1. Department of Health Hospital Statistical Licensing Requirements

2. Behavioral Objectives
At the end of the session, the students should be able to: 1. Discuss the current statistical licensing requirements of the Department of Health based on the standard DOH Hospital Statistical Report form 2. Define the terms utilized in information-gathering for the data required by the DOH 3. Solve for the numerical data required by DOH using the given formulae

3. Introduction
In the Philippines, hospitals are regulated mainly by the Department of Health (DOH) - Republic Act 4226 – Hospital Licensure Act, Executive Order No. 102 and DOH Administrative Order 70-A, series 2002
The DOH regulates hospitals to ensure delivery of high quality of health care to the hospitals’ patients by releasing licenses to operate only to those assessed to have complied with the following:
1. service capability: administrative, clinical, ancillary, and other services
2. personnel: staffing of qualified and trained personnel
3. equipment / instruments
4. structural standards/physical plant

4. Introduction
The DOH ensures compliance with its standard requirements through an organized process of assessment and through the evaluation of the submitted hospital statistical report

5. Why Does DOH Need The Data?
To assess the quality of care given by the hospital
To compare the past and present performance of the hospital
To ensure that hospitals maintain the regular collection of these data which is an important tool in the operation and management of these hospitals
To maintain a consolidated national repository of healthcare facility data
To provide information for national health care statistical purposes, especially in aid of legislation
To be used for studies and researches conducted by DOH and other authorized agencies

6. Reportorial Requirements: Statistics
The reportorial requirements of the DOH are basically in the form of statistics which are numerical facts that break down data into a concise and useful form; and involves the process of collection, analysis, interpretation and presentation of facts as numbers.

7. Hospital Statistical Data
Not only the DOH needs these statistical data. The hospital, itself, needs them so these data really need to be reliable, complete, legible, timely, accessible and have an accurate and valid original source data.

8. Filing The Report
Filing of Renewal of Application is from October – December of the current year
Forms can be downloaded at
We coordinate with the DOH Central Office: Bureau of Health Facilities and Services (BHFS): Center for Health Development (CHD): Regulations, Licensing and Enforcement Division (RLED)

9. Definition of Terms
Service Capability - Capability of the hospital/other health facilities to render administrative, clinical, ancillary and other services
Quality Management/Quality Assurance Program - Organized set of activities designed to demonstrate on-going assessment of important aspects of patient care and services.
Hospital bed - Bed which is maintained for continuous (24 hours) use by an in-patient

10. Definition of Terms
4. Bed Occupancy Rate - The percentage of in-patient beds occupied over a period of time. It is a measure of the intensity of hospital resources utilized by in-patients. 5. Authorized bed - Approved number of beds as per issued license to operate in the hospital and other health facilities. 6. Implementing beds - Actual beds used (based on hospital/facility management decision)

11. Definition of Terms
7. In-Patient Service days- Unit of measure denoting the services received by one in-patient in one 24-hour period. 8. Average Number of In-patients per day - Average no. of in-patients present each day for a given period of time. 9. Total Length of Stay -( for one In-patient)- The number of calendar days from admission to discharge.

12. Definition of Terms
10. Average Length of Stay - Average no. of days each in-patient stays in the hospital for each episode of care. 11. Spontaneous Abortion – expulsion of a dead fetus from the uterus without intervention 12. Induced Abortion - expulsion of a dead fetus from the uterus with intervention 13. Septic Abortion - expulsion of a dead fetus from the uterus with concomitant infection

13. Definition of Terms
14. Non-Septic Abortion - expulsion of a dead fetus from the uterus without concomitant infection 15. Major Operations - Surgical procedures requiring anesthesia/ spinal anesthesia to be performed in an operating room 16. Minor Operations - Surgical procedures requiring only local anesthesia; no operating room needed (e.g., simple wound suturing)

14. Definition of Terms 17. ICD-10 Code 18. Non-PHilHealth
the International Classification of Diseases version 10.
DOH stated, through Administrative Order No. 47, s dated May 5, 2000, that ICD-10 coding shall be fully implemented in all government and private hospitals starting January 2001 to improve the quality of morbidity and mortality statistics.
18. Non-PHilHealth
type of accommodation that pertains to patients without PhilHealth Insurance.
subdivided to Pay and Service (Charity).

15. Definition of Terms 19. PhilHealth
type of accommodation that pertains to patients with PhilHealth Insurance.
subdivided into Pay and Service (Charity).
a. Pay - Patients confined in the pay wards or private rooms
b. Service- Patients confined in the service wards which used to be called Charity wards

16. Definition of Terms b. Service- Subtypes
b.1 Indigent- Patient under the service care who is an enrolled PHIC indigent as validated by a PHIC Indigent Card.
b.2 Member/Dependent – Patient under the service care with mandatory or voluntary PHIC membership or is a dependent of said member.
NOTE: The principle behind identifying these groupings is to have a
clearer picture of who is responsible for the treatment cost of the
patients.

17. Definition of Terms 20. OWWA 21. HMO
Overseas Workers Welfare Administration
provides health/hospitalization insurance of the overseas workers and their dependents.
21. HMO
Health Maintenance Organization
provides medical/hospitalization insurance to policy-holders

18. Definition of Terms 22. Categorization of Patients
for availment of social services in hospitals
Department Order No.435, s. 1990
a. Class A – Pay
Patients shall pay in full the hospital services in suites, private or semi-private rooms.
PhilHealth patients/other health insurance shall pay the excess of their privilege in full.
b. Class B – Pay Ward ( 3 beds and above)
Patients shall pay the hospital services on the ward level.

19. Definition of Terms c. Class C – Service
PhilHealth; partial sharing : donation
Patients with PhilHealth benefits/other health insurance but cannot pay the excess in full.
Patient’s share of the balance after health insurance shall be in accordance with C1, C2, or C3 sub-classification, as affected by modifiers.

20. Definition of Terms c. Class C Subclassification
C1 - patients whose aggregate monthly family income is equal to or above the NSCB subsistence threshold.
C2 - patients whose aggregate monthly family income is more than 50% of the NSCB subsistence threshold.
C3 - patients whose aggregate monthly family income is less than 50% but more than 20% of the NSCB subsistence threshold.

21. Definition of Terms d. Class D - Complete social service/Indigent
Patients below class C3.
Patients with no visible income or means of support.
Patients who are covered by special laws.
(see also Administrative Order No. 171, s dated October 1, 2004 and Administrative Order No. 177, s dated November 12, 2004 – Policies and Guidelines to Implement the Relevant Provisions of RA 9257 “Expanded Senior Citizens Act of 2003” DOH website:

22. Formula: Bed Occupancy Rate
Bed Occupancy Rate (BOR) - the ratio of the total inpatient service days over the authorized bed capacity in a given period.
= _______Total In-patient service days in a period_____ x 100 %
(Total no. of authorized beds) x (Total days in the same period)
Newborns must not be included in the computation.
Beds in the Labor Room (LR), ER, clinics, Examination Room, Recovery Room (RR) or temporary set ups for temporary overflows (cots, bed in hall, etc) or beds in the ward setup but with no staff or patients using them (vacant or closed off area or wards, stored beds) are not to be counted
70% is the minimum required to stay “even” or support the hospital’s existence

23. Bed Occupancy Rate Example:
Blue Ridge Medical Center has 400 available beds (excluding newborn bassinets) and rendered 8,600 patient days in April April has 30 days. The Bed Occupancy Rate for Blue Ridge MC in April 2011 was:
8,600 patient bed days x 100% = X 100% = %
400 patient beds x 30 days

24. Formula: Average Daily Census
Average Daily Census of Admitted Patients-
= Total in-patient service days for a period
Total days in the same period

25. Average Daily Census Example:
Blue Ridge Medical Center rendered 8,600 patient days (excluding newborn babies) in July July has 31 days. The Average Daily Census of Blue Ridge MC in July 2011 was:
8,600 patient days = patient days/day
31 days
This would be rounded off to give the average daily inpatient census in July 2011 of 277 patients/day.
This indicator is calculated separately for newborns.

26. Formula: Average Length of Stay
Length of Stay - duration of a single episode of hospitalization.
In computing for the length of stay, the date of admission is counted but not the day of discharge.
Average Length of Stay (ALOS) –
= Total Length of stay of discharged patients (incl. deaths) for a period
Total discharges and deaths in the period

27. Average Length of Stay 17,322 days = 5.4 days/patient 3,204 patients
Example:
Blue Ridge Medical Center discharged 3,204 patients (including deaths, but excluding newborns) in January Their combined length of stay was 17,322 days. What was the Average Length of Stay in Blue Ridge MC in January 2011?
17,322 days = 5.4 days/patient
3,204 patients

28. Formula: Gross Death Rate
Gross Death Rate – the comparison of all inpatient deaths to all discharges for a given period.
Also referred to as Mortality Rate
= Total Deaths (including newborn) for a given period x 100%
Total Discharges (including deaths) for the same period

29. Gross Death Rate 22 patient deaths x 100% = 2.56 or 2.6%
Example:
Blue Ridge Medical Center had a total of 22 deaths in March A total of 860 patients were discharged (including the 22 deaths) within the month. What was the Hospital Death Rate?
22 patient deaths x 100% = 2.56 or 2.6%
860 patient discharges
DOA, stillbirth and ER deaths are not included
Newborn deaths are included in the computation
Below 3% is acceptable

30. Formula: Net Death Rate
Net Death Rate – the death rate excluding deaths under 48 hours of admission. It produces a lower figure than the gross death rate.
Also referred to as Institutional Death Rate
= [{Total Deaths (incl. Newborn)} – {those under 48 hrs. for the period}] x 100%
[{Total No. of Discharges (including deaths and newborn)} - {death under 48
hours for the period}]

31. Net Death Rate
Example:
Of the 22 deaths at Blue Ridge Medical Center in the month of March 2011, 6 of them died within 48 hours upon admission. As can be recalled, a total of 860 patients were discharged (including the 22 deaths) within the month. What was the Net Death Rate?
22 patient deaths – 6 patient deaths under 48 hrs x 100% = 1.87 or 1.9%
860 patient discharges – 6 patient deaths under 48 hrs
ER deaths are not counted if the patient is not yet considered admitted
% is acceptable western standard

32. Formula: Caesarean Section Rate
Caesarean Section Rate –the comparison of the number of caesarian section operations performed against the total number of deliveries = Total Caesarean sections in a given period x 100% Total OB Discharges

33. Formula: Fetal Death Rate
Fetal Death Rate - Death of an offspring to its complete expulsion or extraction from the womb regardless of duration of pregnancy
= _____Total No. of intermediate and/or late fetal deaths for the period___ X 100%
Total No. of livebirths ( incl. Intermediate and late fetal deaths) for the period
Early fetal deaths - < 22 completed weeks of gestation or 500 g. birth-weight
Late fetal deaths - 22 or more completed weeks of gestation or 500g. or more birth-weight

34. Formula: Neonatal Death Rate
Neonatal Death Rate - Death of a child whose heart beat after complete expulsion from the mother, and died within 28 days of birth
=_______Total No. of newborn deaths for the period______ X 100%
Total No. of newborn discharges (including deaths) for the same period
Early neonatal deaths - < 24 hours of birth

35. Formula: Infant Death Rate
Infant Death Rate - Measures the risk of dying during the 1st year of life
= ___Total No. of deaths under 1 year of age for the period__ x 100%
Total No. of infant discharges (including deaths) for the same period

36. Formula: Maternal Death Rate
Maternal Death - the death of any woman, from any cause related to or aggravated by pregnancy or its management (regardless of duration or site of pregnancy) within 42 days of termination of pregnancy, but not from accidental or incidental causes.
Maternal Death Rate
= ______Total No. of direct maternal deaths for the period ______X100%
Total No. of maternal (OB) discharges (including deaths) for the period

37. Updated Annual Hospital Statistical Form

38. Thank You!