There are numerous tables in the Trella Health Hospice Solution that include data calculated using mortality counts and rates. Understanding mortality counts and rates is critical because high numbers suggest higher acuity patients that are appropriate for hospice care. When facilities or physicians have a patient population with high rates of mortalities, you know they have a difficult population to manage, and thus have patients much in need of Post-Acute Care (PAC).
This is important for Hospice agencies, because high mortalities are a sign of high potential for hospice services. This is also important for HHA agencies, because a more acute patient indicates patients in need of their services.
Mortalities impact Trella Health data in a variety of ways depending on the type of provider being reviewed.
Understanding the Data:
|Solution Location||Column/Row Name||Calculation|
Physicians Page - Main Table
Physician Detail Page - Patient Metrics and Hospice Utilization
|Mortalities||This is a count of patients who died within the 4 quarters of the one year reporting period AND were seen by the listed Physician during the six months prior to death.|
|Facility Detail Page - Key Stats||In Facility Mortality (INP only)||This is the percentage rate of patients who died in the facility on the page during the four quarters of the one year reporting period. The calculation comes from the number of patients whose status code was "died in Facility" divided by the total number of hospital episodes. See Counting - Stays, Episodes and Patients.|
|Facility Detail Page - Key Stats AND Patient Diagnostic Mix||30 Day Mortality (INP Only)||This is the percentage rate at which patients died within 30 days of discharge from the facility on the same page. The calculation uses the number of patients who were discharged (live) from the facility and then died within 30 days divided by the total number of live discharges.|
|Facility Detail Page - Key Stats||Number of Deaths||The count of patients who received care at the facility on the page during the one year reporting period who expired during the same period.|
|Facility Detail Page - Post Acute Destinations/Discharge Metrics||30 day Mortality||This is the percentage rate of patients in the post acute care setting in each row who die within 30 days of discharge from the facility on this page. The calculation uses the number of patients discharged live from the facility who went to the listed PAC and then died divided by the total live discharges who went to each PAC.|
|Hospice Detail Page - Patient Acuity Mix||% of Deaths||This is the percentage of patients seen by the hospice agency who died in the last year. This calculation uses the number of patients seen by this agency who died in the last year divided by the total number of patients seen by this agency in the same period. Note: The death could be during the patient's stay in the hospice or within 30 days of live discharge.|
Physicians with a high Mortality count and low number of Physician Hospice Patients could be excellent sources of Hospice referrals.
- Navigate to the Physicians Page using the Top Navigation Menu.
- Filter out Radiology, Pathology, and Anesthesiology from Specialties. (See Article: “Using Filters” for more information.)
- Click “Mortalities to bring the largest Mortality counts to the top.
- Compare the counts between two columns, “Mortalities,” and, “Physician Hospice Patients.”
- For Physicians with a large difference, examining their detail page will help with full evaluation.
In this example, the physician treated 788 patients who died within the one-year reporting period. Only 251 of this physician's patients received Hospice Care during the same period. The difference is 537 patients, but remember that this is a minimum, some portion of the 251 Hospice patients could be those who are still receiving care at the close of the reporting period. It is likely that there are more than 537 patients who died without receiving Hospice Care.
For Physicians who present a large difference between these two columns, (with Mortalities higher) this signifies that the physician has many patients who die without receiving Hospice Care. Although these physicians warrant further investigation, some possibilities for collaboration seem evident:
- The physician is unfamiliar with Hospice care or the value of Hospice care and needs to be educated.
- The physician is uncomfortable with the painful discussion with patients and family members regarding Hospice care and needs to be encouraged
- The physician is not practiced at identifying Hospice appropriate patients and could use the assistance of hospice professionals
- Physicians, especially in some specialties, may tend to want to continue curative measures beyond the time that a cure is possible. This desperation is often felt by family members as well. Although this is a challenging situation, intervention by a hospice professional could help to close the gap and encourage appropriate care.
In the end, using this table to identify these gaps in care is a good starting point for targeting physician sources of hospice patients and helping more patients to receive the care they need.