The PHC4ís mission is to provide the public with information that will help to improve the quality of health care services while also providing opportunities to restrain costs. The measurement of quality in health care is not an exact science and is still in its beginning stages. And while there may be a number of ways to define quality, for the purposes of this report, three factors are suggested:


® Volume of Cases - For each hospital, the number of cases in each DRG after exclusions is reported. This can give a patient or a purchaser an idea of the experience each facility has in treating such patients. Studies have suggested that in at least some areas, the number of cases treated by a physician or hospital can be a factor in the success of the treatment.

Note: Small or specialty hospitals may report low volume due to the unique patient population they serve or geographic location.

® Risk-adjusted Mortality Rates - PHC4 has used risk-adjusted mortality statistics as a measure of quality since it began publishing reports in 1989. Using a complex mathematical formula that assesses the degree of illness for patients upon their admission to the hospital, PHC4 calculates an expected, or predicted, number of deaths. In simple terms, based upon how sick the patients are, PHC4ís method determines the number of patients one could reasonably expect to die in a given hospital in a given DRG. Hospitals that treat sicker patients are given "credit" in the system; more patients can be expected to die because they are more seriously ill.

® Risk-adjusted Length of Stay - This measure represents a step forward in the measurement of the quality of care. How long a patient stays in the hospital can reflect how successful the treatment is that the hospital provides, and has an impact on the resources brought to bear in delivering treatment. In much the same way as the mortality measure, key patient risk factors related to how sick patients are when admitted to the hospital are taken into account. These patient risk factors are then adjusted or accounted for so that, for example, a younger, healthier patient is not treated the same statistically as an older, sicker one. These adjustments allow for an apples to apples comparison - patient severity or risk factors cannot explain the remaining differences. Yet after patient risk factors have been equalized among hospitals in the same treatment categories, there are still differences in the length of hospitalization.


The risk-adjusted mortality and risk-adjusted length of stay figures in this report are important measures of quality as well as resource utilization, but cannot be considered the only measures. The measurement of quality is highly complex and the information used to capture such measures is limited. A hospital death is frequently an unavoidable consequence of a patientís medical condition. Hospitals and physicians may do everything right and still the patient can die. However, after taking the significant risk factors available to the PHC4 into account, there are differences with respect to patient mortality and lengths of hospitalization that exist among hospitals.