JOURNEY to HEALTH, a Hospital Discharge Data Brief for the NRPC
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JOURNEY TO HEALTH An Analysis of Hospital-Discharged Medical Visits for the Greater Nashua and Milford, NH Region Data Brief BACKGROUND Figure 1: In-State Hospital Choice Among NRPC Residents All licensed hospitals in New Hampshire report patient-level discharge information to the New Hampshire Department of Health and Human Services (NH DHHS), who also collects data from select rehabilitation hospitals, rehabilitation and psychiatric units within acute care hospitals, and from free-standing ambulatory surgical treat- ment centers that are part of a hospital. These discharge data, known as the New Hampshire Uniform Healthcare Facility Discharge Data Set (UHFDDS), can be released to entities upon request for independent study and analysis. The following analyses are based on a custom report of aggregated UHFDD data for the NRPC region for the years 2016 and 2018. 2018 repre- sents the most current data available from NH DHHS, and 2016 is the latest year for which vis- its to out-of-state facilities is included. Trip types include Inpatient, Outpatient, Emergency Department, and Specialty, but do not distin- guish trips by more specific diagnostic code. For these category breakdowns that resulted in greater than 100 trips, the data could be further grouped into the following age cohorts: 0-19, 20 -40, 45-64, 65-74, and 75+. Table 1: Top 10 In-State Hospitals Among NRPC Residents For any Town/Hospital/Age category for which HOSPITAL VISITS HOSPITAL VISITS trips were between 1-4, NHDHHS reported this inexact range to protect patient confidentiality; in 1. Southern NH 246,377 6. Parkland 5,400 these cases, NPRC quantified these counts as 1 2. St. Joseph 169,931 7. Monadnock 2,483 in the following analyses. 3. Dartmouth- 59,676 8. Concord 1,400 The data only provides the name of the hospital, Hitchcock not the location of the facility visited, which is a data limitation for hospitals with more than one 4. Elliot 33,030 9. Northeast Rehab 1,172 location. 5. Catholic 24,086 10. Wentworth Douglass 474 Page 1 VISITS BY TYPE Emergency visits: urgent un- scheduled visits whereby a Residents in the NRPC region make a total of patient is treated and dis- 546,225 visits to 30 in-state hospitals in 2018. Over charged from the hospital’s three-fourths of these trips were to services at either emergency department. Of Southern New Hampshire Medical Center or St. Jo- the 30 hospitals visited by seph Hospital with main campuses in Nashua (Table NRPC residents, 26 have 1). Dartmouth Hitchcock, Elliot, and Catholic Hospi- emergency rooms. tals were also well-utilized, and a minority but notable number of trips were made to services at Parkland Medical Center in Derry and Monadnock Community Inpatient care: non-specialty Hospital in Peterborough. care requiring at least one overnight stay at the hospital in which the procedure was done. 22 of the 30 hospitals visited by NRPC residents ad- mit patients on an inpatient basis. Patients receiving outpatient care don’t need an overnight stay and are free to leave the hospital when it is over. All 22 of the non-specialty hospitals visited by NRPC residents provide outpatient care. Specialty services include physical therapy for orthopedic For the NRPC region in 2018 87% of visits were for and neurologic conditions as outpatient procedures and only 3% were inpatient well as psychologic services requiring an overnight stay. 10% of visits were for and chemical dependency. Emergency Department (ED) services, and Specialty Services may be provided on Visits were almost negligible at less than 1%. an inpatient or outpatient ba- sis. In 2018 there were four Elliot Hospital Catholic Medical Center specialty hospitals utilized by NRPC residents: Northeast Rehab in Salem, Hampstead Hospital, and New Hampshire Hospital and HealthSouth Re- hab, both in Concord. Page 2 Saint Joseph Hospital Parkland Medical Center Monadnock Community Hospital The chart below illustrates the variation in visit types for the 10 most-visited hospitals by NRPC residents in 2018. As expected, residents choose the closest emergency depart- ments, including that at Southern, St. Joseph in the region, and Elliot and Catholic in Man- chester. Well under 10% of all visits at the Manchester hospitals, Elliot and Catholic, were for emergency reasons, which is somewhat surprising considering Catholic’s specialties in cardiovascular disciplines and the fact that Elliot is both a Level II Trauma Center and a Pe- diatric ED. Dartmouth-Hitchcock is 3rd most popular among NRPC residents for outpatient procedures, but their ED in Lebanon is too far away from the region to see any meaningful utilization. In contrast, which overall visits at Parkland, Monadnock, Concord, and Wentworth Douglass are relatively few, they are more likely to be of an emergency nature, perhaps re- flecting unexpected treatment occurring residents were away from home. As previously discussed, all visits to Northeast Rehab were of a specialty nature. Page 3 VISITS BY AGE The following graph presents a summary of visits by age groups: pediatric population (age 0- 19), younger working age people (age 20-44), older working age people (age 45-64), senior workers and retirement age (age 65-74), and the elder population (age 75+). Total visits were divided by the estimated 2018 population within each group. As expected, in the region the frequency of hospital visits steadily increases with age overall, but the trend in emergency visits is not linear: these visits tend to be more common in the younger working-age group (ages 20-44) and among the oldest people (age 75+). OUT-OF-STATE VISITS NRPC residents generally favor in-state hospitals over out of state, with only 2.6% percent of all visits occurring out of state. Nevertheless, over 20% of inpatient and nearly 10% of emergen- cies were handled at out-of-state hospi- tals. These data do not describe where these patients were seen or for what reasons, unfortunately, but it is reason- able to assume many patients were transported to or otherwise accessed services in the greater Boston area. Page 4 VISITS BY APPROXIMATE TRAVEL DISTANCE Fortunately, NRPC residents enjoy relatively easy access to many major medical ameni- ties. Here, trip origins were mapped to community geo- graphic centroids, and the dis- tance to each in-state hospital destination was calculated in miles and then plotted by number of trips. The scatter- plot above illustrates what is generally intuitive about health care utilization: people show a strong preference for services close to where they live. Southern NH Medical Center Dartmouth-Hitchcock Nashua Concord Hospital Page 5 OUTPATIENT & SPECIALTY VISITS FOR PERSONS AGE 65+ As previously described, the utilization of hospital- The 2020 NRPC based services, particularly routine outpatient and Locally-Coordinated Transpor- specialty visits, increases with age. In the NRPC tation Plan region, 39% (n=197,233 trips) of all hospital trips are made by persons age 65+. Community transportation Older populations are more likely to have income serves a critical need in the and/or disability; both of which conditions contribute Greater Nashua and Milford to mobility challenges for these people, and in- region, providing access to crease the need for transportation alternatives. Par- jobs, education, healthcare, atransit and other ride services provide many trips to outpatient (OP) and specialty (SP) medical ap- human services, and allowing pointments, in particular. all community members, in- cluding older adults and peo- As Table II below illustrates, this older demographic ple with disabilities, to live in- is much more likely to visit St. Joseph’s hospital dependently and engage in than is the NRPC population as a whole. They are also more likely to visit Catholic Hospital versus the community life. This is critical Elliot. to the rural communities in the western reaches of our region, Table II: In-State Hospital Choice Among as well as the more urban are- NRPC Residents age 65+, OP and SP Visits as in and around Nashua. VISIT TOTAL HOSPITAL TYPE VISITS The 2020 NRPC Locally- 1. St. Joseph Hospital OP 80,203 Coordinated Plan’s recom- 2. Southern New Hampshire OP 73,198 mendations include the devel- 3. Dartmouth Hitchcock OP 18,537 opment of service options to 4. Catholic OP 12,144 critical destinations including: 5. Elliot OP 10,515 6. Parkland OP 1,375 • Elliot and CMC hospitals 7. Monadnock OP 677 • Monadnock Community 8. Northeast Rehab SP 431 Hospital • General transportation to 9. Concord Hospital OP 142 medical appointments. 10. New Hampshire Hospital SP 9 11. Wentworth Douglass OP 2 Northeast Rehab Hospital Wentworth-Douglass Hospital Page 8 .