Question

Exhibit F.12 shows the case mix distribution by severity level across the five MDCs for each hospital as well as the statewide rates. The data are contrived. Use the indirect age-adjustment technique to calculate the number of expected deaths in each of the six MDCs for each of the two severity levels for each hospital using Exhibit F.12 as a template. What are the overall expected deaths for each hospital? What is the SMR, or risk-adjusted mortality index (RAMI)? Which hospital has a better SMR?

600 Capstone Cases (continued from previous page) UK UL State Rates Expected Deaths Expected Deaths Cases 900 EXHIBIT F.12 Cases and Expected Deaths using Statewide Rates. Univer- sity of Ken- tucky (UK) and University of Louisville (UL) Hospitals Five Major Diagnos tic Categories and Severity 1,864 Cases 800 3,320 700 0.07 0.008 0.1 Heart disease, severe Heart disease, mild Respiratory diseases, severe Respiratory diseases, mild 400 0.02 1,693 1,414 0.08 650 600 0.02 1,128 Gl diseases, severe GI diseases, mild Musculoskeletal, severe Musculoskeletal, mild Nervous system, severe Nervous system, mild Total 1,719 400 1,672 351 1,100 0.02 0.005 0.1 0.01 300 237 800 1,180 12,434 8,794

Answer 1

case mix distribution by severity level across five MDCs for each hospital as well as statewide rate

UK 1 State plate Staff and patient will need to engage with ucolours device throughout patient's stay and charting, outflow, case eupected death case Heart eupected death recut the disease, severe 6.07 800 10.07x800 = 56 900 0.07 * 900 = 63 Hestita dideall, mild Heart 0.008 3,3200.00883,320=26.5 1864 10.008x 1864 149 Respiratory diveaue, Severe orl I 700 10. 1x700 = 70 400 oil X Yoo . 4o Respiratory dikecue, mild 0.82 1693 10.02x1693=338 1914 0.02 x 1414 = 28-2 a I dileare, severe 0.08 6 So 6.08 x 65o= 52 600 6.08 x 600 48 I dideene, mild 0.02 1719 16.02 x 1719- 34.3 Toro2 x 1719- 34.3 I 1128 2 10.02x 1128= 22.56 0.02 musculo cutanan, sever 400 0.02 x 400- 8 351 6.02 x 3515 7 musculoskeletal, mild Orvos 1672 0.oosx1672-8-3 1100 0065*1100 5.5 Neovou 300 or 1x300= 30 237 0.14 237= 24 Nervous system, mild 0.01 | 1180/0.01 & 1180- 11.8 1 800 0.1 x 800 = 8 Severie - I Toted 8.33 12,434 331 187941 2611 No. of eupected death in severe, Heat Heart dreoue in uk hospital - 5G. No. of eupected death in severe a Respiratory dixeone in uk halbited - 70 No. of enpected death in severe af dineoul in uk= 52. Tun leuke sted death in severe, musculoskeletal didease in Uk=8

H No. of eupected death in severe, Heat Heart dreoue in uk hospital = 56 A No. of enpected death in severe a Respiratory dixeare in uk halpital = 70 P No. of enpected death in severe AI diseaul in uk= 52 No. of eupected death in severe , musculoskeletal disease in Uk=8. 4 No. of eupected death in revere a neavous system in uk=30 No. of eupected dearth in severe Heast dineast in UL = 63 A No. of eupected death in leveres Reepiratory dleoul in UL=40 No. of expected death in severe, al disease in uL = 48 No. of expected death in severe, muscular keleted diseas in UL = 7 Noor of eupected death in severe, Nervous syltemin = 24 Totall, sevire enpected death in Uk=216. Total a severe enpected death in ul=182

③ overall eupected death in uk = 331 overall cupected death in UL = 261 (3) SMR = Standarized mortality rate mortality Population SAR of UK = 331 = 0.026 12434 SAR of UL = 261 = 0.029 8794 Risk-adjusted mortality index = obleave moritality rate. CRAM) Practical mortality rate RACII of ok = 0.026 = 0.08 RAMI of uk = 0.029 - 6.09 0-33 U ke hospital have better SMR