Louisiana Hospital Inform - - Quality Definitions and Methodology

Quality Definitions and Methodology

Hospital Compare Footnotes

1. The number of cases is too small (n<25) for purposes of reliably predicting hospital performance.: For each measure, the rate is displayed as a percent of the number of patients for whom the measured treatment is appropriate. For hospitals with small numbers of patients for whom the measured treatment is appropriate during the reporting period (fewer than 25 patients), the calculated rate may not be predictive of the hospital's future performance. As the quality data base is expanded to a full rolling four quarters of data for each measure, the number of cases used to determine hospitals' rates will likely increase, thereby increasing the reliability and stability of the rates. Note: This footnote does not necessarily reflect hospital size or overall patient volume.
2. Measure reflects the hospital's indication that its submission was based upon a sample of its relevant discharges.: Rates are based on the cases reported by hospitals. A rate may be based upon the total number of cases treated by a hospital, or for a facility with a large caseload, a rate may be based on a random sample of the cases the hospital treated. This footnote indicates that a hospital chose to submit data for a sample of its total cases (following specific rules for how to the select the cases).
3. Rate reflects fewer than the maximum possible quarters of data for the measure.: Each rate reflects the care provided over a specific time period, up to a maximum of four quarters. For the ten measures in the "Starter Set", the maximum number of quarters for which the hospital could have provided data was four quarters. For the seven additional measures that were first reported in April 2005, the maximum number of quarters for which a hospital could have provided data was three quarters (April - December 2004). For the three additional measures reported in September 2005, the maximum number of quarters a hospital could have provided data was two quarters (July - December 2004). This footnote indicates that the rate was calculated based on fewer than the maximum possible number of quarters for the measure.
4. Inaccurate information submitted and suppressed for one or more quarters.: Hospitals are required to submit accurate, reportable data to the Centers for Medicare and Medicaid Services (CMS). The rates for these measures were calculated by excluding data that had been suppressed for one or more quarters because they were identified as inaccurate.
5. No data is available from the hospital for this measure.: Hospitals volunteer to provide data for reporting on Hospital Compare. This footnote is applied when the hospital did not submit any cases for a measure.
6. Fewer than 100 patients completed the HCAHPS survey. Use these rates with caution, as the number of surveys may be too low to reliably assess hospital performance.: The number of completed surveys the hospital or its vendor provided to CMS is less than 100.
7. This displays less than 9 months of accurate data.: This footnote is applied when CMS opts to display HCAHPS results on fewer than the required months of survey data.
8. Survey results are not available for this period.: This footnote is applied when a hospital did not participate in HCAHPS, did not collect sufficient HCAHPS data for public reporting purposes, or chose to suppress their HCAHPS results.
9. No patients were eligible for the HCAHPS Survey.: This footnote is applied when a hospital has no patients eligible to participate in the HCAHPS survey.