• Methodology Overview
  • Hospital Quality Ratings
  • Hospital Utilization (Care, Costs & Charges)
  • County Rates of Hospital Use

  • Methodology Overview

    Methodology Overview

    Data presented on this website is available at 2 geographies, individual hospitals and counties. Individual hospital data can be viewed in the hospital profiles or the compare hospitals sections of this website.

    County data is comprised of hospital level data that is rolled up to the county level. County assignment is based on patient address, not by the physical location of the hospital. County data can be viewed in the County profiles or in the compare counties sections of this website.

    Data presented on this website is compiled from various sources representing 2 major data types, Hospital Quality Ratings and Hospital Utilization. Based on the data source and method of grouping used, these 2 data types are presented throughout the website as "Content Areas".

      Hospital Quality Ratings
        Content Areas
        CMS Hospital Quality - only available at the hospital level
          HCAHPS patient experience ratings (subcategory of CMS Hospital Quality)
        AHRQ Quality Indicators
      Hospital Utilization
        Content Areas
        Major Diagnostic Category
          Diagnosis Related Groups (subcategory of Major Diagnostic Category)
        Inpatient Conditions
        Inpatient Procedures

    Within each content area data are further categorized into sub groups. The type of categorization depends on the classification and data source. More details on each classification and their sub groups can be found in their respective sections below.

    Hospital Quality Ratings

    What are the hospital quality ratings?

    There are many ways to judge the quality of health care. Health care quality can be described as doing the right thing, at the right time, in the right way -- and having the best possible results.

    Quality ratings are based on specific quality indicators. A quality indicator is a piece of information, usually a number, that shows how often patients had a particular experience when they received medical care. These experiences reflect a particular aspect of hospital quality. This report uses three different types of quality indicators.

      AHRQ Quality Indicators: The AHRQ Quality Indicators were developed by the Agency for Healthcare Research and Quality (AHRQ), a federal government agency whose mission is to improve the quality and safety of health care in the United States. The AHRQ Quality Indicators are calculated from standardized information that hospitals collect as part of the hospital bill. For more information, please visit the AHRQ Quality Indicators Website.

      CMS Hospital Quality: The Centers for Medicare and Medicaid Services publicly reports hospital quality measures on its Website, Hospital Compare, which was created as a joint effort by CMS and the Hospital Quality Alliance (HQA). Over 4,500 U.S. hospitals - nearly every hospital in the nation - report performance data to CMS Hospital Compare. Some hospitals in this website do not have CMS data available. For more information, please visit the CMS Hospital Compare Website.

      HCAHPS patient experience ratings: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national, standard survey that asks a random sample of hospital patients about their recent hospital experience. The HCAHPS survey was developed by a partnership of public and private organizations, including CMS and AHRQ. For the purpose of this website, HCAHPS data is presented as a subcategory of CMS Hospital Quality. For more information, please visit the HCAHPS Website.

    What are the health topics?

    Quality ratings are organized into topics by health conditions or by different aspects of health care quality, such as patient safety or patient satisfaction. With the exception of some information in "Childbirth", all information refers to adult patients.

    CMS Hospital Quality

    For more information on the ratings included in each topic, visit Measure Details.

      Complications and Deaths: Complications and deaths - provider data. This data set includes provider-level data for the hip/knee complication measure, the CMS Patient Safety Indicators, and 30-day death rates.

      Healthcare Associated Infections: The Healthcare-Associated Infection (HAI) measures - provider data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected through the National Healthcare Safety Network (NHSN). They provide information on infections that occur while the patient is in the hospital. These infections can be related to devices, such as central lines and urinary catheters, or spread from patient to patient after contact with an infected person or surface. Many healthcare associated infections can be prevented when the hospitals use CDC-recommended infection control steps.

      HCAHPS Patient experiences: A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay.

      Outpatient Imaging Efficiency: Use of medical imaging - provider data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical imaging tests include CT scans and MRIs.

      Medicare Hospital Spending per Patient: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (“episode”) at a specific hospital compared to all hospitals nationally. An MSPB episode includes Medicare Part A and Part B payments for services provided by hospitals and other healthcare providers the 3 days prior to, during, and 30 days following a patient’s inpatient stay. This measure evaluates hospitals’ costs compared to the costs of the national median (or midpoint) hospital. This measure takes into account important factors like patient age and health status (risk adjustment) and geographic payment differences (payment-standardization).

      Payment and Value of Care: Payment measures and value of care displays – provider data. This data set includes provider data for the payment measures and value of care displays.

      Structural Measures: A list of hospitals and the structural measures they report. A structural measure reflects the environment in which hospitals care for patients.

      Timely and Effective Care: Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of cataract surgery outcome, colonoscopy follow-up, heart attack care, emergency department care, preventive care, pregnancy and delivery care, and cancer care.

      Unplanned Hospital Visits: Unplanned Hospital Visits – provider data. This data set includes provider data for the hospital return days (or excess days in acute care [EDAC]) measures, the unplanned readmissions measures, and the result of unplanned hospital visits after an outpatient procedure.

    AHRQ Quality Indicators

    For more information on the ratings included in each topic, visit Measure Details.

      Prevention Quality Indicators: The Prevention Quality Indicators (PQIs) identify issues of access to outpatient care, including appropriate follow-up care after hospital discharge. More specifically, the PQIs use data from hospital discharges to identify admissions that might have been avoided through access to high-quality outpatient care. The PQIs are population based indicators that capture all cases of the potentially preventable complications that occur in a given population (in a community or region) either during a hospitalization or in a subsequent hospitalization. The PQIs are a key tool for community health needs assessments.

      Inpatient Quality Indicators: The Inpatient Quality Indicators (IQIs) provide a perspective on quality of care inside hospitals, including: Inpatient mortality for surgical procedures and medical conditions; Utilization of procedures for which there are questions of overuse, underuse, and misuse;

      Patient Safety Indicators: The Patient Safety Indicators (PSIs) provide information on potentially avoidable safety events that represent opportunities for improvement in the delivery of care. More specifically, they focus on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.

      Pediatric Quality Indicators: The Pediatric Quality Indicators (PDIs) focus on potentially preventable complications and iatrogenic events for pediatric patients treated in hospitals and on preventable hospitalizations among pediatric patients, taking into account the special characteristics of the pediatric population.

      Composites: Measures that combine more than one measure into one score. Composite measures provide a summary of quality or performance.

    How did we analyze this data?

      AHRQ Quality Indicators: ADHS displays measure results calculated by AHRQ's Quality Indicators software, version v2019.0.1, to directly calculate the AHRQ Quality Indicators based on hospital discharge data collected. For more information on the methods used by the AHRQ QI software, visit the AHRQ QI Website.

      CMS Hospital Compare ratings: ADHS obtains this information from the Hospital Compare site. The ratings are calculated by CMS using nationally accepted standards based on data that individual hospitals provide to Hospital Compare. For more information on the methods used by Hospital Compare, visit the Hospital Compare Website.

      HCAHPS patient experience ratings: ADHS obtains this information from the Hospital Compare Website. These ratings are reported to CMS by the individual hospitals that provide data to Hospital Compare. For more information on HCAHPS, visit the HCAHPS Website. For more information on HCAHPS measures in Hospital Compare, visit the Hospital Compare Website.

      For more details on individual measures, visit Measure Details.

    Are the ratings risk adjusted?

    Risk adjustment is a statistical process of accounting for how sick patients are before they enter the hospital. This statistical process aims to 'level the playing field' by accounting for health risks that patients have before they enter the hospital.

      AHRQ Quality Indicators: Most AHRQ Quality Indicators are risk adjusted. To learn which indicators are risk adjusted, visit Measure Details (link). For more information on the risk adjustment methods used for the AHRQ QIs, visit the AHRQ QI Website.

      CMS Hospital Compare ratings: Hospital Compare ratings in the "Results of care" group are risk adjusted. Other Hospital Compare ratings are not risk adjusted. For more information on the risk adjustment methods used by Hospital Compare, visit the Hospital Compare Website.

      HCAHPS patient experience ratings: HCAHPS ratings are not risk adjusted.

    Hospital Utilization

    What is hospital utilization (Care, Costs & Charges)?

    Hospital utilization means use of hospital services, such as the number and length of hospital stays for different health conditions or procedures. It includes information on:

      Number of hospital stays: A hospital stay means that you are admitted into the hospital and stay for at least one night. One person may have multiple hospital stays.

      Length of hospital stays: This is the number of days a person spends in the hospital during one hospital stay.

      Charges or costs for hospital stays: Charges are what a hospital asks to be paid for its services. Costs are what it actually costs the hospital to provide the services. Neither of these is necessarily what the hospital is paid for its services in the end.

    How did we analyze this data?

    Hospital utilization is calculated from hospital discharge data collected from hospitals in Arizona. Each discharge is counted as a separate hospital stay. No risk adjustment is applied. Condition or procedure categories are assigned based on DRG, MDC, or diagnosis or procedure codes. Diagnosis and procedure codes are grouped using AHRQ's Clinical Classification Software.

    To report information on costs, ADHS uses AHRQ's Cost-to-Charge Ratio Files. AHRQ creates these files using CMS data. They are calculated at the hospital level. Demographic breakdowns by age category, gender, race, and payer type are calculated using demographic information available in the hospital discharge data. National are derived from AHRQ's HCUP Nationwide Inpatient Sample (NIS).

    What are the conditions and procedures?

    For each hospital stay, hospitals assign one or more codes that describe the diagnosis and the procedures that were performed. You can select conditions and procedures by:

      Diagnosis Related Groups (DRGs): DRG codes classify hospital stays into groups based on how much it costs to care for patients. Each hospital stay is assigned one DRG. The version of DRG may vary between years. The version of DRG used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the DRG than recent datasets.

      Major Diagnostic Categories (MDCs): MDC codes group DRGs into broader categories such as respiratory system or digestive system. Each hospital stay is assigned one MDC. The version of MDC may vary between years. The version of MDC used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the MDC than recent datasets.

      Conditions: Conditions are assigned by AHRQ's Clinical Classification Software (CCS) based on the principal diagnosis codes assigned by hospitals. More than one condition can be assigned to each hospital stay. The principal diagnosis is the main reason for the hospital stay. The version of CCS may vary between years. The version of CCS used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the CCS than recent datasets.

      Procedures: Procedures are also assigned by AHRQ's Clinical Classification Software (CCS) based on the principal procedure codes assigned by hospitals. More than one procedure can be assigned to each hospital stay. The principal procedure is the main procedure done to address the principal diagnosis. The version of CCS may vary between years. The version of CCS used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the CCS than recent datasets.

    How do I interpret the tables?

    Information is provided for each selected hospital by condition or procedure grouping. Select the titles in the top row to sort the results. Tables may include the following:

      Total US: National numbers are weighted estimates from the HCUP Nationwide Inpatient Sample (NIS), 2010, Agency for Healthcare Research and Quality (AHRQ).

      Total Arizona: Total of all Arizona hospitals in this dataset.

      Hospitals: Previously chosen hospitals are listed. You can select a hospital from the list for more detailed results. Detailed results include characteristics of each hospital stay (age, gender, payer, and race).

      Hospital county: The county for each hospital is provided.

      Number of discharges (all-listed): The number of hospital stays (or discharges) for the selected condition or procedure is provided for each hospital. All listed diagnoses include the principal diagnosis (or reason for going to the hospital) as well as any other conditions that coexist during the hospital stay. All listed procedures include all procedures done for the patient.

      Number of discharges (principal): The number of hospital stays (or discharges) for the selected condition or procedure is provided for each hospital. Principal diagnosis means this is the condition chiefly responsible for admission to the hospital for care. The principal procedure is the procedure that was done to address the principal diagnosis.

      Mean charges in dollars: The mean or average charge is sometimes reported for each hospital. This is the amount the hospital asked to be paid for services. This does not include professional (MD) fees. Charges are not necessarily how much was paid.

      Mean costs in dollars: The mean or average cost is sometimes reported for each hospital. Costs are the actual value of services performed (while charges represent the amount the hospital asked to be paid for services). Total charges were converted to costs using cost-to-charge ratios based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS). In general, costs are less than charges. AHRQ adjusts the cost-to-charge ratios to work with this type of hospital data.

      Mean length of stay in days: The average or mean length of stay (LOS) is reported for each hospital. This is the average number of nights the patient remained in the hospital. When a patient is admitted and discharged on the same day, it has a length of stay of zero. A longer length of stay does not necessarily mean better or more care is given to patients.

    If you select a measure with advanced options availble you will be able to get the following.

      Age group: Patient age in years is based on the admission date to the hospital and date of birth. The number of stays in each age is reported.

      Gender: The number of males and females is reported for the selected hospital and condition or procedure.

      Payer: Payer is the expected payer for the hospital stay. Payers are grouped into general categories: Medicaid, Medicare, private insurance, uninsured, other, and missing. The number of stays for each payer category is reported for the selected hospital and condition or procedure.

      Race" Race/ethnicity of the patient as listed in the medical record. Racial and ethnic categories are collapsed into larger groups based on US Census Bureau designations.

    You may notice some special codes in the tables:

      Dash (-): A dash is reported when there are not enough data for the given selection. There are many reasons there may not be enough data to report.

      N/A: Not applicable, this appears when there is no data available for the selection.

      Small number suppression: Small raw numbers may be suppressed to protect patient confidentiality.

    County Rates of Hospital Use

    What are county rates of hospital use?

    County rates show use of hospital services by county, such as the number and length of hospital stays for different health conditions or procedures. These rates are based on where patients live, not where the hospitals they visit are located.

      Number of hospital stays: A hospital stay means that you are admitted into the hospital and stay for at least one night. One person may have multiple hospital stays. County rates show the number of stays for each 1,000 people who live in the county.

      Charges or costs for hospital stays: Charges are what a hospital asks to be paid for services. Costs are the actual value of these services. Neither is necessarily the same as what was actually paid.

    How did we analyze this data?

    County rates are calculated based on hospital discharge data collected from hospitals in Arizona. Each discharge is counted as a separate hospital stay. Rates are determined by patient residence, not by hospital location. No risk adjustment is applied. Condition or procedure categories are assigned based on DRG, MDC, or principal or all-listed diagnosis or procedure.

    To report rates by county, ADHS uses county populations from US Census Bureau data. County rates show the number of hospital discharges per 1,000 county residents. To estimate cost information, ADHS uses AHRQ's cost-to-charge ratios. AHRQ creates these files using CMS data. They are calculated at the hospital level. The national and regional values shown in the tables are derived from 2010 data from AHRQ's HCUP Nationwide Inpatient Sample (NIS).

    Numerators for demographic breakdowns by age category, gender, and race are calculated using demographic information provided in the hospital discharge data. Denominators for each demographic category are obtained from Census data.

    What are the conditions and procedures?

    For each hospital stay, hospitals assign one or more codes that describe the diagnosis and the procedures that were performed. You can select conditions and procedures by:

      Diagnosis Related Groups (DRGs): DRG codes classify hospital stays into groups based on how much it costs to care for patients. Each hospital stay is assigned one DRG. The version of DRG may vary between years. The version of DRG used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the DRG than recent datasets.

      Major Diagnostic Categories (MDCs): MDC codes group DRGs into broader categories such as respiratory system or digestive system. Each hospital stay is assigned one MDC. The version of MDC may vary between years. The version of MDC used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the MDC than recent datasets.

      Conditions: Conditions are assigned by AHRQ's Clinical Classification Software (CCS) based on the principal diagnosis codes assigned by hospitals. More than one condition can be assigned to each hospital stay. The principal diagnosis is the main reason for the hospital stay. The version of CCS may vary between years. The version of CCS used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the CCS than recent datasets.

      Procedures: Procedures are also assigned by AHRQ's Clinical Classification Software (CCS) based on the principal procedure codes assigned by hospitals. More than one procedure can be assigned to each hospital stay. The principal procedure is the main procedure done to address the principal diagnosis. The version of CCS may vary between years. The version of CCS used to group ICD codes was the current version at the time the dataset was created. Older annual files may use a different version of the CCS than recent datasets.

    How do I interpret the tables?

    Information is provided for each selected county by condition or procedure grouping. Select the titles in the top row to sort the results. Tables may include the following:

      Total US: National numbers are weighted estimates from the HCUP Nationwide Inpatient Sample (NIS), 2010, Agency for Healthcare Research and Quality (AHRQ).

      Total Arizona: Total of all counties in this dataset.

      Counties: Previously chosen counties are listed. You can select a specific county for more detailed results. Detailed results include characteristics for each county (age, gender, payer, and race).

      Number of discharges: The number of hospital stays (or discharges) for the selected condition or procedure is provided for each county.

      Rate of discharges: The number of hospital stays (or discharges) divided by the number of residents in the county. County resident or population numbers are obtained from the US Census Bureau.

      Mean costs in dollars: The mean or average cost is sometimes reported for each county. Costs are the actual value of these services (while charges are what a hospital asks to be paid for services). Total charges were converted to costs using cost-to-charge ratios based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS). In general, costs are less than charges. AHRQ adjusts the cost-to-charge ratios to work with this type of hospital data.

    If you select a measure with advanced options available you will get following:

      Age group: Patient age in years is based on the admission date to the hospital and date of birth. The number of stays in each age group is reported.

      Gender: The number of males and females is reported for the selected county and condition or procedure.

      Race: Race/ethnicity of the patient as listed in the medical record. Racial and ethnic categories are collapsed into larger groups based on US Census Bureau designations.

    You may notice some special codes in the tables:

      Dash (-): A dash is reported when there are not enough data for the given selection. There are many reasons there may not be enough data to report.

      N/A: Not applicable, this appears when there is no data available for the selection.

      Small number suppression: Small raw numbers may be suppressed to protect patient confidentiality.

    How do I interpret the maps?

    Map colors are assigned based on natural breaks. When there are not enough data to report a value, the map color is grey dashes.

    More info coming soon