The Indiana State Department of Health (ISDH), through provisions in Indiana Code 16-21-6-11, is required to publish "a consumer guide to Indiana hospitals." It is the objective of this report to provide data on basic hospital services and to permit valid comparisons among the various hospitals in the state. The Data Analysis Team of the ISDH Epidemiology Resource Center compiled this report from calendar year 1996 data submitted by the hospitals to ISDH through the Indiana Hospital&Health Association.

Hospitals in the state are classified into peer groups based on their providing similar types and levels of services. Peer group assignment takes into account the number of beds, number of discharges and types of major services offered by the hospital. Therefore, comparisons of total length of stay and average charge data among hospitals in the same peer group should be more valid.

The 1996 Hospital Consumer Guide includes information for each hospital on reported inpatient discharges in several different ways. The first section presents information on selected diagnosis related groups (APR-DRGs) and procedures associated with heart disease. The next section presents similar information on childbirth and related procedures. The third major section presents data from selected APR-DRGs of importance in Indiana and the last section on selected procedures that may be of general interest. The tables for each APR-DRG include the number of discharges by APR-DRG and hospital, average length of stay (LOS), median LOS, the average total charges, the median total charges, and comparative data for peer group hospitals. The tables for each procedure include the number of discharges by procedure and hospital, average length of stay (LOS), median LOS, the average total charges, and the median total charges. The top five principal diagnoses and procedures associated with each APR-DRG and the top five diagnoses associated with each selected procedure are also included. Median LOS and median total charges were also chosen for reporting because they represent the midpoint or 50^th percentile, rather than average, LOS and total charges. (The median is the value that half the numbers fall below and half above.) Other states and agencies also commonly report median values as a better descriptor of data that can be markedly skewed.

An average severity for each APR-DRG was calculated for every hospital. This "average severity" number was used to adjust for differences in severity among hospitals. Severity takes into account secondary diagnoses and the effect of other factors such as the age of the patient, procedures performed, etc. Severity classes range between "1" for minor to "4" for extreme. Average severity cannot be calculated in the same way for procedures.

In order to provide a 'length of stay' comparison among hospitals in a particular peer group, the average severity for a given APR-DRG for the hospital was calculated and the LOS compared to the peer group's value at that severity level. For example, if a hospital’s discharges had an average severity of 1.5, its LOS would be compared to the peer group's value halfway between the peer group's LOS for a severity of one ("1") and its LOS for a severity of two ("2").

To provide a 'total charge' comparison, a hospital’s average severity for a given APR-DRG was calculated and the total charge compared to the peer group's value at that severity level. For example, if a hospital’s discharges had an average severity of 1.5, its total charge would be compared to the peer group's value halfway between the peer group's total charge for a severity of one ("1") and the peer group's total charge for a severity of two ("2"). However, there is no way to tell what charges are included in the hospital’s total charge category. For example, some hospitals may include anesthesiology in the cost category, while other hospitals may bill for anesthesiology separately.

Tables II-1, 2, 3, 4, 5, and 6; Tables III-1, 2, 3, and 4; and Tables IV-1, 2, 3, and 4 provide the information needed to make comparisons among hospitals for each selected APR-DRG. The average length of stay and average total charges by hospital are listed. This information can be compared to the final two columns that contain information on the "expected" length of stay and "expected" total charge for the particular peer group. For example, for APR-DRG 370 - Cesarean Delivery, Ball Memorial Hospital's discharges had an average severity of 1.58 and an average length of stay of 2.88 days, compared with a length of stay of 3.14 days for the peer group adjusted for the severity. The hospital’s average total charges were $5,039, compared to $5,325 for the peer group. This hospital’s length of stay and total charges are less than those that would be expected for the peer group based on the particular severity for cesarean section.

Tables VI-1 and VI-3 provide summary information on the 50 most frequent APR-DRGs and Procedures appearing in the data and Tables VI-2 and VI-4 provide a complete listing of all APR-DRGs and Procedures in Indiana that occurred more than 20 times.