) = 152.8186813, or 153 2. What was the average daily impatient census for the entire year: 173,174,175, or 193? 1st six months = 27,813 last six months = 35,873 ------------------------------- total: 63,686 patients days of service for the year if it is not a leap year: average daily inpatient census = (63,686 patients days of service)/(365 days) = 174.4821918, or 174 if it is a leap year: average daily inpatient census = (63,686 patients days of service)/(366 days) = 174.0054645, or 174

Sandy Beach Hospital reports 1,652 discharges for September. The infection control report documents 21 nosocomial infections and 27 community-acquired infections for the same month. What is the community-acquired infection rate?

1.6

Tampa Bay Health Center discharged 6,069 adults/children and 545 newborns last year. A total of 1,648 adults/children and 1,279 newborns were seen in the emergency department. Information on the deaths at Happy Valley last year is listed below. scprrhia01q.13.041 What was the net death rate at Tampa Bay Health Center last year?

1.7% [108 deaths > 48 hours/(6,614 total discharges - 253 deaths< 48 hours)] x 100 = 1.697

A study found that liver cancer rates per 100,000 males among cigarette smokers and nonsmokers in a major U.S. city were 48.0 and 25.4, respectively. The relative risk of developing liver cancer for male smokers compared to nonsmokers is

1.89 RR = risk exposed divided by risk not exposed = 48 divided by 25.4 = 1.89

CASE NUMBER BRIEF DESCRIPTION 101 -43-26 A 32-year-old female was admitted through the ED following an automobile accident. She spontaneously delivered a 720 g fetus that showed no sign of life. 101 -44-23 A 22-year-old female was admitted in labor. Following an uneventful course, she delivered a 7 pound 4 ounce term male. The child developed sudden and unexpected respiratory distress. All attempts at resuscitation failed; the baby was pronounced dead less than 2 hours after delivery. 101 -48-69 A 19-year-old female spontaneously delivered a 475 g fetus following a fall down the stairs at home. 101 -56-29 A 28-year-old female was admitted for a late-term therapeutic abortion. The procedure was completed without complication; product of conception weighed 728 g. When the committee considers these adverse outcomes from the OB/GYN Department, which of the cases will be included in the numerator of the facility's fetal death rate? The OB/GYN Department reported the information in the table shown above to the Quality Management/Statistics Committee. When the committee considers these adverse outcomes from the OB/GYN Department, which of the cases will be included in the numerator of the facility's fetal death rate?

101-43-26

CASE NUMBER BRIEF DESCRIPTION 101-43-26 A 32-year-old female was admitted through the ED following an automobile accident. She spontaneously delivered a 720 g fetus that showed no sign of life. 101-44-23 A 22-year-old female was admitted in labor. Following an uneventful course, she delivered a 7 lb 4 oz term male. The child developed sudden and unexpected respiratory distress. All attempts at resuscitation failed; the baby was pronounced dead less than 2 hours after delivery. 101-48-69 A 19-year-old female spontaneously delivered a 475 g fetus following a fall down the stairs at home. 101-56-29 A 28-year-old female was admitted for a late-term therapeutic abortion. The procedure was completed without complication; product of conception weighed 728g. Which of the cases listed in the table above will have an impact on the facility's gross death rate?

101-44-23

A hospital had a total of 15 deaths during the month of June. A total of 540 patients were discharged (including the 15 deaths) during the month. The hospital death rate is:

15 x 100 ---------------- 540 = 2.77 or 2.8%

A patient admitted to the hospital on January 24 and discharged on February 9 has a length of stay of

16 days

Exercise 9.8 Community Physican's Clinic is a large clinic in your community with 85 physicians. They treat about 8,600 patients each week. Coders are expected to code 100 clinic records each day. How many FTEs are needed to code these records?

17.2 FTEs The number of FTEs will be the total number of patients divided by the total number of records required per week (assume a 5-day work week). 8,600/(100 x 5) = 17.2 FTEs

Mr. McDonaldson was admitted to your hospital at 10:45 PM on January 1. He died at 4:22 AM on January 3. How many inpatient service days did Mr. McDonaldson receive?

2

Use the statistics provided in the table to compute the fetal death rate at All Women's Hospital for March. All Women's Hospital March Statistics Live births 225 Intermediate and late fetal deaths 5 Early fetal deaths 4 Newborn discharges 235

2.2% 5/(225 + 5) =2.173

If there are 150,000 medical records and the Health Information Department receives 3,545 requests for records in a week, what percentage of the records are requested weekly?

2.4%

Bayside Hospital has 275 adult beds, 30 pediatric beds, and 40 bassinets. In a nonleap year, inpatient service days were 75,860 for adults, 7,100 for pediatrics, and 11,800 for newborns. What was the average daily census for the year?

227 (75,860 + 7,100) / 365 = 227 (Note: Average daily census includes adult and pediatrics, but NOT newborns.)

Use the historical graph below to answer question. CH13-UNF-14 The total number of infections at South Beach Hospital during the first quarter (January-March) was

38

You are responsible for calculating and reporting average length of stay (ALOS) for your hospital each month. This month, there were 92 discharges, and the total discharge days equal 875. One of the patients discharged this month had a total of 428 discharge days, so the ALOS is distorted by this unusually long stay. In this situation, you should report an ALOS of

4.91 days and make a note that the data on one patient with an unusually long LOS were subtracted prior to making the calculation.

The standard deviation of a particular set of measures was found to be 20.00. The sample variance would then be:

400

Tampa Bay Health Center discharged 6,069 adults/children and 545 newborns last year. A total of 1,648 adults/children and 1,279 newborns were seen in the emergency department. Information on the deaths at Happy Valley last year is listed below. scprrhia01q.13.041 What was the gross (hospital) death rate at Tampa Bay Health Center last year?

5.5% Calculations: 361 total inpatient deaths x 100/6,614 total discharges = 5.45 = 5.5% Fetal deaths and outpatient deaths are not included in this calculation.

The following obstetrical statistics were collected for the month of October. Use the data in the table below to answer the question. scprrhia01q.13.037 The number of deliveries in the facility in October is

55 Multiple births are one delivery; fetal deaths are counted as deliveries 50 + 3 + 1 + 1 = 55

The following obstetrical statistics were collected for the month of October. Use the data in the table below to answer the question. Single infant 50 Twins 3 sets The number of births in the facility in October is

56

All Women's Hospital reports the following statistics: Single births Vaginal 40 C-section 0 Twin births Twins&—vaginal 12 (6 sets) Twins&—C-section 8 (4 sets) Other multiple births 0 Intermediate fetal deaths Vaginal 5 C-section 0 Late fetal deaths Vaginal 2 C-section 0 How many deliveries occurred?

57 40 + 10 + 5 + 2 = 57

longhth of stay- patient admitted may 3rd, discharged may 9th

6 days

The inpatient census at midnight is 67. Two patients were admitted in the morning; one died 2 hours later; the second patient was transferred to another facility that same afternoon. The inpatient service days for that day will be

69 67 + 2 = 69 admissions/discharges same day (Transfers to other facilities and deaths are forms of discharge.)

Royal Palm Hospital has 500 beds and 55 bassinets. In February of a nonleap year, it reported the following statistics: Inpatient service days: Adult and pediatric 12,345 Newborn 553 Discharges: Adult and pediatric 1,351 Newborn 77 Discharge days: Adult and pediatric 9,457 Newborn 231 What was the average length of stay at Royal Palm Hospital in February?

7 days 9,457 discharge days/1,351 discharges = 7 days

Sea Crest Hospital has 200 beds and 20 bassinets. There was a sudden spurt in the birth rate in the town in November. The hospital set up five additional bassinets for the entire month. Total bed count days for Sea Crest Hospital in a nonleap year would be

73,000 200 beds x 365 days in a nonleap year = 73,000 (Note: Bassinets are excluded.)

The following data were collected in your physician office practice from one morning's visits. Visit ID Minutes Physician 508-123 5 Robinson 508-124 9 Robinson 508-125 8 Beasley 508-126 12 Wolf 508-127 6 Beasley 508-128 7 Beasley 508-129 5 Wolf 508-130 10 Baumstark 508-131 7 Baumstark 508-132 9 Robinson 508-133 11 Wolf The median number of minutes with the physician (considering all physicians) is

8 minutes.

The following data were collected in your physician office practice from one morning's visits. Visit ID Minutes Physician 508-123 5 Robinson 508-124 9 Robinson 508-125 8 Beasley 508-126 12 Wolf 508-127 6 Beasley 508-128 7 Beasley 508-129 5 Wolf 508-130 10 Baumstark 508-131 7 Baumstark 508-132 9 Robinson 508-133 11 Wolf The mean number of minutes with the physician (considering all physicians) is

8 minutes. Calculation: 5 + 9 + 8 + 12 + 6 + 7 + 5 + 10 + 7 + 9 + 11 = 89 / 11 = 8.09

Lake City Health Center has 200 beds and 20 bassinets. In a nonleap year, Styles Hospital admitted 16,437 adults and children; 16,570 adults and children were discharged. There were 1,764 live births and 1,798 newborns discharged. The bed turnover rate for the year was

82.9 16,570 adult and peds discharges/200 adult and peds beds = 82.85 = 82.9%

You have been conducting productivity studies on your coders and find that 20% of their time is devoted to querying physicians about missing or unclear diagnoses. Assuming your coders work a 7-hour day, how many minutes do they spend per day querying physicians?

84 7 hours per day X 60 minutes per hour = 420 minutes per day. 20% of 420 = 84

A hospital reported the following statistics during a nonleap year. Calculate the percentage of occupancy for the entire year. Time Period Bed Count Inpatient Service Days Jan 1-May 31 200 28,690 June 1-Oct 15 250 27,400 Oct 16-Dec 31 275 19,250

88% (28,690 + 27,400 + 19,250)/[(151 x 200) + (137 x 250) + (77 x 275)] x 100 = (75,340/85625) x 100 = 87.988

Royal Palm Hospital has 500 beds and 55 bassinets. In February of a nonleap year, it reported the following statistics: Inpatient service days: Adult and pediatric 12,345 Newborn 553 Discharges: Adult and pediatric 1,351 Newborn 77 Discharge days: Adult and pediatric 9,457 Newborn 231 What was the percentage of occupancy for adults and pediatrics in February?

88.2% 12,345/(500 x 28) x 100 = 88.178

What conclusion can you make from the pie graph below?

A pie graph should not be used, because there are too many categories for effective display.

performed when a need exists to compare more than two groups. if significance level is 0.05 , reject null hypothesis

ANOVA tests

The average length of stay is the total length of stay divided by the number of patients discharged.

AVERAGE Length of Stay

based on activities or projects rather than on departments

Activity based badget

You are choosing restaurants where you might eat while you are in Chicago at the AHIMA Leadership Conference. You have collected the following information about four possible lunch restaurants that are all located within easy walking distance of the meeting site. The data are displayed below. Price Stand. Deviation Bon Appetite $8.00 0.75 Mario's $7.50 1 Au Courant $9.00 1.25 The Windy City Grill $7.50 1.5 You want to stay within the reimbursement rate allowed by your Component State Association, so it is important to you that you have at least a 95% chance of eating a lunch that costs no more than $10.00. Therefore, when lunchtime comes, you head to

Bon Appetite or Mario's.

The coding supervisor at Bayside Hospital regularly has the coders recode records from the previous week in an effort to improve and monitor coding consistency. The supervisor has collected the data displayed below on four coders. Coder A 28 22 20 Coder B 18 16 16 Coder C 45 42 43 Coder D 17 15 16 The coder with the highest overall accuracy rating will get the day after Thanksgiving off. Which coder will get to spend the day after Thanksgiving off rather than coding?

Coder C

In healthcare statistics, data that represent measurable quantities but are not restricted to certain specified values

Continuous data

A run chart with lines on it called control limits that provides information to help predict the future outcome of a process with a high degree of accuracy; shows variation in key processes over time

Control chart

interviewing or surveying participants at their convenience. Ex: interviewing physicians on their satisfaction with a department when they come up to that department.

Convenience Sampling

A common resource used in hospitals for the evaluation of outcomes management to improve clinical performance. Statement of Outcomes and Clinical Practice Guidelines are also tools that can be used to measure the performance of an organization.

Core Measures

database that incorporates special indexing and management functions to capture , sort, process and present info back to the user

Data repository

the acquisition of all the business data and information from potentially multiple,cross-platform sources and then the warehouse will store the data in one consistent format.

Data warehousing

A hospital had a total of 15 deaths during the month of June. A total of 540 patients were discharged (including the 15 deaths) during the month, of the 15 deaths, 4 patients died under 48 hours, leaving 11 patients who died 24 hours or more after admission. The total discharges, including deaths were 540. calculate the net death rate

Deaths minus those w/in 48 hours of admission in a given period x 100 ----------------------------------- Total number of discharges and deaths, minus Deaths w/in 48 hours of admission w/in the same period 15 - 4 x 100 = 11 x 100 ---------------- ------------ 540 - 4 = 536 = 2.09% or 2.1%

The total number of days between the admission and discharge dates for each patient (length of stay).

Discharge Days *The day of admission but not the day of discharge is counted as a discharge day (except for admission and discharge on the same day, which is counted as one discharge day)

occurs during a hospital stay and is conducted by a case manager or social worker. Planning process involves an assessment of the care level the pt will need upon discharge.

Discharge Planning

Data that represent separate and distinct values or observations; that is, data that contain only finite numbers and have only specified values

Discrete data

A list of diseases and conditions of patients sequenced according to the code numbers of the classification system in use

Disease index

A decision support system that uses a set of rules or encoded concepts to construct a reasoning process. (artificial intelligence).

Expert decision support system

the authorizing of a practitioner to provide specific care services. Such as "performing deliveries and doing gynecological surgery." Criteria for awarding clinical privileges must be detailed in the medical staff bylaws.

Granting Privileges

centralized model: stores pt records in a single database. it returns results quick but it is more expensive.

HIE models

A computation that compares the number of new cases of a specific disease for a given time period to the population at risk for the disease during the same time period

Incidence rate

HIE model that contains no central location of data. Health information is exchanged in a point-to-point manner across organizational participants.

Inconsistent Federated model

involves drawing conclusions based on a limited number of observations

Inductive Reasoning

Data that have been combined to produce value. Information is the outcome of analyzing data for a specific purpose.

Information

Record creation, capture, or receipt: include imaging and EDI

Information Life cycle

uses PAI ( patient assessment instrument) to classify pt into case mix groups (CMGs)

Inpatient rehabilitation facility (IRF)

A measure of a research instrument's consistency in data collection when used by different abstractors

Interrater reliability

A measure of a research instrument's consistency in data collection when used by different abstractors. Checking reliability by having more than one person abstract data for the same case. The results are then compared to identify any discrepancies.

Interrater reliability

when reliability is checked by having one or more person abstract data for the same case.

Interrater reliability

based on calendar days from the time the patient was admitted to his/her day of discharge. Subtract the date of admission from the date of discharge.

Length of Stay

Venice Bay Health Center collected the data displayed below concerning its four highest volume MSDRGs. CMS has increased the weight for MS-DRG A by 14%, increased the weight for MS-DRG B by 20%, and decreased the weight for MS-DRG D by 10%. Given these new weights, which MS-DRG generated the most revenue for Venice Bay Health Center?

MS-DRG C MS-DRG A = 2.023 × 0.14 = 0.283; 0.283 + 2.023 = 2.306 × 323 = 744.84 • MS-DRG B = 0.987 × 0.20 = 0.197; 0.987 + 0.197 = 1.184 × 489 = 578.98 • MS-DRG C = 1.925 × 402 = 773.85 • MS-DRG D = 1.243 × 0.10 = 0.124; 1.243 - 0.124 = 1.119 × 386 = 431.93

Venice Bay Health Center collected the data displayed below concerning its four highest volume MSDRGs. scprrhia01q.13.074 The MS-DRG that generated the most revenue for Venice Bay Health Center is

MS-DRG C.

To be eligible for CMS reimbursement, providers must become Medicare-certified by demonstrating compliance with the Conditions of Participation demonstrating that they have met pre-determined standards

Medicare certification

national association that promotes quality care by certifying qualified professionals.

National Association of Healthcare Quality

Contains reports on malpractice settlements, clinical privilege actions, and professional society membership actions against licensed providers.

National Practitioner Database

A mechanism to prove that the sender or recipient actually sent or received a message

Non repudiation

Ocean View Healthcare Center recorded six fetal deaths during the last year; details are listed below. Fetal Death Information ID WEIGHT GESTATIONAL AGE A 526 g 22 weeks B 405 g 18 weeks C 817 g 26 weeks D 1,023 g 30 weeks E 629 g 24 weeks F 1,113 g 29 weeks How should these deaths be counted in the hospital death rates?

None of these deaths will be included in the gross death rate.

data 1, 2, and 3 Std Deviations from the mean fall within 68.3%, 95.4%, and 99.7% of the curve respectively.

Normal Distribution

financial obligation that has specific terms of payment in the form of a contract. Effectively, a note is a type of loan.

Note

During the month of June there were 736 discharges (including deaths) from a hospital with 210 beds. The turnover rate for June was:

Number of discharges (separations) in the period ----------------------------------- Available beds 736/210 = 3.50 or 3.5

details the OIG focus for Medicare fraud and abuse for the year. it gives healthcare providers an indication of general and specific areas that are targeted for review

OIG workplan

online real time transaction processing. real time processing of dat to day transactions

OLTP

used to compare a population to a standard value

One sample t test

recognizes machine-generated characters (for example, preprinted numbers and letters) by interpreting the scanned, bit-mapped shapes of the characters' images and then converting the characters into computer-processable codes.

Optical character recognition technology (OCR )

1. The process of systematically tracking a patient's clinical treatment and responses to that treatment, including measures of morbidity and functional status, for the purpose of improving care 2. A measure that indicates the result of the performance (or nonperformance) of a function or process

Outcome measures

On June 1, at midnight at the end of the day the patient census was 240. Number of patients admitted on June 2 = 40 Number of patients discharged on June 2 = 35 Number of patients admitted and discharged on June 2 = 3 . calculate the I/P service days

Patient census on June 2 at midnight = 245 Inpatient services days for June 2 = 248 240 + 40 [admissions] = 280 - 35 [discharges] = 245 Patient Census at next census taking hour. 245 +3 [patients admitted and discharged] = 248 inpatient service days

Which of the following interactions fits the definition of a patient encounter? Phyllis saw Dr. Holland during a scheduled office visit. Dr. Holland prescribed a new medication. Jean called Dr. Holland with a question about her medication. Dr. Holland returned the telephone call and answered Jean's question. Howard was seen by Dr. Holland in the hospital emergency department after having a reaction to his medication. The pharmacy received telephone approval from Dr. Horton for a refill on Jackson's prescription.

Phyllis and Howard

A list of patients and their physicians usually arranged according to the physician code numbers assigned by the healthcare facility

Physician index

Using the information in the table below, calculate the cost breakdown per item and the monthly cost for the release of information (ROI) services at Community Hospital.

Postage: $0.76 per request $365/482 = 0.757 = $0.76 per request Service contract: $0.18 per request $85/482 = 0.176 = $0.18 per request Equipment: $0.25 per request $122/482 = $0.25 per request Supplies: $0.19 per request $92/482 = $0.19 per request Wages: $11.50 x 2,080 = $23,920 annual salary $23,920/12 = $1,993 monthly salary $1,993/482 = $4.13 per request Monthly cost: $2,655.82 $0.76 + $0.18 + $0.25 + $0.19 + $4.13 = $5.51 x 482 requests = $2,655.82.

unexpected events causing injury or potential injury which are likely to result in a claim being filed. The risk manager evaluates these PCE's.

Potentially Compensable Event

A type of review conducted before a patient's admission to an acute care facility to determine whether the planned service (intensity of service) or the patient's condition (severity of illness) warrants care in an inpatient setting

Preadmission utilization review

Data mining technique used by CMS to identify fraudulent medicare claims

Predictive model

The proportion of people in a population who have a particular disease at a specific point in time or over a specified period of time

Prevalence rate

Measures that focus on a process that leads to a certain outcome, meaning that a scientific basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome

Process measures

Term used by IOM and others to describe the difference between average care and the best care. There are many reasons for gaps between best-practice and current treatment choices. There is a gap in knowledge between researchers and physicians. There is skepticism of cost-effectiveness leading to failure to implement best practices.

Quality Gap

An organization that performs medical peer review of Medicare and Medicaid claims, including review of validity of hospital diagnosis and procedure coding information; completeness, adequacy, and quality of care; and appropriateness of prospective payments for outlier cases and nonemergent use of the emergency room; until 2002, called peer review organization

Quality Improvment organization (QIO)

looks at medicare improper payments, underpayments and overpayments

RAC

Carry it out to 3 decimal places, then round it to two decimal places.

Rates less than 1%

morbidity (illness), mortality (death), and natality (birthrate) at the local, state, and national levels.

Ratio, proportion, rate

Called a process icon and represents periods in the process when actions are being performed by humans.

Rectangle Symbol in a flowchart

composed of MDS, core assessment process (CAA) and RAI utilization guidelines

Resident assessment Instrument (RAI)

a federally mandated standard assessment used to collect demographic and clinical data on residents in a Medicare- or Medicaid-certified long-term care facility. It consists of three components: the Minimum Data Set (MDS) Version 3.0, the Care Area Assessment (CAA) process, and the RAI utilization guidelines

Resident assessment instrument (RAI)

system used in PPS for skilled nursing facilities

Resource utilization groups (RUGs)

The principle that all people are presumed to be free and responsible and should be treated accordingly

Respect for Persons

sophisticated program that functions to identify, reduce, or eliminate potentially compensable events, thereby decreasing the financial liability of injuries or accidents to patients, staff, or visitors.

Risk Management

continuous quality improvement tool used to display data.

Scatter Diagram

Data analysis tool used to plot points of two variables suspected of being related to each other in some way

Scatter diagram

Method of research involving analysis of the original work of another person or organization. Researchers analyze original data by combining data sets to answer new questions. Example: MEDPAR file.

Secondary analysis

scale used to ascertain a group's perspective or image of a healthcare org, product, or program. Ex: you want to conduct research on the physicians' view of the department's image.

Semantic Differential Scale

A measure that records a group's perception of a product, organization, or program through bipolar adjectives on a seven-point continuum, resulting in a profile

Semantic differential scale

The consecutive handling of tasks or products by individuals who perform a specific function in sequence. Often referred to as a production line work division, serial work division tends to create task specialists

Serial work devision

A hospital with 100 beds had 2,500 inpatient service days for the month of June. whst id the average daily I/P census

Set up formula: 2500 inpatient service days 2500/30= 83.3 30 days [days in the month of June] The average daily census for the month of June was 83.3.

1. The process of using clinical evidence to identify the level of resource consumption 2. A method for determining degrees of illness

Severity indexing

Which statistical analysis would be the best technique to use on the following problem? A study compared the effects of retesting on the scores of students who failed a writing test. Students who did not pass on their first attempt were allowed to retest. Results showed that students had higher mean scores at retest whether they attended additional training before retesting or not.

T test (A statistical examination of two population means. A two-sample t-test examines whether two samples are different and is commonly used when the variances of two normal distributions are unknown and when an experiment uses a small sample size)

used to compare if 2 groups have different average values. it tests the null hypothesis to see if a set of results is statistically significant <5% (p<5%)

T-test

Expanded CMS quality initiatives to the hospital outpatient and ambulatory surgical centers

Tax Relief and Health Care Act of 2006 (MIEA-TRHCA)

Exercise 9.5 Your physician clinic's chief financial officer has determined that it costs the clinic $3.75 per telephone call for the receptionist to set up an appointment with a physician in the clinic compared to $1.50 per online request via the Online Appointment Request Form. What would the cost savings be if, during one day at the clinic, 150 patient appointments were arranged by online request rather than by telephone?

Telephone requests: $3.75 x 150 = $562.50 Online Appointment Request Form: $150.00 x 150 = $225.00 Cost savings: $562.50 - $225.00 = $337.50 or $2.25 per appointment

average length of stay Ten patients had the following length of stays: 4,2,5,4,3,6,3,7,1,3

The average length of stay is the total length of stay divided by the number of patients discharged. The average length of stay of those ten patients with a total length of stay of 38 days: 38/10 = 3.8 days

You are the newly employed statistician at Memorial Hospital. The management information system is currently being redesigned. To assure that the statistics are being calculated correctly, you manually calculate the statistics to assure accuracy. The following statistics are given for the month of July: # admissions 929 # discharges 909 # discharge days 4, 988 # census days 5,022 # beds 250 # patients remaining last day of month 184 What was the occupancy rate? Round off to one place behind the decimal.

The correct answer is 10,075. 15000 + 500 = 15500 15500 x 35% = 5425 15500 - 5425 = 10075

Each patient care unit counts the number of inpatients present in the facility at midnight, at the end of the day on Dec. 1. The total patients present were 100. During Dec. 2nd, 3 patients were admitted but one of these patients expired 5 hours after being admitted. what was the daily I/P census

The daily inpatient census for December 2nd was 103.

The data displayed in the histogram below could best be described as

The data displayed in the histogram below could best be described as

Exercise 9.3 average request 542 Postage $456 Service contract (includes copier) $216 Equipment (includes copies) $135 Supplies (includes toner, printer cartridges, paper) $110 Wages $11.00 per hour

The monthly cost for the ROI services is the sum of the costs per request multiplied by the number of requests. Postage: $0.84 per request $456/542 = $0.84 per request Service contract: $0.40 per request $216/542 = 0.398 = $0.40 per request Equipment: $0.25 per request $135/542 = 0.249 = $0.25 per request Supplies: $0.20 per request $110/542 = $0.20 per request Wages: $11.00 x 2,080 = $22,880 annual salary $22,880/12 = $1,906.66 $1,906.66/542 = 3.5217 = $3.52

Exercise 9.9 1. Community Hospital wants to make the transition to an electronic data management system. The process will involve scanning 5,000 inpatient records, 2,000 outpatient records, and 1,500 ED records into the new system. The hospital estimates that there are 30 pages per inpatient record, four pages per outpatient record, and three pages per ED record. Assuming that one scanning clerk can scan 1,500 pages per day, how many days will it take to complete the transition? 1. The HIM Department would like to complete this project in 30 days. How many FTEs will the HIM Department manager need to hire to complete this in the month?

The number of days required is the total number of pages required divided by the number of pages per day that can be scanned 5,000 inpatient records x 30 pages = 150,000 2,000 outpatient records x 4 pages = 8,000 1,500 ED records x 3 = 4,500 (150,000 + 8,000 + 4,000)/1,500 = 108.0 days The number of FTEs will be the total number of days required divided by the total number of days available for the project. 108/30 = 3.6 FTEs needed. or the student could determine that if one scanner can scan 1,500 pages each day, how many pages would be scanned in each day to complete in 30 days. 162,000/30 days = 5,400 pages needing to be scanned 5,400/1,500 = 3.6 FTEs needed

Total length of stay Ten patients had the following length of stays: 4,2,5,4,3,6,3,7,1,3

The total length of stay for these patients was 38 days.

1. Transcriptionist A is a full-time employee earning $13.00 per hour and an annual salary of $27,040. She transcribes 1,200 lines per day for a total of 312,000 lines per year. What is the unit medical transcription labor cost for transcriptionist A (or, how much does a line cost when transcribed by Transcriptionist A)?

The unit labor cost is found by dividing total compensation by total productivity $27,040/312,000 = 0.087 = 0.09 or 9 cents per line

2. Transcriptionist B is a full-time employee earning $10.00 per hour and an annual salary of $20,800. He transcribes 900 lines per day for a total of 234,000 lines per year. What is the unit medical transcription labor cost for transcriptionist B?

The unit labor cost is found by dividing total compensation by total productivity 0.9 or 9 cents per line $20,800/234,000 = 0.089 = 0.09 or 9 cents per line.

What is the biggest problem with the pie graph displayed above?

There is more than one variable displayed on the chart.

A transcription supervisor collected the data displayed above. What kind of data display is it? And how many errors are attributed to skipped words?

This is a Pareto diagram; twelve (12) errors were due to skipped words.

During the month of August a hospital performed 750 operations, and 750 anesthetics were administered. There was 1 death due to anesthesia. The anesthesia death rate is:

Total deaths caused by anesthetic agents X 100 ----------------------------------- Total number of anesthetics administered 1 X 100 ------------- 750 = 0.13%

In a hospital with 15 deaths during the month of June, 7 autopsies were performed on hospital patients whose bodies were available for hospital autopsy. The hospital autopsy rate is

Total number of autopsies for a given period x 100 ----------------------------------- Total number of inpatient deaths for the same period 7 x 100 ------------- 15 = 46.66 or 46.7%

In a hospital with 15 deaths during the month of June, 7 autopsies were performed on hospital patients whose bodies were available for hospital autopsy. of the 15 deaths and 7 autopsies in June 2 deaths were reported to the coroner/medical examiner and the bodies removed from the hospital and no hospital autopsy was performed. The net autopsy rate

Total number of autopsies for a given period x 100 -----------------------------------Total number of deaths minus unautopsied Coroner's cases for the same period 7 x 100 ----------- 15 - 2 700 ------ 13 = 53.84 or 53.8%

During the month of May, 310 deliveries occurred. Of this number 5 deliveries were by cesarean section. Using the above formula, the cesarean section rate is

Total number of cesarean sections performed in a period x 100 -------------------------------- total number of deliveries in the period 5 x 100 ---------- 310 = 1.61 or 1.6%

During the month of November a hospital performed 275 operations, and 269 patients were operated on. There were 2 deaths that occurred within 10 days of surgery, and 1 that occurred after 10 days. The postoperative death rate is:

Total number of deaths(within 10 days of surgery) X 100 ----------------------------------- Total number of patients who were operated on for the period 2 X 100 -------------- 269 = 0.74%

In the month of May, there were 294 births, including 4 fetal deaths, and 2 babies subsequently died within seven days of birth. The fetal death rate for May, therefore, was:

Total number of fetal deaths for a given period x 100 -------------------------------- Total number of births and fetal deaths for the same period 4 x 100 ---------- 294 = 1.36 or 1.4%

During May an obstetric hospital discharged 230 obstetric patients, of this number, 1 patient died. Using the above formula the maternal death rate would be:

Total number of maternal deaths for a given period x 100 ---------------------------------- Total number of obstetric discharges, including deaths,for the same period 1 x 100 ---------- 230 = 0.43 or 0.4%

A hospital with 210 available beds (excluding newborn bassinets) rendered 4,780 patient days in June. June has 30 days. The percentage of occupancy for the hospital in June was:

Total number of patient days for a given period x 100 ------------------------------------ Available beds (bed complement) x the number of days in the period 4780 x 100 = 78000 = 210 x 30 6300 75.87 or 75.9%

In the month of May, there were 294 births, including 4 fetal deaths, and 2 babies subsequently died within seven days of birth. The perinatal death rate for May, therefore, was:

Total number of perinatal deaths in a given period x 100 ---------------------------------- Total number of live births and fetal deaths in the same period

3. An HIM department has eight full-time transcriptionists. Five of them produce 1,000 lines each per day. Of these five, one earns $12.00 per hour, three earn $12.50 per hour, and one earns $13.00 per hour. Two other transcriptionists in the department produce 1,100 lines per day. Of these two, one earns $13.00 per hour and the other earns $14.00 per hour. Finally, the eighth transcriptionist produces 1,200 lines per day and earns $12.00 per hour. a. What is the difference in cost per line between the employee who produces 1,000 lines per day and makes $12.00 per hour and the employee who produces 1,200 lines per day and makes $12.00 per hour? b. What general observations can you make about the unit labor cost and the two employees just mentioned? c. What is the difference in cost per line between the employee who produces 1,000 lines per day and makes $13.00 per hour and the employee who produces 1,100 lines per day and makes $13.00 per hour? d. What is the total unit cost for medical transcription?

Transcriptionist who produces 1,000 lines per day: 0.096 or 10 cents per line $24,960/260,000 = 0.096 or 10 cents per line Transcriptionist who produces 1,200 lines per day: 8 cents per line $24,960/312,000 = 0.08 = 8 cents Both make $12.00 per hour, but one produces 1,000 and one produces 1,200 lines per day. As the production increases, the labor unit cost decreases. Transcriptionist who produces 1,000 per day: 0.10 or 10 cents per line $27,040/260,000 = 0.10 or 10 cents per line Transcriptionist who produces 1,100 per day 0.09 or 9 cents per line $27,040/286,000 = 0.09 or 9 cents per line Total compensation/total productivity The total annual salaries for the eight transcriptionists = $211,120. Students could perform this calculation by either multiplying each of the eight hourly salaries by 2,080 and adding them together or adding the individual hourly salaries and multiplying by 2,080. Productivity could be calculated by either multiplying each individual transcriptionist's production by 5 workdays per week x 52 weeks and adding them together or by adding the total production and multiplying by 5 workdays per week x 52 weeks. 2,184,000 lines per year The total medical transcriptionist's annual productivity = 2,184,000 lines per year. The unit cost = $211,120/2,184,000 = 0.97 or 10 cents per line

The physicians at Sunset Shore Clinic reported the following statistics last Tuesday. It takes twice as long to perform Service C, so the doctors decided Service C should count as two services for the purpose of calculating workload. If Service C counts twice as much as Service A or Service B, then the physician who provided the most services was Doctor

Truba.

selected before the research start.

Type I error

Simultaneous assembly in which everyone performs a different specialized task at the same time. The tasks are all related to the same end product but are not dependent on each other.

Unit work devision

The process of determining whether the medical care provided to a specific patient is necessary according to preestablished objective screening criteria at time frames specified in the organization's utilization management plan

Utilization review (UR)

Physicians at South Seas Clinic are expected to see six patients per hour on average. The physicians with the highest productivity each week are exempted from on-call responsibilities for the weekend. Which physician will get the weekend off this week? hours patients Robinson 32 185 Beasley 30 161 Hiltz 35 200 Wolf 26 157

Wolf

The following data were collected in your physician office practice from one morning's visits. Visit ID Minutes Physician 508-123 5 Robinson 508-124 9 Robinson 508-125 8 Beasley 508-126 12 Wolf 508-127 6 Beasley 508-128 7 Beasley 508-129 5 Wolf 508-130 10 Baumstark 508-131 7 Baumstark 508-132 9 Robinson 508-133 11 Wolf Which physician spent the longest average time with patients on that day?

Wolf

The physicians at Sunset Shore Clinic reported the following statistics last Tuesday. scprrhia01q.13.078 The physician who performed the highest number of services overall last Tuesday was Doctor

Wooley.

You and your colleague are designing a study to try to determine the ideal mean cost for a discretionary service. You will market your service to a very large population. Your colleague thinks you will get the best data if you take lots of small samples. You think the data will be more reliable if you take one or two very large samples.

You are right-the means of a few large samples will yield more reliable results.

Types of budgets in which each budget cycle poses the opportunity to continue or discontinue services based on available resources so that every department or activity must be justified and prioritized annually to effectively allocate resources

Zero based badget

formula mean

add all the values and divide the sum by the # of values involved

In order to derive the total inpatient service days for any given day, you would need to

add same-day admits and discharges to the inpatient census.

Harry H. Potter was admitted to your hospital to receive a second round of chemotherapy for an invasive tumor. Four days after admission, Harry complained of a sore throat and developed a fever. Harry's throat culture was positive for strep. His strep throat will be

added to the numerator of the hospital's nosocomial infection rate.

The practice of counting the days, generally in 30-day increments, from the time a bill was sent to the payer to the current day

aging of accounts

formula incidence rate

all new and preexisting cases of a disease x100 --------------------------------- total populaton

assign a public key to data. two keys are used one to encrypt and one to decrypt

asymmetric encryption

the # of days an account will be held after pt is discharged so that charges can be entered .

bill hold days

required to be kept for 30 years per CDC

cancer records

The American Health Information Management Association conducted a study on job stress and job satisfaction in HIM professionals with more than 5 years of experience. The data they collected are displayed below. scprrhia01q.13.081 A researcher has repeated the same study 10 times. Each time the study is repeated, the p value decreases. As the p value approaches zero, the

chance that the results are due to a sampling error decreases.

involves accumulating charges for services, submitting claims for reimbursement, and ensuring that claims are satisfied.

claim processing

exposed and unexposed groups are followed for a periods of time to compare the incidence in the two groups

cohort study

site that hold computer processors but no data, used in emergency situations

cold site

The people of Treasure Island Beach have been struck with a rash that seems to be infecting almost everyone in town. The staff of the hospital is working to design a study of this mysterious disease. They decide to do a cross-sectional study because cross-sectional or prevalence studies are known for

concurrently describing characteristics and health outcomes at one specific point in time.

utilizes independent "vaults" or databases so the data are centrally managed but both logically and physically separated.

consistent federated model

one in which there is a central store of data that are logically separated with access controls requiring specific authorization for sharing the data.

consolidated model

assist patients in making decisions regarding care and healthy lifestyles

consumer empowerment

it limits users to accessing information not only in accordance with their identity and role, but to the location and time in which they are accessing the information

context based access control

policies and procedure that outline how a facility will respond in the vent of information system emergency. it should include a data backup plan

contingency plan

Snap shot of patient's records for easy sharing between providers

continuity of care record (CCR)

The American Health Information Management Association conducted a study on job stress and job satisfaction in HIM professionals with more than 5 years of experience. The data they collected are displayed below. scprrhia01q.13.081 scprrhia01q.13.083 The researchers at AHIMA who had professionals with 5 or more years' HIM experience rate their stress on a scale of 1-5, as shown in the chart above. Both job satisfaction and job stress are continuous variables. If the AHIMA researchers want to assess both the direction and the degree of the relationship between these two continuous variables, they may choose to compute the

continuous correlation coefficient.

All of the following items mean the same thing, EXCEPT a. daily inpatient census. b. daily census. c. inpatient service day. d. inpatient census.

d. inpatient census.

examining raw data to draw conclusions

data analytics

the process of hiding original data with random characters or data.

data masking

exploring data to identify trends and patterns. aka knowledge discovery

data mining

Organizations collect statistics to increase their knowledge of a specified population. The knowledge does not come automatically-it is developed in the following sequence:

data → information → facts → knowledge.

Use the formula below as a resource to answer the question. Np (1-p) n = __________________ (N-1)B squared/4 + (p) (1-p) If population size (N) = 1,200 and the proportion of subjects needed (p) = 0.5 and the acceptable amount of error (B) = 0.05, then sample size (n) = After the researchers see the number of subjects they will have to interview, they reexamine their criteria. The researchers could decrease the number of subjects while having the least impact on the reliability of the study by

decreasing p or increasing B.

You are planning a prospective study to try to prove a cause and effect relationship between dipping snuff and throat cancer. First, you identify subjects who regularly dip snuff and who are free of any signs of throat cancer. Next, you need to identify subjects who

do not dip snuff and who are free of any signs of throat cancer.

usually in the form of product demonstrations, site visits, reference checks, and corporate investigations of the vendor (LaTour 147). used to narrow vendor choices

due diligence

when a pt has more than one MRN is same database

duplicate

the leaders and respected role models in the organization, and their adoption of an idea or practice does much to initiate change.

early adopters

individuals in this group represent the backbone of the organization, are deliberate in thinking about and acceptance of an idea, and serve as a natural bridge between early and late adopters.

early majority

You are preparing data from a series of weight loss studies for display. The data collected during the study are as follows: #lost grpA grpB 7.5 - 9.4 1 2 9.5 - 11.4 3 2 11.5 - 13.4 6 5 13.5 - 15.4 5 4 15.5 - 17.4 8 7 17.5 - 19.4 2 3 If you want to allow the reader to compare the results of Group A with those of Group B on one graphic display, your best choice would be to construct a.

histogram.

William Rumple was pronounced dead on arrival (DOA). The hospital pathologist performed an autopsy on Mr. Rumple's body. This statistical event would be counted in the

hospital autopsy rate.

compares the number of new cases of a specific disease for a given time period to the population at risk for the disease during the same time period

incidence

Twelve new cases of a certain disease occurred during the month of August. If 4,000 persons were at risk during August, then the

incidence was 3 per 1,000 persons.

Measurements within sample A are assumed to be more variable than measurements within sample B when

individuals within sample A differ more from one another than individuals within sample B.

John Parker surveyed members of AHIMA's student COP regarding the relationship between clinical experiences and job opportunities. All respondents were seniors in HIA programs and each one expected to graduate and take the national exam within the next 6 months. Fifteen of the 18 respondents indicated that at least one clinical rotation had resulted in a job offer. Based on this information, Parker expects to be offered a job during senior clinical rotations. John is basing this expectation on

inductive reasoning

The coding supervisor at Bayside Hospital regularly has the coders recode records from the previous week in an effort to improve and monitor coding consistency. The supervisor has collected the data displayed below on four coders. Coder Records Under Review Same Code on Self-Coding Review Same Code on Peer Coding Review Coder A 28 22 20 Coder B 18 16 16 Coder C 45 42 43 Coder D 17 15 16 The data in the column on the far right were collected when the coders traded records for recoding. This is a common practice used to check

interrater reliability.

Your facility conducted a study of patient satisfaction, but you question the reliability of the questionnaire you used. The high degree of patient satisfaction expressed on the questionnaire just does not match the large number of complaints you have been receiving. You decide to try switching to an investigative strategy that will give you an immediate opportunity to review patient responses and correct errors. You have decided to use

interviews.

The primary difference between an experimental (randomized) clinical trial and other observational study designs in epidemiology is that in an experimental trial, the

investigator determines who is and who is not exposed.

Investigator A claims that his results are statistically significant at the 10% level. Investigator B argues that significance should be announced only if the results are statistically significant at the 5% level. From this we can conclude that

it will be more difficult for investigator A to reject statistical null hypotheses if he always works at the 10% level compared with investigator B who works at the 5% level.

vertical stretching of a distribution

kurtosis

the last ones to respond to innovation and make up as much as 16 percent of the organization. The laggards are often characterized as isolated, uninformed, and mistrustful of change and change agents, but they may serve a function by keeping the organization from changing too quickly.

laggers

Given a positively skewed frequency distribution

larger frequencies are concentrated at the low end of the variable.

The individuals in this group usually adopt innovations only after social or financial pressure to do so. they are the skeptical group

late majority

You want to graph the number of patients admitted to three different medical staff services on each day of the last month. Because you have a large number of observations (one for each day of the month) and you want to be able to compare the observations for each of the three services on one data display, your best choice is a

line graph.

efers to the ease with which assets can be turned into cash. This is important because payroll, loan payments, and other financial obligations are typically paid in cash

liquidity

You have made a list of the advantages and disadvantages of a measure of central tendency. ADVANTAGES Easy to obtain and interpret Not sensitive to extreme observations in the frequency distribution Easy to communicate and explain to others DISADVANTAGES May not be descriptive of the distribution May not be unique Does not provide information about the entire distribution The measure of central tendency you are describing is the

mode.

Equity is the arithmetic difference between assets and liabilities. In a not-for-profit environment, the difference between assets and liabilities is referred to as net assets. Assets - liabilities = net assets (equity)

net Asset

A small portion of the form you are using for a research study is reproduced below. Male 1 Female 2 This is an example of

nominal data.

collect 15% of the limiting charge over the nonpar medicare fee schedule

non par physicians, not accepting assignment

There were some HIM professionals who refused to participate in a job stress/job satisfaction study. This is of great concern to the AHIMA researchers, who worry about the introduction of

nonresponse bias.

The American Health Information Management Association conducted a study on job stress and job satisfaction in HIM professionals with more than 5 years of experience. The data they collected are displayed below. CH13-UNF-18 The researchers at AHIMA started by assuming there was no relationship between job stress and job satisfaction. This statement is generally called the

null hypothesis.

formula I/P bed count

number of avaliable hospital beds, both occupied and vacant, on any given day

the exposure and the outcome for each individual in the study is studied

observational study

data access architecture that allows users to retrieve specific info from large volume of data

online analytical processing (OLAP)

You are conducting a study on the pain associated with a specific illness. For the purpose of your study, you classify pain level as follows: CODE PAIN LEVEL (as described by the patient) 01 None 02 Little or Minimal 03 Moderate 04 Heavy 05 Severe

ordinal.

will receive the lesser total charge or par medicare fee schedule

participating physicians

links each patient to health records # under which clinical info can be located

patient index

regression analysis between two variable both numbers. it measures the relationship between both variables. if r is close to 0 then it is a weak relation. if r is close to 1, -1 then it is strong, if 4 is between 0.6 to 1 then it is a very strong relation.

pearson product moment correlation

You are trying to improve communication with your staff by posting graphs of significant statistics on the employee bulletin board. You recently calculated the percentage of time employees spend on each of six major tasks. Because you would like the employees to appreciate each task as a percentage of their whole day, you will post these figures using a

pie graph.

You point out to your administrator that the study model generally accepted to be the best method to determine the magnitude of risk in the population with the characteristic or suspected risk factor is the

prospective study design.

AKA pre-certification. looks at surgeries and decide if surgery can be performed less expensively

prospective utilization review

is the difference between the minimum and maximum values. The range is by definition very sensitive to outliers, since it is calculated as the difference between the two most extreme values.

range

Without even performing any complex calculations, you can get a quick, simple measure of dispersion in the LOS for yesterday's discharges by computing the

range of the data set..

A key infrastructure component of the Common Framework to support connectivity and interoperability

record locator service (RLS)

The major purpose of random assignment in a clinical trial is to

reduce selection bias in allocation of treatment.

statistical tool used ti investigate relationship between two variable. simple regression is one variable, bi-variable is two variables

regression analysis

The ability to obtain the same results from different studies using different methodologies and different populations is

reliability

CE must comply unless it meets one of the exceptions

request for restriction

Joseph Woodley has been on a third-floor nursing unit since October 2012 and was finally discharged to a nursing home in December 2013. When the average length of stay is calculated for the year 2013, this very long length of stay will

result in a special cause variation in the average length of stay.

The billing processes associated with preregistration, prebooking, scheduling, and registration activities that collect patient demographic and insurance information, perform verification of patient insurance, and determine medical necessity

revenue cycle Front end process

charge capture, case management, clinical documentation and coding

revenue cycle Middle process

claim processing, payment posting, follow up, customer service, collection and denial management

revenue cycle back end

process of asserting risk, taking steps to reduce risk to an acceptable level and maintaining that level of risk

risk management

nominal, ordinal, interval, ratio. Data description is continuous or discreet

scale of measurement

making predictions

scientific inquiry

a tool that provides a visual representation of an organization's critical strategies and the relationships among them that drive organizational performance toward its vision

strategy map

total I/P bed count day

sum of I/P bed count days for each day in the period

You are conducting a patient satisfaction survey in your outpatient clinic using interviewers who administer a questionnaire. Because you typically see about 300 people per day in the clinic, you decide to have the interviewers administer the questionnaire on every tenth patient. You are using

systematic sampling.

A major disadvantage of cross-sectional studies is that

the time sequence of exposure and disease is usually not known.

Pasadena Bay Hospital reports an average LOS in February of 3.7 days with a standard deviation of 20. This tells us that

there was a large variation in the LOS.

formula bed turn over rate: direct formula

total # of D/Cs for a period --------------------------------------- averagr bed count for the same period

formula gross hospital death rate

total # of I/P deaths (includiong NB)x100 ---------------------------------------------------------- total # of D/C's (including deaths and newborns)

formula percentage of occupancy

total # of I/P service days for a period X 100 -------------------------------------------------------------- total I/P bed count days x # of days in the period

formula neonatal death rate (infant mortality)

total # of NB (NB deaths for a period x100) ------------------------------------------------------------- total # of newborn (NB D/C's

formula hospital autopsy rate (adjusted)

total # of autopsies -------------------------------------------------------- # of deaths of hospital patient's whose bodies are avaliable for autopsy note: include I/P unless the bodies are removed by legal authoritis, also home care/outpatient/other patients whose bodies have been made avaliable for the performance of an autopsy it is included.

formula cesarean section rate

total # of cesarean sections performed x 100 ---------------------------------------------------------------- total # of deliveries

formula consultation rate

total # of consultations x 100 -------------------------------------------- total # of D/C's

formula anesthesia death rate

total # of deaths caused by anesthetic agent x 100 ------------------------------------------------------------------------ total # of anethetics administered

formula delinquent medical record rate

total # of delinquent records x 100 ------------------------------------------------------ total # of D/C's during a completion period

formula total hospital (morbidity) in fection rate

total # of hospital infections x 100 ---------------------------------------------------- total # of D/C's

formula incomplete record rate

total # of incomplete records x 100 ------------------------------------------------------ total # of D/C's during a completion period

formula % rate

total # of times events actually happened x 100 -------------------------------------------------------------------- # of total times the event could have happened

formula average daily census

total I/P service days (excluding NB) ______________________________________ total number of days in a period

formula average LOS

total LOS ____________________________ total # of D/C's