Hospital Discharge Definitions

Age-Adjusted Rates

A weighted average of the age-specific rates, where the weights are the proportions of persons in the corresponding age groups of a standard population. The calculation of an Age-Adjusted Rate uses the year 2000 U.S. standard million. Benefit: Controls for differences in age structure so that observed differences in rates across areas such as counties are not due solely to differences in the proportion of people in different age groups in different areas. Rates are per 100,000 population.

Cause Categories/Groupings

OASIS Detailed Cause Groups: These categories can be more detailed than rankable cause categories and are not mutually exclusive. Causes are organized in parent-child relationships: For example 'Motor Vehicle Crashes' is a child cause of the 'External Causes' parent. Parent causes have a broader definition of ICD codes than child causes. Note: Adding up all the child causes will not necessarily add up to the parent cause.

Georgia Rankable Cause Groups: Georgia Rankable Causes are mutually exclusive cause categories and therefore rankable. They are unique to Georgia and were developed to represent mutually exclusive groups of ICD codes that are intended to share common etiology and/or common intervention.

NCHS Rankable Cause Groups: NCHS Rankable Causes are mutually exclusive cause categories and therefore rankable. They are prepared by the National Center for Health Statistics and used nationwide.

Cause Group use: See the Cause Definitions tables below for details of each cause category. Generally, use Rankable Cause Groups if ranking by cause and Detailed Cause Groups when looking for more detail.

Cause of Discharge

Causes are based on the principal diagnosis, except where the principal diagnosis is an injury code. All discharges/ER visits having ICD-9-CM external causes (injuries) are assigned their appropriate External Cause of Injury Code (E-Code) in accordance with STIPDA (State and Territorial Injury Prevention Directors Association) 2003 guidelines. The standards can be found at: http://www.safestates.org/. Similarly, all hospital discharges/ER visits having ICD-10-CM causes are based on the principal diagnosis, except where the principal diagnosis is an Injury code. If so, the Discharge/ER visit is assigned the appropriate External Cause of Injury in accordance with Safe States guidelines.

Deduplicated Discharges

The number of persons discharged alive from non-Federal acute-care facilities (hospitals) for illness. Only discharges of Georgia residents who were seen in a Georgia facility are included. Persons are counted only once if readmitted for the same chronic condition during a calendar year. Deduplicated Discharges also excludes people discharged dead, healthy newborn infants, and healthy mothers giving birth to newborn infants. Since the number and rate are derived only from hospitalizations, they do not include all existing cases (prevalence) or new cases (incidence) among residents of Georgia.

Deduplicated Discharge Rate

Formula = [Number of Deduplicated Discharges / Population] * 100,000. Rates that use Census Population Estimates in the denominator are unable to be calculated when the selected population is Unknown.

Discharges

The number of inpatients discharged from non-Federal acute-care inpatient facilities. Only discharges of Georgia residents who were seen in a Georgia facility are included. Persons can be counted more than once if readmitted. Discharges include people both living and who have died. Since the number and rate are reflect only hospitalizations, they do not include all existing cases (prevalence) or new cases (incidence) among residents of Georgia. Discharges are reported by date of discharge, not admitting date.

Discharge Rate

Formula = [Number of Discharges / Population] * 100,000. Rates that use Census Population Estimates in the denominator are unable to be calculated when the selected population is Unknown.

Ethnicity

Hispanic or Latino includes persons of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. Non-Hispanic + Hispanic may not equal the total number of events due to persons of unknown ethnicity.

International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)

A statistical classification system, in use since 1979, that arranges diseases and injuries into groups according to established criteria. It is used to improve comparability of cause of death statistics reported by different governmental entities. Most ICD-9-CM codes are numeric and consist of three, four or five numbers and a description. The codes are revised approximately every 10 years by the World Health Organization and annual updates are published by the Health Care Financing Administration (HCFA), now the Center for Medicare, Medicaid Services.

International Classification of Diseases, 10th Revision, (ICD-10)

An alphanumeric coding scheme that replaces ICD-9, and used for dischage data since the 4^th quarter of 2015. ICD-10 codes were developed by the World Health Organization Collaborating Centres for Classification of Diseases.

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) vs. ICD10

The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification (CM) of the classification for morbidity (hospital and ER data) purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. ICD-10-CM is the replacement for ICD-9-CM, effective October 1, 2015 in discharge and ER data.

The ICD-10 is copyrighted by the World Health Organization (WHO). WHO has authorized the development of an adaptation of ICD-10 for use in the United States (ICD-10-CM). All modifications to the ICD-10 must conform to WHO conventions for the ICD. https://www.cdc.gov/nchs/icd/icd10cm.htm

Lifestages

An age year grouping methodology based upon predictable mortality. Georgia uses the following Lifestages: <1 Infancy, 1-4 Early Childhood, 5-12 Later Childhood, 13-19 Adolescence, 20-29 Early Adulthood, 30-44 Young Adulthood, 45-59 Middle Adulthood, 60-74 Late Adulthood, and 75+ Older Adulthood. The highest value for age is 120 years.

Non-Rural

Any county with 50,000 or more total population according to the United States decennial census of 2010 or any future such census (GA Code § 31-6-2 and 31-7-94.1).

Payor

Payor is the primary entity responsible for payment of services. Values for Payor include:

• Medicaid, based on Title XIX of the Social Security Act, is a Federal-State matching entitlement program that pays for medical assistance for certain vulnerable and needy individuals and families with low incomes and resources;
• PeachCare for Kids (Georgia's State Child Health Insurance Program (SCHIP)) is a program that provides comprehensive health care insurance for children through the age of 18 who do not qualify for Medicaid and live in households with incomes at or below the federal poverty level;
• Medicare is a health insurance program for people age 65 or older, some disabled people under age 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant);
• Private Insurance includes Blue Cross / Blue Shield, HMO/Managed Care, Commercial Insurance, Other non-specified Managed Care, PPO (Preferred Provider Organization), POS (Point of Service Provider),State Health Benefit Plan (SHBP); and
• Self Pay includes patients with no proof of insurance, patients filing their own insurance claims, patients paying their own bills, Hill-Burton cases, charity cases, etc.; and
• Other (All other plans)
• Unknown Payor

NOTE: Rates by Payor (crude or age-adjusted) do not include payor-specific denominators. Use with caution.

Percent of State Population

Formula = [The number of population in a selected geography / Total population of the state] *100.

Percent of Discharges by Cause

Formula = [The number of hospital discharge from a selected cause / Total number of discharges] * 100.

Percent of Discharges within State

Formula = [Number of hospital discharges in a selected geography / Total number of hospital discharges in the state] * 100.

Race

Per the Federal Office of Management and Budget, Directive 15 (1997),

• White is a person having origins in any of the original peoples of Europe, the Middle East or North Africa;
• Black or African-American is a person having origins in any of the black racial groups of Africa;
• Asian is a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam;
• American Indian/Alaska Native is a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment;
• Native Hawaiian or Other Pacific Islander is a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands;
• Multiracial is a person declaring 2 or more of these races.

Note: Rates for years prior to year 2000 use population estimates for the denominator that adhere to a different Federal standard for race: White, Black, Asian or Other Pacific Islander, American Indian and Alaska Native. So, unlike years 2000 and after, Multiracial is not included. Also, Asian by itself is not available because it was grouped with Pacific Islander (After 1999 Asian is separate from Native Hawaiian or Other Pacific Islander).

Rates using Census Population Estimates in the denominator are not calculated when a selected race is not available in the denominator, or zero.

Nevertheless, selections available in OASIS' Race query box reflect the 1997 Race classifications described above. Most of the numerators used in indicators in Oasis *do* have the year 2000 race selections. Therefore, selections of multiple years that span <2000 and 2000+ will return a *number (count)* for all race selections, but the *rates* may be limited by the change in racial classifications the federal government used as noted above. In these cases you will see NA₁ in the output cell (NA₁ therefore by definition will only show up in rates for the years before 2000).

In some cases, the numerator's race classification may be more precise, or up to date, than the Census population estimate counterpart used in the denominator. You may find that there are a number of births of a given race for a county/age-group selection, but no count of population estimated for the denominator. In such cases where the race selection was available for both the numerator and the denominator, but the denominator's estimate was zero, you will see a NA₂. If the numerator was greater than the denominator, but the denominator was > 0, you will see a NA₃ returned.

Rate

Both Numerator and Denominator can be Place, Race, Age, Time, Ethnicity, and Sex-specific:
Rate = [ N _PRATES-M / D _PRATES ] * 100,000
where

M - Measure(s) (e.g. ER Visits to Males aged 45-49)
N - Number of ER Visits
D - Population (e.g. Males aged 45-49)

Rates that use Census Population Estimates in the denominator are unable to be calculated when the selected population is Unknown.

Rural

Any county having a population of less than 50,000 according to the United States decennial census of 2010 or any future such census (GA Code § 31-6-2 and 31-7-94.1).

Selected Causes Total

‘Selected Causes Total’ shows up in Web Query output tables that have been Stratified, and refers only to any subcategories of a given “parent” cause category. Please note that if a parent cause category is chosen in addition to subcategories, ‘Selected Causes Total’ refers only to the subcategories. Example:

‘Selected Causes Total’ refers only to Falls and Drowning, not the parent category External Causes of which Falls and Drowning are a part. The same principle applies to Selected Races, Selected Ethnicities, etc.

Sex-Specific rates

PLEASE NOTE: Unless a sex is specifically selected, Breast, Ovarian, Cervical, Uterine and Prostate and Testes cancers will have both males and females in the numerator and denominator. Note that usually (e.g. as reported in the Vital Statistics Report), Breast, Ovarian, Cervical and Uterine have only females in both the numerator and denominator, while Prostate and Testis have only males in both the numerator and denominator.

Socioeconomic (SES) Vulnerability

Socioeconomic (SES) Vulnerability refers to the socioeconomic status domain/subset of the CDC’s Social Vulnerability Index (SVI) 2020. Socioeconomic vulnerability ranks census tracts within Georgia on 5 factors: below 150% poverty, unemployed, housing cost burden, no high school diploma, and no health insurance. Percentile ranking values range from 0 to 1, with higher values indicating greater vulnerability/lower socioeconomic status. Quintiles of the percentile rankings were used to create class breaks (Very Low, Low, Average, High and Very High SES Vulnerability). Keep in mind that “Very Low” SES Vulnerability equates to a High SES status. For more information see https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. For data dictionary click here.

Standard Discharge Ratio (SDR)

Answers whether a local rate is statistically significantly different from the same rate for the State. SDR is a statistical calibrator of confidence level in the rates of populations. It is indicative whether a rate is within the "normal" range of estimated values or significantly higher/lower to such estimates. Rates are compared to those for Georgia as a whole. State rates are the standard against which local rates are compared, in order to forecast the number of likely events in a local area. It is a statistic indicating significance at the 95% confidence level.
Higher: Significantly higher ratio than expected based on the State ratio. Expected: No significant difference as compared to the State. Lower: Significantly lower ratio as compared with the State.
Note that an SDR is not shown for the state as a whole - an N/A will be shown instead. For counties, N/A means Not Applicable due to zero events.

V1.20 (11/4/2024)