HONOLULU — Nearly one in five of Hawaii’s waitlisted patients—that is, those remaining in a hospital after the need for acute care ceases—have an infectious disease, according to discharge data analyzed by the Hawaii Health Information Corporation (HHIC), the state’s premier healthcare data collector and analyzer.
Waitlist patients are those needing treatment, but not at the severity level that requires inpatient care. These patients often continue to stay in a hospital because there are limited available community placement options that meet the patient’s needs.
According to 2011 data, infectious diseases, including septicemia, parasitic diseases and cellulitis, are the most costly conditions among waitlist patients in our state. Septicemia (a severe blood infection that can lead to organ failure or death) is the most common and most expensive of these conditions, costing hospitals $4.7 million annually. The number of waitlist patients with this life-threatening disease increased 163 percent between 2006 and 2011. Waitlist patients with infectious diseases are the most difficult to place and result in a patient being waitlisted for an extended period.
The second most expensive waitlist patients are those with a tracheostomy, a surgically created opening in the neck leading directly to the trachea (windpipe), which allows a person to breathe without the use of his or her nose or mouth. In Hawaii, this group costs hospitals $3.5 million annually. Tracheostomy is also among the longest-stay conditions for waitlisted patients.
Also among the top 12 most costly conditions are: cerebrovascular atherosclerosis (hardening of the arteries and the leading cause of heart attacks), amputation of lower limbs, hip and femur procedures for trauma, major respiratory infections, renal failure, head trauma with coma for less than an hour, and back and neck disorders. Combined, the top 12 waitlisted conditions cost $25.6 million, representing 37 percent of the $62.7 million annual waitlist cost to hospitals in 2011.
HHIC also found that mental illness is a common underlying and complicating condition, affecting 49 percent of waitlisted patients. Four of the top 12 longest-stay waitlisted conditions—drug and alcohol abuse, schizophrenia, bipolar disorders and depression—are mental health-related.
Between 2006 and 2011, heart failure, kidney and urinary tract infections and pneumonia received much focus in quality assurance programs and have fallen off the list of the top 12 most costly waitlist conditions.
The key barriers to community placement of waitlisted patients include insufficient staff with higher skill-mix in nursing homes and other placement alternatives to meet the needs of those with complex conditions, a lack of specialty equipment to provide appropriate care, the cost of multiple or high-cost antibiotics, and lack of community-based resources to support patients with underlying mentally illness in managing their other medical conditions.
“Meeting the complex medical and behavioral needs of waitlisted patients is a key challenge in reducing the hospital waitlist,” said Peter Sybinsky, Ph.D., president and CEO of HHIC. “Solutions will require development of appropriate community and institutional resources and the funding sources to maintain them. As a community, we need to take aggressive efforts to address both.”
Findings are based on data collected from all hospitals across the state, except Tripler Army Medical Center. The report was prepared based on funding provided by Hawaii Medical Service Association, Kaiser-Permanente, AlohaCare, Ohana Healthcare and United Healthcare, in an attempt to provide a clear description of Hawaii’s waitlist population and estimate the financial impact on Hawaii’s hospitals.
Established in 1994, HHIC maintains one of the largest comprehensive health care databases in the state, comprised of local and national inpatient, emergency department, ambulatory care, financial data and other data. The research and data compiled are analyzed and disseminated statewide and are used to help shape healthcare policy and educate decision makers, health care providers and industry experts. Through HHIC Knowledge Nuggets, the organization seeks to inform the public about important healthcare topics. For more information, visit www.hhic.org.