The analysis framework of a free clinical-care database is intuitive enough for even reporters to figure out.
MODERN HEALTHCARE selected a representative general hospital at random and quickly isolated findings that could stand a closer look.
One finding suggested that the well-respected hospital, which is in the West, could improve the efficiency and survival rate surrounding chronic ischemic heart disease, the facility's highest-volume admission.
Another finding raised a red flag on the medical center's response to septicemia, an infection complication.
The hospital had a heavy load of heart-disease cases in 1997, the latest year for which Medicare data were available. The top four principal diagnoses were heart-related, collectively representing more than 1,800 cases, or 31% of all hospital admissions.
Of those, ischemia treatment accounted for 997, or 17%, of all cases. The expense of such treatment was even more dramatic. Ischemia racked up $17.5 million in costs, 31% of the hospital's total costs of $56 million.
But in nearly 10% of the ischemia cases, the CaduCIS clinical database uncovered complications that could have been avoided or better controlled by sound practices.
According to the database's calculations, the hospital could have trimmed 412 patient days by providing improved treatment. That amounts to a total of $2.2 million in extra costs that could have been cut by investigating the underlying reasons for the inefficiency.
The facility also reported 17 deaths of ischemia patients, 10 of which could have been avoided given the patients' condition at admission.
By comparison, diagnoses of septicemia were much rarer but far more likely to result in death. Of 166 cases, 25 deaths were reported, the most for any diagnosis. Nine patients had avoidable complications.
Septicemia is frequently a complication of other infections that are not monitored closely enough in the hospital, said David Brailer, M.D., chief executive officer of Care Management Science Corp., which markets the CaduCIS database.
The septicemia complication results when pathogens from an infection in, for example, the urinary tract enter a patient's bloodstream, Brailer said.
It's an expensive condition to treat, frequently resulting in an extra week in the hospital. Consequently, a low average of patient days and expenses per case may represent a problem rather than an achievement, because either sufficient resources weren't mobilized or the patient died before the hospital could respond, he said.
The facility evaluated actually showed few opportunities for improvement-only 58 excess patient days and $207,000 in excess costs of $1.2 million spent fighting the problem. No avoidable deaths were identified among the 25 reported.
But those statistics could result from doing too little to salvage a patient who has septicemia when admitted or failing to pick up the condition fast enough in the hospital, Brailer said. The absence of avoidable deaths, usually a sign of good care, could instead indicate that the cases quickly got out of control and nothing could be done, he added.