Description:

We are going to walk through a set of slides from the American Hospital Association 2011 Chart Pack. The data are from 2009 and 2010. You will see reference to community hospitals.

In the AHA classification, a community hospital is defined as non federal, short term hospital that is open to the general public. Community hospitals may be general or specialty, teaching or non teaching. I don't want you to focus on discrete data points. This is more about patterns and trends.

Chart 2.3 shows inpatient hospital beds in community hospitals by state per 1,000 people. Look at the range in how some colors are clustered. The darker the state, the higher the ratio of beds to people. Washington and Oregon have the smallest number. And it is more than doubled in The Dakotas.

Chart 3.4 shows total inpatient days from 1989 to 2009 as a rate, days per 1,000 persons. There has been a decrease over time, although it is flattening some in the later years.

Chart 3.5 gives the average length of stay. What is the mean number of inpatient days for the years worth of admissions. It is easier to quantify the trend as the bars are numbered. In 1989, the average length of stay was 7.2 days. By 1999, it was down to 5.9. And in 2009, 5.4 days.

Chart 3.6 is back to the states. Again, you see a range across states. Again, Washington and Oregon have the low numbers with shorter length of stay. This has at least doubled in The Dakotas. There are some similarities in the distribution of light and dark states, but the pattern is not identical.

Chart 3.8 shows emergency room visits from 1991 to 2009. It is a rate, not an absolute number of visits. ED utilization is going up. Is this because people are sicker? Is it pour access to primary care? One thing we do know is that it is expensive. Emergency rooms are resource intensive settings, which means it costs more for the same type of patient to be seen in an Ed as opposed to a primary care clinic.

Chart 3.9 shows ED overcrowding or lack of capacity to serve the number of presenting patients. What you want to notice is that the type of hospital makes a difference. Geography makes a difference. Teaching hospitals are the most likely to be over capacity, followed by urban hospitals. The groups are not mutually exclusive. An urban teaching hospital would be counted in both bars.

Chart the 3.10 shows the percent of hospitals that had at least some degree of ambulance diversion. Basically closing to new traffic. Again, this is more of a problem in the urban and teaching hospitals.

Chart 3.11 looks more deeply into the diversions. It is more about having the space, which are staffed beds, than actually having the staff. There is just no room. Think about the video clip you watched from the documentary The Waiting Room last week.

Chart 2.4 shows the consequence of closings, mergers, and acquisitions. Over almost 10 years, the number of hospitals and health systems has increased, with a blip around 2007. There is not a single take home message here, but over time things change, generally in the same direction and geography matters.

Now, we are moving on to trends and health care employment. Chart 6.2 shows the increase in number of hospital employees. Chart 5.4 is the number of hospital employees as full time equivalents. This adjusts the number of employees to a common metric and allows for comparisons.

When you adjust a full time equivalents, the increase is much less severe. How would you explain this? What would be the advantage to a hospital of changing from full time to part time employees, even if the total number of hours is held constant?

Chart 5.12 compares the projected demand for RN full time equivalents, which is in blue, to the projected supply, and that's in yellow. The gap is expected to widen as demand increases and supply decreases simultaneously. Chart 7.1 helps to explain why demand may increase. Look at the increase in total population and specifically at the increase in number of elderly person's. Older people tend to have more health problems and need more care.

Chart 6.6 breaks down hospital employees by type. Health care providers are by far the largest group. Where would you place health communicators? Finally, chart 6.10 looks at hospital expenses. Labor costs dwarf the other categories.

Here is a link to the media file cryan_slides.mp4