TABLE OF CONTENTS

CHAPTER 3.0: Utilization and Volume

Chart 3.1: Inpatient Admissions in Community Hospitals, 1981 – 2006

Chart 3.2: Total Inpatient Days in Community Hospitals, 1981 – 2006

Chart 3.3: Inpatient Admissions per 1,000 Persons, 1981 – 2006

Chart 3.4: Inpatient Days per 1,000 Persons, 1981 – 2006

Chart 3.5: Average Length of Stay in Community Hospitals, 1981 – 2006

Chart 3.6: Average Length of Stay in Community Hospitals by State, 2006

Chart 3.7: Emergency Department Visits and Emergency Departments in Community Hospitals, 1991 – 2006

Chart 3.8: Hospital Emergency Department Visits per 1,000 Persons, 1991 – 2006

Chart 3.9: Percent of Hospitals Reporting Emergency Department Capacity Issues by Type of Hospital, 2007

Chart 3.10: Percent of Hospitals Reporting Time on Ambulance Diversion in Last 12 Months

Chart 3.11: Conditions Hospitals Reported as Number One Factor Contributing toAmbulance Diversions, January 2007

Chart 3.12: Total Hospital Outpatient Visits in Community Hospitals, 1981 – 2006

Chart 3.13: Hospital Outpatient Visits per 1,000 Persons, 1981 – 2006

Chart 3.14: Percentage Share of Inpatient vs. Outpatient Surgeries, 1981 – 2006

Chart 3.1: Inpatient Admissions in Community Hospitals, 1981 – 2006

27

28

29

30

31

32

33

34

35

36

37

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Mill

ions

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals.

Chart 3.2: Total Inpatient Days in Community Hospitals, 1981 – 2006

100

140

180

220

260

300

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Mill

ions

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals.

Chart 3.3: Inpatient Admissions per 1,000 Persons, 1981 – 2006

0

20

40

60

80

100

120

140

160

180

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Inpa

tient

Adm

issi

ons

per

Tho

usan

d

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals. US Census Bureau: National and State Population Estimates, July 1, 2006. Link: http://www.census.gov/popest/states/tables/NST-EST2006-01.xls.

Chart 3.4: Inpatient Days per 1,000 Persons, 1981 – 2006

0

200

400

600

800

1,000

1,200

1,400

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Inpa

tient

Day

s pe

r T

hous

and

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals. US Census Bureau: National and State Population Estimates, July 1, 2006. Link: http://www.census.gov/popest/states/tables/NST-EST2006-01.xls.

Chart 3.5: Average Length of Stay in Community Hospitals, 1981 – 2006

7.6

7.6

7.6

7.3

7.1

7.1 7.2

7.2

7.2

7.2

7.2

7.1

7.0

6.7

6.5

6.2

6.1

6.0

5.9

5.8

5.7

5.7

5.7

5.6

5.6

5.6

0

1

2

3

4

5

6

7

8

9

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Day

s

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals.

Chart 3.6: Average Length of Stay in Community Hospitals by State,2006

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals.

5.0 to 5.9 Days

4.0 to 4.9 Days

6.0 to 7.9 Days

> 8 Days

RI 5.4 DaysDE 6.4 DaysDC 7.0 Days

Chart 3.7: Emergency Department Visits and Emergency Departments(1) in Community Hospitals, 1991 – 2006

80

85

90

95

100

105

110

115

120

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Num

ber

of E

D V

isits

(M

illio

ns)

3,500

3,700

3,900

4,100

4,300

4,500

4,700

4,900

5,100

5,300

Em

erge

ncy

Dep

artm

ents

ED Visits Emergency Departments

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals. (1) Defined as hospitals reporting ED visits in 2005 AHA Annual Survey.

Chart 3.8: Hospital Emergency Department Visits per 1,000 Persons,1991 – 2006

250

270

290

310

330

350

370

390

410

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Vis

its p

er T

hous

and

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals. US Census Bureau: National and State Population Estimates, July 1, 2006. Link: http://www.census.gov/popest/states/tables/NST-EST2006-01.xls.

Chart 3.9: Percent of Hospitals Reporting Emergency Department Capacity Issues by Type of Hospital, 2007

Source: American Hospital Association 2007 Survey of Hospital Leaders.

25%

24%

27%

20%

30%

22%

18%

46%

11%

35%

47%

42%

73%

31%

65%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

All Hospitals

Non-teaching Hospitals

Teaching Hospitals

Rural Hospitals

Urban Hospitals

ED is "At" Capacity ED is "Over" Capacity

Chart 3.10: Percent of Hospitals Reporting Time on Ambulance Diversion in Last 12 Months

Source: American Hospital Association 2007 Survey of Hospital Leaders.

36%

30%

64%

17%

56%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

All Hospitals

Non-teaching

Teaching

Rural

Urban

Percentage of Hospitals

Chart 3.11: Conditions Hospitals Reported as Number One Factor Contributing to Ambulance Diversions, January 2007

Source: American Hospital Association 2007 Survey of Hospital Leaders.

4%

7%

12%

17%

29%

30%

0% 10% 20% 30% 40%

Lack of Psychiatric Beds

Lack of Specialty Physician Coverage

Staff Shortages

Lack of General Acute Care Beds

ED Overcrowded

Lack of Staffed Critical Care Beds

Percentage of Hospitals

Chart 3.12: Total Hospital Outpatient Visits in Community Hospitals,1981 – 2006

0

100

200

300

400

500

600

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Mill

ions

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals.

(1) Due to a restructuring of this survey question in 1982, some respondents reported occasions of service rather than visits, resulting in an artificially large number of outpatient visits. In 1983, the survey reverted back to the original question, which remains the same today. To smooth the trend line to better reflect what was the actual number of visits, the 1982 data point in the chart is an average of the 1981 and 1983 figures. The number collected from the survey is reported in the appendix table but should be used with caution.

(1)

Chart 3.13: Hospital Outpatient Visits per 1,000 Persons, 1981 – 2006

0

500

1,000

1,500

2,000

2,500

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Vis

its p

er T

hous

and

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals. US Census Bureau: National and State Population Estimates, July 1, 2006. Link: http://www.census.gov/popest/states/tables/NST-EST2006-01.xls.(1) Due to a restructuring of this survey question in 1982, some respondents reported occasions of service rather than visits, resulting in an artificially large number of outpatient visits. In 1983, the survey reverted back to the original question, which remains the same today. To smooth the trend line to better reflect what was the actual number of visits, the 1982 data point in the chart is an average of the 1981 and 1983 figures. The number collected from the survey is reported in the appendix table but should be used with caution.

(1)

Chart 3.14: Percentage Share of Inpatient vs. Outpatient Surgeries,1981 – 2006

Outpatient Surgeries

Inpatient Surgeries

0%

20%

40%

60%

80%

100%

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Per

cent

age

of S

urge

ries

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2006, for community hospitals.