Technical Notes

Scoring Mechanism. A five bullet scale was used to reflect the extent to which hospital responses were consistent with the non-volume activities contained in each of the Coalition guidelines. Each guideline was scored separately and 100 points per guideline was the maximum score. Hospitals that performed a number of the surveyed services have specific and separate scores for each of the relevant guidelines. The five bullet scale is noted below.

Guideline Scores, Labels, and Point Distributions

••••• 100% to 95.0 % of possible points
•••• 94.9% to 80% of possible points
••• 79.9 to 60.0% of possible points
•• 59.9 to 40.0 of possible points
• 39.9 to 0% of possible points
N/A - Not applicable
N/R - Not reported

Question Weights. The questions in the survey were assigned different weights depending on what aspect of the guideline they addressed. Except for the Intensive Care Unit Physician Staffing (IPS) guideline, three distinct groups of questions were contained in each of the guidelines and they relate to: possession and use of criteria to evaluate the appropriateness of care; use of risk-adjustment systems to collect and interpret patient outcomes; and willingness to submit data to a statewide database that will be used as a tool to evaluate and improve the quality of care. In general, weights were assigned to the three content areas as follows:

Appropriateness 50% of weight
Risk-adjustment 25% of weight
Statewide database 25% of weight

The volume of procedures performed by a hospital were not considered in the question weights or final scores. Instead, raw volume data is reported directly. For the IPS guideline, there were two distinct groups of questions: the extent to which an appropriately qualified physician directs care in the ICU and the extent to which care is provided on a 24-hour basis by appropriately qualified physicians and mid-level practitioners. Weights for these two groups of questions were assigned as follows:

Intensivist-directed care 50% of weight
Intensivist coverage 50% of weight

Reporting Status. Not all hospitals that participated in the survey performed all of the surveyed procedures. In these cases, the hospitals were noted as N/A (not applicable) and were listed separately. In other cases where data were missing, the label N/R (not reported) was used.