Improve hospital bed count data used to estimate hospital system capacity

[lossyrob]

This issue was derived from the README text

The goal of this issue is to establish an improved dataset for US health facility bed counts to be used in the notebook to calculate capacity anaysis.

This includes:

• Accounting for the difference between a "staffed" bed vs total number of physical beds.
• Differentiating between pediatric ICU bed counts and adult ICU bed counts: The total and ICU bed counts also doesn't distinguish between adult or peds. One approach would be to make an estimate based on the distribution of adult vs peds beds across a county or state
• Reviewing and incorporating other datasets

Other datasets that could be used include:

• another set of national numbers on beds and other facility stats could come from the AHA:
  • https://www.aha.org/system/files/2018-07/2018-aha-chartbook.pdf
  • https://www.aha.org/statistics/fast-facts-us-hospitals
• or on a state level, by the licensing reports filed with each DOH, i.e. for California: https://healthdata.gov/dataset/licensed-and-certified-healthcare-facility-bed-types-and-counts
  • note that these are licensed bed counts as opposed to staffed beds so this would be on the upper end of potential capacity for a facility

Currently, we're using HCRIS data on how many hospital bed there are at each US health facility.

The definition of a bed defined in HCRIS (nicely tucked away on page 62 of Chapter 40 of the Provider Reimbursement Manual, see below for excerpt) is what was staffed across the reporting year, not the total # of physical beds or licensed beds

A bed means an adult bed, pediatric bed, portion of inpatient labor/delivery/postpartum (LDP) room (also referred to as birthing room) bed when used for services other than labor and delivery, 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 post-anesthesia, post- operative recovery rooms, outpatient areas, emergency rooms, ancillary departments (however, see exception for labor and delivery department), nurses' and other staff residences, and other such areas that 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. (See CMS Pub. 15-1, chapter 22, §2205.)

This means the bed counts here are lower end of the range for total potential bed capacity, although it should be a good baseline of what "business as usual" hospital capacity has been in recently years.

another set of national numbers on beds and other facility stats could come from the AHA: https://www.aha.org/system/files/2018-07/2018-aha-chartbook.pdf https://www.aha.org/statistics/fast-facts-us-hospitals or on a state level, by the licensing reports filed with each DOH, i.e. for California: https://healthdata.gov/dataset/licensed-and-certified-healthcare-facility-bed-types-and-counts note that these are licensed bed counts as opposed to staffed beds so this would be on the upper end of potential capacity for a facility

[lossyrob]

The notebook currently aggregates to these statistics:

Total Beds        742,562.0
ICU Total Beds     74,688.0

This page: https://www.aha.org/statistics/fast-facts-us-hospitals

Gives these figures:

Total Staffed Beds in All U.S. Hospitals: 924,107
Staffed Beds in Community Hospitals:  792,417
Intensive Care Beds in Community Hospitals: 97,776

There is a note:

Note that intensive care bed counts reflect only those hospitals that responded to the Facilities and Services of the AHA Annual Survey. In 2018, approximately 80% of hospitals responded to this section. Therefore, these responses may not be complete. Intensive care bed counts are also reported in the CMS Healthcare Cost Report Information System (HCRIS) and may be more comprehensive. Total intensive care beds are not summed because the care provided is specialized.

which points to the HCRIS data as more comprehensive, and perhaps explains the variability. However, that text seems to indicate that these figures would be an underestimation, and the totals are greater than what our HCRIS data aggregates to.

[lossyrob]

From https://github.com/daveluo/covid19-healthsystemcapacity/blob/71a455849190b5487230a1d59258e43482d5429b/nbs/usa_beds_capacity_analysis_20200313_v2.ipynb:

Check bed stats against:

https://www.kff.org/other/state-indicator/beds-by-ownership/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

• 2.4 staffed beds per 1,000 pop across USA

https://www.sccm.org/Communications/Critical-Care-Statistics

AHA data: According to the AHA 2015 annual survey, the United States had

• 4862 acute care registered hospitals;
  • 2814 of these had at least 10 acute care beds and at least 1 ICU bed.
• These hospitals had a total of 540,668 staffed beds and 94,837 ICU beds (14.3% ICU beds/total beds) in 5229 ICUs.
  • There were 46,490 medical-surgical beds in 2644 units,
  • 14,731 cardiac beds in 976 units,
  • 6588 other beds in 379 units,
  • 4698 pediatric beds in 307 units, and
  • 22,330 neonatal beds in 920 units.
• The median number of beds in medical-surgical, cardiac, and other units was 12, with 10 beds in pediatrics and 18 in neonatal. Fifty-two percent of hospitals had 1 unit, 24% had 2 units, and 24% had 3 or more units.

HCRIS data:

• In 2010 there were 2977 acute care hospitals with ICU beds.
• In these, there were 641,395 total acute care beds with 103,900 ICU beds (16.2% ICU beds/total beds).
• From 2000 to 2010, the number of critical care beds in the United States increased by 17.8%, from 88,235 to 103,900. However, the majority of the growth in critical care bed supply is occurring in a small number of U.S. regions that tend to have large populations, fewer baseline ICUs per 100,000 capita, higher baseline ICU occupancy, and increased market competition. Additionally, between 2000 and 2010, the greatest percentage increases were in neonatal beds (29%), followed by adult beds (26%); there were minimal changes in pediatric beds (2.7%).
• Of the 103,900 ICU beds in 2010,
  • 83,417 (80.3%) were adult,
  • 1917 (1.8%) were pediatric, and
  • 18,567 (17.9%) were neonatal.
• In total, there were 33.6 beds per 100,000 population,
  • 35.5 beds per 100,000 adult beds (age > 18 years),
  • 2.7 beds/100,000 pediatric beds (age 1-17 years),
  • and 470 beds/100,000 neonatal beds (age < 1 year).

ICU days: HCRIS analysis showed that there were 150.9 million hospital days, including 25 million ICU days in 2010 (16.5% ICU days/total days). Medicare accounted for 7.9 million ICU days (31.4%) and Medicaid 4.3 million ICU days (17.2%).

Occupancy: Occupancy rates were calculated from HCRIS (days/possible days) data. In 2010, hospital and ICU occupancy rates were 64.6% and 68%, respectively. Occupancy rates vary by hospital size, with higher occupancy rates associated with larger hospitals.