Application case 1 – aging the pediatric patient (part 1)

 Please review this file  download and observe how patient age is calculated, and how cohorts are created for each category of Pediatric Patient. Please go thru each of the worksheets presented as “Step 1”, “Step 2”, and so forth. Upon completion, create a Pivot Table in Step 6 which analyzes the Pediatric patient data by age cohort in Step 5. Submit the MS Excel file here. 

Part 2:   Case StudyWeek 2:Defining Age Cohort Definitional Problems in anAcute Care Hospital Quality Resource DepartmentCase Background:  A 450 bed acute care hospital that was runningat a typical daily occupancy of rate of 86% performs approximately 85focused chart reviews per day, concentrating on a number of factors, including the patient’s length of stay  (LOS),  severity,  current  diagnosis, pre-operative surgical risk  factor  status, infection  status,  current  medication protocols, and a number of behavioral health indicators.During the course of developing chart review protocolsin anticipation of a focused review involving the Department of Pediatrics,  a  lively  discussion  ensued  among  the  Quality  Resource  Management (QRM) staff  as to  what constituteda “Pediatric”case.  A number of members of the team had different opinions as to which patient ageboundaries should be  used  whendesignating  a  case  to  qualify  as “Pediatric”.    Some  members felt  that  many  of  the older patients  seen within  the  Pediatric  Department should be  classified  as “adults”due  to  a  number  of  physiological  and  psychological factors,  while  other  members  of  the  team  felt  that  it  was  important,  for  reasons  of  data  consistency,  to  maintain  the traditional pediatric age cut-off point of “under age 18years”for designating pediatric patients.Data  Collection, Preparation,  and  Analysis: The  Chairman  of  the  Department  of  Pediatrics charged  those  individuals responsible  for  data  collection,  preparation,  and  analysis  to  take  an “open”and “flexible”approach  to  the  issue  of designating  which  patients  would  be  considered “pediatric”from  a  clinical  perspective  versus  from  an  administrative perspective.    In  essence,  the  Chairman  was  directing  the  team  to analyze  the datain  such  a  way  that  would  permit grouping of patients by age into multiple cohorts.  One member of the team cautioned that creating multiple definitions of “pediatric”might create confusion when conducting analysis. Conclusion:  The Quality Resource Management staff ultimately decided to create sixage cohort designations based on the patient’s age at the time of admission.   These cohorts consisted of these groupings:

Pt Age RangePt Age Range Designation< 1 YearInfant1 –3YearsToddler4–10YearsPediatric11 –12YearsPreAdolescent13 –15 YearsAdolescent16 –17 YearsPost AdolescentUnanticipated Outcome:Shortly after this decision was made, the QRM staff discovered that a similar issue existed for patients classified as “Geriatric”.  In this case, the discussion focused on the gradualincrease in patient age experienced in the healthcare environment, with specific attention to patients who are over the age of 90.  In this case, the Quality Resource  Management  Team  developed  the  following  age  cohorts  to  describe  patients  who  previously  had  all  been collapsed into a single category of “Geriatric”:Pt Age RangePt Age Range Designation65-69Young Geriatric70-74Septuagenarian 175-79Septuagenarian 280-84Octogenarian 185-89Octogenarian 290-99Nonagenarian100+Centenarian 

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