Integrate Definitive Healthcare (DH) data

[lossyrob]

Dataset

This has ICU beds, licensed beds, and staffed beds.

This was generated by Definitive Health, who is opening up their data for COVID-19 relief (thank you!!!). Definitive Health acquired Billian's HealthDATA in 2016; Billian's is the database referenced in the paper Assessing the capacity of the healthcare system to use additional mechanical ventilators during a large-scale public health emergency which we are hoping to use to model capacity under different capacity levels (Conventional, Contingency, Crisis).

This dataset should be integrated into our hospital system capacity dataset at the facility level (similar to #25), and included in the aggregations from #32

[daveluo]

Great news! Unfortunately, that top link goes to a 404 and all I seem to be able to find available is(UPDATE: direct link to dataset works now) this dashboard: https://www.arcgis.com/apps/opsdashboard/index.html#/8c4dcccd9e3845eb89f6401f919007f2

Is the dataset itself from Definitive Health no longer available / open? I can't seem to find it or be able to access data besides what's shown on the dashboard visualization.

Another thing I noticed is they do have total licensed beds, staffed beds, total (staffed?) bed occupancy rates, and # of ICU beds per facility but it's not clear if "ICU Bed" is a staffed or licensed bed and there's no occupancy rate given specifically for whatever their definition of ICU bed is.

Maybe I missed something but a bit disappointing if the data is only available via this ArcGIS dashboard

[lossyrob]

I think maybe the automatic markdown link conversion was broken because of the characters ::? Not sure, but I converted to a markdown link and it should work now.

Spreadsheet here

[lossyrob]

Copying about text to see if this answers the ICU bed staffed vs licensed question:

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Definitive Healthcare is the leading provider of data, intelligence, and analytics on healthcare organizations and practitioners. In this service, Definitive Healthcare provides intelligence on the numbers of licensed beds, staffed beds, ICU beds, and the bed utilization rate for the hospitals in the United States. Please see the following for more details about each metric, data was last updated on 19 March 2020:

Number of Licensed beds: is the maximum number of beds for which a hospital holds a license to operate; however, many hospitals do not operate all the beds for which they are licensed. This number is obtained through DHC Primary Research. Licensed beds for Health Systems are equal to the total number of licensed beds of individual Hospitals within a given Health System.

Number of Staffed Bed: is defined as an "adult bed, pediatric bed, birthing room, or newborn ICU bed (excluding newborn bassinets) maintained in a patient care area for lodging patients in acute, long term, or domiciliary areas of the hospital." Beds in labor room, birthing room, post-anesthesia, postoperative recovery rooms, outpatient areas, emergency rooms, ancillary departments, nurses and other staff residences, and other such areas which are regularly maintained and utilized for only a portion of the stay of patients (primarily for special procedures or not for inpatient lodging) are not termed a bed for these purposes. Definitive Healthcare sources Staffed Bed data from the Medicare Cost Report or Proprietary Research as needed. As with all Medicare Cost Report metrics, this number is self-reported by providers. Staffed beds for Health Systems are equal to the total number of staffed beds of individual Hospitals within a given Health System. Total number of staffed beds in the US should exclude Hospital Systems to avoid double counting. ICU beds are likely to follow the same logic as a subset of Staffed beds.

Number of ICU Beds - ICU (Intensive Care Unit) Beds: are qualified based on definitions by CMS, Section 2202.7, 22-8.2. These beds include ICU beds, burn ICU beds, surgical ICU beds, premature ICU beds, neonatal ICU beds, pediatric ICU beds, psychiatric ICU beds, trauma ICU beds, and Detox ICU beds.

Bed Utilization Rate: is calculated based on metrics from the Medicare Cost Report: Bed Utilization Rate = Total Patient Days (excluding nursery days)/Bed Days Available

Potential Increase in Bed Capacity: This metric is computed by subtracting “Number of Staffed Beds from Number of Licensed beds” (Licensed Beds – Staffed Beds). This would provide insights into scenario planning for when staff can be shifted around to increase available bed capacity as needed.

Hospital Definition: Definitive Healthcare defines a hospital as a healthcare institution providing inpatient, therapeutic, or rehabilitation services under the supervision of physicians. In order for a facility to be considered a hospital it must provide inpatient care.

Hospital types are defined by the last four digits of the hospital’s Medicare Provider Number. If the hospital does not have a Medicare Provider Number, Definitive Healthcare determines the Hospital type by proprietary research.

Hospital Types:

· Short Term Acute Care Hospital (STAC)

o Provides inpatient care and other services for surgery, acute medical conditions, or injuries

o Patients care can be provided overnight, and average length of stay is less than 25 days

· Critical Access Hospital (CAH)

o 25 or fewer acute care inpatient beds

o Located more than 35 miles from another hospital

o Annual average length of stay is 96 hours or less for acute care patients

o Must provide 24/7 emergency care services

o Designation by CMS to reduce financial vulnerability of rural hospitals and improve access to healthcare

· Religious Non-Medical Health Care Institutions

o Provide nonmedical health care items and services to people who need hospital or skilled nursing facility care, but for whom that care would be inconsistent with their religious beliefs

· Long Term Acute Care Hospitals

o Average length of stay is more than 25 days

o Patients are receiving acute care - services often include respiratory therapy, head trauma treatment, and pain management

· Rehabilitation Hospitals

o Specializes in improving or restoring patients' functional abilities through therapies

· Children’s Hospitals

o Majority of inpatients under 18 years old

· Psychiatric Hospitals

o Provides inpatient services for diagnosis and treatment of mental illness 24/7

o Under the supervision of a physician

· Veteran's Affairs (VA) Hospital

o Responsible for the care of war veterans and other retired military personnel

o Administered by the U.S. VA, and funded by the federal government

· Department of Defense (DoD) Hospital

o Provides care for military service people (Army, Navy, Air Force, Marines, and Coast Guard), their dependents, and retirees (not all military service retirees are eligible for VA services)

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Section 2207.7 from CMS doc here:

2202.7 Special Care Units/Intensive Care type Units.-- I. Special Care Units for Cost Reporting Periods Beginning Prior to October 1, 1980. A. Requirements to Qualify as an SCU.--To be considered a special care inpatient hospital unit, the following requirements must be met:

1. The unit must be in a hospital.
2. The unit must be one in which the nursing care required is extraordinary and on a concentrated and continuous basis. Extraordinary care incorporates extensive lifesaving nursing services of the type generally associated with nursing services provided in burn, coronary care, pulmonary care, trauma, and intensive care units. For this reason, special life-saving equipment should be routinely available in the unit.
3. The unit must be physically identifiable as separate from general care areas and the unit's nursing personnel must not be integrated with the general care nursing personnel.
4. There shall be specific written policies for each of such designated units which include, but are not limited to, burn, coronary care, pulmonary care, trauma, and intensive care units, but exclude postoperative recovery rooms, or maternity labor rooms. The unit's staff must be specially trained to serve in such areas. Segregation of patients to specific areas by type of illness or age, such as psychiatric, neuropsychiatric, geriatric, pediatric, mental health, rehabilitation, etc., does not qualify as special care inpatient hospital units for purposes of apportionment unless the above requirements are met. NOTE: If a neonatal unit qualifies as an SCU, the days are considered SCU days rather than nursery days (see Part II, Chapter 3, § 304.2, lines 4, 5, 6, paragraph 5). A regular well-baby nursery may not be considered an SCU. See § 2217 where a hospital places general care patients temporarily in special care units because all available general care beds are occupied.

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Since they are using CMS definitions, do you think ICU beds are from HCRIS?

[daveluo]

Thanks @lossyrob for clarifying about the data link! Looks good now and yea I think it's because the :: is throwing off the auto-linking. And kudos again to Definitive Health for releasing this! :clap:

Re: ICU bed definition, based on what you've pasted, my impression is the same as yours. If the ICU bed count is coming from the HCRIS cost report, it's staffed ICU beds. This is helpful as a way for us to crosscheck our data against Definitive Health's since the staffed ICU beds should be == between the two.

[lossyrob]

Being done as part of #37