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GLOSSARY Prepared by Frank Zilm & Corlett Orr

ABSORPTION CHILLER : an air conditioning water chiller using steam as its energy source in lieu of electrical power.

ACTIVITIES OF DAILY LIVING (ADL) : a program in Physical Rehabilitation departments to help the patient re-learn and adjust to accomplishing the everyday tasks of living in the home in new and different ways as a result of illness or injury. Model kitchens and bathrooms are used to train the patient.

ADJUSTED PATIENT (ADMISSIONS/DAYS) : an adjustment factor for admissions and patient days to reflect the relative volume of outpatient activity.(1)

ADMISSIONS : the number of patients admitted to a hospital within a specific period of time. Admission status for inpatient facilities is frequently classified as Emergency, Urgent, or Elective.

EMERGENCY: Emergency admissions apply to medical conditions or acute trauma such that life, limb, or the body function of the patient depends on the immediacy of medical treatment. In an emergency admission, the condition requires immediate medical attention and any time delay would be harmful to the patient. The patient does not have to be admitted via the Emergency Room to be considered an emergency admission.

URGENT: Urgent admissions involve medical conditions or acute trauma such that medical attention, while not im­mediate¬ly essential, should be provided very early in order to prevent possible loss or impairment of life, limb, or body function. This group includes those cases where very early medical evaluation or treatment is necessary because the patient has either serious disease or injury or symptoms of such disease or injury. A true emergency does not exist but the physician considers the patient must have the next available bed.

ELECTIVE: Elective admissions refer to those patients designated as scheduled or routine admissions. This group includes those cases where there is no urgency for immediate or very early medical evaluation or treatment because the possibility of serious consequences resulting from lack of medical attention is small.

AMORTIZE: to liquidate on an installment basis; an amortized loan is one in which the principal amount of the loan is repaid in installments during the life of the loan.(6)

AS-BUILT DRAWINGS: copies of working and siteworks drawings showing any changes, additions or deletions which have occurred during the construction period­.(7)

ASSIGNABLE SQUARE FEET : The sum of all areas on all floors of a building assigned to or available for assignment to an occupant, including every type of space functionally useable by an occupant (except custodial, circulation area, an mechanical).(2)

AVERAGE DAILY CENSUS or AVERAGE DAILY PATIENTS : This refers to the average number of inpatients receiving care each day during a reporting period, excluding newborns.(3) The total patient days over a period of time are divided by the number of days in the period; this calculation estimates the "typical" census on any day.

AVERAGE LENGTH OF STAY (ALOS) : In the National Hospital Discharge Survey, the average length of stay is the total number of patient days accumulated at the time of discharge, counting the date of admission but not the date of discharge by patients discharged during a reporting period, divided by the number of patients discharged.As measured in the National Nursing Home Survey, length of stay for residents is the time from their admission until the reporting time, while the length of stay for discharges is the time between the date of admission and the date of discharge.(3)

BALLOON PAYMENT : when a debt is not fully amortized, the final payment is larger than the preceding payments and is called a "balloon" payment.(6)

BED : Any bed that is set up and staffed for use for inpatients is counted as a bed in a facility. In the National Master Facility Inventory, the count is of beds at the end of the reporting period; for the American Hospital Association, it is of the average number of beds during the entire period. The World Health Organization defines a hospital bed as one regularly maintained and staffed for the accommodation and full-time care of a succession of inpatients and situated in a part of the hospital where continuous medical care for inpatients is provided.(3)

LICENSED: the number of beds a hospital is allowed to maintain, as determined by a governmental regulatory agency, usually of the state.

STAFFED: the number of beds the hospital is able to adequately service, depending upon the size of staffing.

BENEFITS: a payment or service provided under an insurance policy or prepayment plan. In the case of Blue Cross, the payments are made directly to the hospital on behalf of all patients who are covered. Commercial insurers either make payments to the hospital or the patient.(6)

BID: the price buyers offer to pay for bonds; the price at which sellers may dispose of them.(6)

BIRTH RATE: This measure divides the number of live births in a population in a given period by the resident population at the middle of that period. The rate may be restricted to births to women of specific age, race, marital status, or geographic location, or it may be related to the entire population.(3)

BLOCK SCHEMATICS: the first step in the design state, they are drawings which show the total building and preliminary design concept adapted to a particular site in single line treatment.(7)

BOND: a long-term debt instrument.(6)

BOND DISCOUNT (or DEBT DISCOUNT): amount by which the selling (or purchase) price is less than the face value of a bond or other form of indebtedness.(6)

BOND PREMIUM (or DEBT PREMIUM): amount by which the selling (or purchase) price exceeds the face value of a bond or other form of indebtedness.(6)

BOOK VALUE: the value of an asset as shown in the accounting records of a firm.(6)

BUBBLE DIAGRAMS: spatial diagrams developed at the end of the programming stage indicating the relationship of components.(7)

CAUSE OF DEATH: For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate, and utilizing the international rules for selecting the underlying cause of death from the reported conditions. For data years 1968-78, the Eighth Revision International Classification of Diseases, Adapted for Use in the United States is used for coding. Earlier data used the then current revision of the International Classification of Diseases. For 1979, the Ninth Revision is used.(3)

CENTRIFUGAL (ELECTRICAL) CHILLER: an air conditioning water chiller using a rotating type compressor in lieu of a recalculating type.

CERTIFICATE OF NEED (CON): a confirmation, usually legal in nature, by an approved agency that a proposal for establishing a program or constructing a facility meets an estimated unmet need in a defined service area.(6)

CHILLED WATER RESET: changing the chilled water supply to its optimum temperature in order to maximize the chiller’s efficiency.

CONCEPT PLANS: diagrams which demonstrate, in conceptual form, the development of the site and the building itself related to existing or new building locations, major building expansion, major internal circulation, vehicular circulation and parking, and other land uses.(7)

CONFIDENCE INTERVALS: a statistical measure used to define, with an identified probability, the numerical boundary values in which a given measure (e.g., mean, projected dependent variable of a regression, etc.) is expected to occur.

CONSTRUCTION COST ESTIMATE: includes cost of new construction or renovation. Does not include local responsibility costs such as those for site acquisition, site development and parking; costs of equipment and furnishings not in contract; professional fees; or planning cost budget.(7)

CONSUMER PRICE INDEX (CPI): The CPI is prepared by the U.S. Bureau of Labor Statistics. It is a measure of the changes in average prices of the goods and services purchased by urban wage earners and by clerical workers and their families. The medical care component of the CPI shows trends in medical care prices based on specific indicators of hospital, medical, dental, and drug prices. A recent revision of the CPI has been in use since January 1978.(3)

CORPORATE REORGANIZATION: a change in the legal structure of a hospital. Performed in many non-profit health facilities to enable them to maintain their financial strength in a time of reduced government reimbursement

COST: the monetary valuation applied to an asset or service that has been obtained by an expenditure of cash or by a commitment to make a future expenditure.(6)

COST-BASED REIMBURSEMENT: the reimbursement approach generally used by third party payers. Under this approach, the third party pays the hospital for the care received by covered patients at cost, with the expense elements included and excluded from cost determined by the third party. (6)

CRITICAL PATH NETWORK: a technique used to describe a schedule for related activities in a project. The activities are initially graphically diagrammed to show the sequence of events in a process. Mathematical formulae can be applied to this "network" of activities to identify the duration for the longest sequence of related activities. This sequence is called the "critical path" because it defines the earliest time a project can be totally complete. Any delay in activities on the critical path results in delaying the finish of the project.

DAILY CENSUS: see Average Daily Census.

DAY: According to the American Hospital Association and National Master Facility Inventory, days or inpatient days are the number of adult and pediatric days of care rendered during a reporting period. Days of care for newborns are excluded. In the National Health Interview Survey, hospital days during the year refer to the total number of hospital days occurring in the 12-month period prior to the interview week. A hospital day is a night spent in the hospital for persons admitted as inpatients to a hospital. In the National Hospital Discharge Survey, days of care refer to the total number of patient days accumulated by patients at the time of discharge from non-federal short-stay hospitals during a reporting period. All days from and including the date of admission to, but not including the date of discharge, are counted. A patient is a person who is formally admitted to the inpatient service of the hospital for observation, care, diagnosis, or treatment.(3)

DEATH RATE: This measure divides the number of deaths in a population in a given period by the resident population at the middle of that period. It may be restricted to deaths in specific age, race, sex, or geographic groups, or it may be related to the entire population. (3)

DEMOGRAPHICS: statistical studies of human population especially with reference to size and density, distribution, and vital statistics.

DEPARTMENTAL GROSS SQUARE FEET (DGSF): the space inside the centerline of the walls separating the department from other areas and includes internal walls, internal corridors, etc.

DIAGNOSIS RELATED GROUP (DRG): a classification system used to cluster patient care activity into similar service utilization characteristics. It is currently used by the U.S. Department of Health and Human Services to establish maximum price charges for acute patient care.

DISABILITY: Disability is any temporary or long-term reduction of a person's activity as a result of an acute or chronic condition. It is often measured in terms of the number of days that a person's activity has been reduced.(3)

DISCHARGE: The National Health Interview Survey defines a hospital discharge as the completion of any continuous period of stay of one night or more in a hospital as an inpatient, excepting the period of stay of a well newborn infant. According to the National Hospital Discharge Survey, American Hospital Association, and National Master Facility Inventory, this is the formal release of an inpatient by a hospital, i.e., the termination of a period of hospitalization (including stay of 0 nights) by death or by disposition to a place of residence, nursing home, or another hospital. In the National Nursing Home Survey, this is the formal release of a resident by a nursing home.(3)

EIGHTH REVISION INTERNATIONAL CLASSIFICATION OF DISEASES, ADAPTED FOR USE IN THE UNITED STATES (ICDA) : ICDA and the International Classification of Diseases (ICD), upon which ICDA is based, classify morbidity and mortality information for statistical purposes. Both are arranged in 17 main sections. Most of the diseases are arranged according to their principal anatomical site, with special sections for infective and parasitic diseases; neoplasms; endocrine, metabolic, and nutritional diseases; mental diseases; complication of pregnancy and childbirth; certain diseases peculiar to the perinatal period; and ill-defined conditions. Separate sections provide a classification of injuries according to the external cause giving rise to the injury, usually used for cause-of-death categories, and a classification according to the nature of injury (such as puncture, open wound or burn), usually used for morbidity categories. Supplementary sections in ICDA on special conditions and examinations without sickness (Y00-Y13) and on surgical operations and diagnostic and other therapeutic procedures are used for coding information on ambulatory and inpatient utilization. ICD was first used in 1900 and has been revised about every 10 years since then. The Ninth Revision, introduced in 1977, is used to code U.S. mortality data beginning with 1979. A modification of the Ninth Revision has been prepared for use with U.S. morbidity data.(3)

FETAL DEATH: The fetal death rate is the number of fetal deaths with stated or presumed gestation of 20 weeks or more per 1,000 total births (i.e., live births plus fetal deaths).(3)

FINAL DESIGN DRAWINGS: developed during the design stage from the simple single line sketch drawings.(7)

FINANCIAL FEASIBILITY: a study undertaken to determine the ability of an institution to meet a proposed financial obligation, typically a bond issues. A feasibility study is conducted by an accounting firm and usually includes a determination of future demand for services, sources and uses of income, and calculation of key ratios relative to the proposed indebtedness. This study may be preceded by a "debt capacity" study.

FIXED ASSETS: assets of a relatively permanent nature held for continuous use in hospital operations and not intended to be converted into cash through sale.(6)

FIXED CHARGES: costs that do not vary with the level of output.(6)

FULL-TIME EQUIVALENT EMPLOYEE (FTE): The American Hospital Association and National Master Facility Inventory use an estimate of full-time equivalent employees that counts two part-time employees as one full-time employee, a full-time employee being someone working 35 hours a week or more. The National Nursing Home Survey uses an estimate of full-time employees that counts 35 hours of part-time employees' work per week as equivalent to one full-time employee.(3)

FUNCTION: sets of activities necessary to carry out a definable mission over an extended period of time.(8)

FUNCTIONAL PROGRAM: a description of activities, processes, people, and equipment necessary to perform a service at a projected workload level. Functional programs are usually organized to describe departments in medical institutions.(8)

FUNCTIONAL PROGRAMMING: the process by which an identified service program and defined level of patient utilization or workload is evaluated to determine the most desirable method of fulfilling the program.(8)

GEOGRAPHIC TERMS: Division and Region: The 50 states and the District of Columbia area grouped for statistical purposes by the U.S. Bureau of the Census into nine divisions within four regions.

GOALS: the general ends or directions that are established for the hospital, the attainment of which will help to further the hospital’s mission. Goals are designed to identify end states that are desired over a period of years and are likely to be altered less often than objectives, but more often than the hospital’s mission.(6)

GROSS NATIONAL PRODUCT (GNP): This is the most comprehensive measure of a nation's total output of goods and services. In the United States, the GNP represents the dollar value in current prices of all goods and services produced for sale plus the estimated value of certain imputed outputs (i.e., goods and services that are neither bought nor sold). The GNP is the sum of: (1) consumption expenditures by both individuals and nonprofit organizations, plus certain imputed values; (2) business investment in equipment, inventories, and new construction; (3) federal, state, and local government purchases of goods and services; and (4) the sale of goods and services abroad minus purchases from abroad.(3)

GROSS SQUARE FEET (GSF): the sum of the floor areas included within the outside faces of exterior walls for all stories or areas which have floor surfaces.(2)

GROSSING FACTORS: multiplication factors applied 1) to net areas for each room or element within a department, and 2) to gross departmental areas. These factors allow for space requirement not included in original net measurements. (7)

HEALTH MAINTENANCE ORGANIZATIONS (HMO's): These are public or private organizations that provide a comprehensive range of health care services, either directly or under arrangement with others, to an enrolled population for a fixed prepaid capitation payment.(3)

HEAT RECOVERY UNIT: a type of thermal transfer device that has the capability of removing and transferring waste heat to a useable terminal.

HOSPITAL: According to the American Hospital Association (AHA) and National Master Facility Inventory (NMFI), hospitals are institutions licensed as hospitals whose primary function is to provide diagnostic and therapeutic patient services for medical conditions and which have at least six beds, an organized physician staff, and continuous nursing services under the supervision of registered nurses. AHA data differ slightly from those of NMFI, since data from NMF reflect osteopathic hospitals as well as hospitals not register with AHA. Non-AHA hospitals comprise 5-10 percent of all hospitals in the country. The World Health Organization considers an establishment a hospital if it is permanently staffed by at least one physician, can offer inpatient accommodation, and can provide active medical and nursing care. Hospitals may be classified by type of service, ownership, and length of stay.

GENERAL HOSPITALS provide both diagnostic and treatment services for patients with a variety of medical conditions, both surgical and nonsurgical. According to the World Health Organization, these are hospitals that provide medical and nursing care for more than one category of medical discipline (e.g., general medicine, specialized medicine, general surgery, specialized surgery, obstetrics, etc.); excluded are hospitals, usually ones in rural areas, which provide a more limited range of care.

PSYCHIATRIC HOSPITALS are ones whose major type of service is psychiatric care.

SPECIALTY HOSPITALS, such as psychiatric, tuberculosis, chronic disease, rehabilitation, maternity, and alcoholic or narcotic, provide a particular type of service to the majority of their patients.

FEDERAL HOSPITALS are operated by the federal government.

NON-FEDERAL GOVERNMENT HOSPITALS are operated by state or local governments. VOLUNTARY NONPROFIT HOSPITALS are operated by a church or other nonprofit organization.

PROPRIETARY HOSPITALS are operated by individuals, partnerships, or corporations for profit.

SHORT-STAY HOSPITALS in the National Hospital Discharge Survey are those in which the average length of stay is less than 30 days. The American Hospital Association and National Master Facility Inventory define short-term hospitals as hospitals in which more than half the patients are admitted to units with an average length of stay of less than 30 days and long-term hospitals as ones in which more than half the patients are admitted to units with an average length of stay of 30 days or more. The National Health Interview Survey defines short-­stay hospitals as any hospital or hospital department in which the type of service provided is general; maternity; eye, ear, nose, and throat; children’s; or osteopathic.(3)

INCIDENCE: Incidence is the number of cases of disease having their onset during a prescribed period of time and is often expressed as a rate (e.g., the incidence of measles per 1,000 children 5-15 years of age during a year). Incidence is a measure of morbidity or other events that occur within a specified period of time.(3)

INDEPENDENT PRACTICE ASSOCIATION (IPA): a prepaid group practice plan similar to an HMO. The IPA contracts with private physicians to provide services at a negotiated fee.

INFANT MORTALITY: Infant mortality is the death of live-born children who have not reached their first birthday and is usually expressed as a rate (i.e., the number of infant deaths during a year per 1,000 live births reported in the year).(3)

INTENSIVE PATIENT CARE: patient care requiring intense nursing care, special monitoring, or equipment. Typically the nursing ratio is two nurses per patient in an ICU, compared to 1:5-6 on a general acute unit.

INTERMEDIATE PATIENT CARE: a patient requiring patient monitoring or nursing care at a level higher than provided on an acute nursing unit, but less than an ICU.

LAND SURVEY DRAWINGS: drawings, which include all information necessary to set out a building on a site. Such information includes topographical contours; grades and lines of streets and adjoining properties; existing structures on the site and on adjoining properties; zoning, rights, restrictions, easements and boundaries; location and type of all utilities (sewer, gas, water, electricity); soil and subsoil conditions; and natural growth features. Provision of land survey drawings is the responsibility of the client.(7)

LENGTH OF STAY (LOS) : see Average Length of Stay.

LICENSED BEDS: see Beds, Licensed.

LIFE EXPECTANCY: Life expectancy is the average number of years of life remaining to a person at a particular age and is based on a given set of age-specific death rates, generally the mortality conditions existing in the period mentioned. Life expectancy may be determined by race, sex, or other characteristics using age-specific death rates for the population with that characteristic.(3)

LONG RANGE PLAN: This is an evaluation of the current situation of an institution and a projection of what it will be five to ten years in the future. This is based on historical and projected: population trends, utilization patterns, physical plant facilities, services offered, environmental/economic factors, and institutional goals. This plan will outline possible growth, expansion, reduction, remodeling, and/or changing of emphases.

LONG-TERM PATIENT CARE : see Hospital, Long-Term.

 

MARKET SHARE : This ratio expresses the percent of all discharges or patient days from a given area and for a given service that was recorded at any given hospital.

MASTER PLAN/MASTER FACILITY PLAN: A Master Facility Plan describes the major physical characteristics of an institution and the plan for future development of facilities.

MEAN: This is the sum of the values for a set of numbers divided by the number of observations in a set. The measure is sometimes referred to as the average. The mean of the set of numbers 1, 3, 5, 7, and 9 is 25/5 = 5.

MEDICAID: This program is federally aided but state operated and administered. It provides medical benefits for certain low-income persons in need of medical care. The program, authorized in 1965 by Title XIX of the Social Security Act, categorically covers participants in the Aid to Families with Dependent Children program as well as some participants in the Supplemental Security Income program and other people deemed medically needy in a participating state. States also determine the benefits covered, rates of payment for providers, and methods of administering the program.(3)

MEDICARE: This is a nationwide health insurance program providing health insurance protection to people 65 years of age and over, people eligible for social security disability payments for more than two years, and people with end-stage renal disease, regardless of income. The program was enacted July 30, 1965, as Title XVIII, Health Insurance for the Aged, of the Social Security Act, and became effective on July 1, 1966. It consists of two separate but coordinated programs: hospital insurance (Part A) and supplementary medical insurance (Part B).(3)

MISSION: a broad, general conception, defining the scope of the hospital’s role. Equivalent to purpose.(6)

MISSION STATEMENT: a formal document presenting the hospital’s mission in language developed for both internal and external audiences (also referred to as statement of purpose).(6)

MONITREND: a management information system maintained by the Hospital Administrative Services (HAS), a division of the American Hospital Association. Monthly, quarterly, and annual statistics are maintained on overall hospital and departmental statistics. These values are typically compared to similar institutions on a state, regional, national, or other significant grouping basis.

NATIONAL HEALTH EXPENDITURES: This measure estimates the amount spent for all health services and supplies and health-related research and construction activities consumed in the United States during a specified time period. Detailed estimates are available by source of expenditure (e.g., consumer out-of-pocket, private health insurance, and government programs) and by type of expenditure (e.g., hospitals, physicians, and drugs). Data are compiled from a variety of sources that collect data from the providers of care.

HEALTH SERVICES AND SUPPLIES EXPENDITURES are outlays for goods and services relating directly to patient care plus expenses for administering health insurance programs and for government public health activities. This category is equivalent to total national health expenditures minus expenditures for research and construction.

PRIVATE EXPENDITURES are outlays for services provided or paid for by non­governmental sources--consumers, insurance companies, private industry, and philanthropic organizations.

PUBLIC EXPENDITURES are outlays for services provided or paid for by federal, state, and local government agencies or expenditures required by governmental action (such as workmen’s compensation insurance payments).(3)

NEGOTIATED UNDERWRITING: a private sale of the bonds by the issuer as contrasted to the advertisement for public bids. Most hospital bond underwriting are negotiated due to special marketing considerations.(6)

NEONATAL MORTALITY: The neonatal mortality rate is the number of deaths under 28 days of age per 1,000 live births.(3)

NET AREA, NET DEPARTMENTAL AREA: measurements used in space tabulation. The net area for a room or element is measured to the interior finished surfaces of all walls and partitions. No deduction is made for columns and small duct and similar spaces within each room. The net area for a department or component, or for a service space, is the total of all the rooms or elements within it. It excludes interior partitions, exterior walls, corridors within the department, and general circulation areas. It also excludes other unlisted items in a space tabulation, such as large ducts, telephone alcoves and electrical closets.(7)

NET ASSIGNABLE SQUARE FEET: see Assignable Square Feet.

NET SQUARE FEET (NSF): the space within the walls of a room, or the useable floor area assigned to a function in an open ("landscape") design.

NURSE PRACTITIONER (NP) : These are specially trained nurses who perform acts of diagnosis, treatment, or prescription which traditionally have been within the exclusive province of the physician. Nurse practitioners function under the supervision of physicians for these medical tasks, but not for their nursing practice.(3)

OCCUPANCY: The National Master Facility Inventory and American Hospital Association define hospital occupancy rate as the average daily census divided by the number of hospital beds during a reporting period. The occupancy rate for other facilities is calculated as the number of residents reported at the time of the interview divided by the number of beds reported.(3)

PATIENT DAYS: see Day.

PAYER MIX (SOURCES OF PAYMENT) : the sources from which the hospital receives payment for its services: the patient (self-pay), commercial insurance (Blue Cross/Blue Shield, other), governmental programs (Medicare, Medicaid).

PERSONAL HEALTH CARE EXPENDITURES: These are outlays for goods and services relating directly to patient care. The expenditures in this category are total national health expenditures minus expenditures for research and construction, expenses for administering health insurance programs, and government public health activities.(3)

POINTS: the same as "percentage". In the case of a bond, a point means $10 since a bond is quoted as a percentage of $1,000. A bond or bond issue which is discounted two points is quoted at 98 percent of its par value.(6)

POISSON CURVE: a theoretical statistical distribution commonly used to estimate probabilities for data with an average value less than 30. The distribution does not take on negative values and has been found to be a useful approximation of variables such as arrivals into a unit, census on a day, and other statistics.

POSTNEONATAL MORTALITY: The postneonatal mortality rate is the number of deaths that occur from 28 days to 365 days after birth per 1,000 live births.(3)

POVERTY LEVEL: As used in the National Survey of Family Growth, poverty is calculated by dividing the total family income by the weighted average threshold income of nonfarm families with the head under 65 years of age based on the poverty levels shown in U.S. Bureau of the Census Population Reports.(3)

PRELIMINARY SITE PLANS: drawings which are a development from a site analysis, and which relate that analysis to block schematics. Major considerations incorporated are vehicular circulation and parking, land use alternatives, and future development possibilities.(7)

PRESENT VALUE (PV) : the value today of a future payment, or stream of payments, discounted at the appropriate discount rate.(6)

PRIME CONTRACTS: contracts generally in force during construction of a building.(7)

PRIVATE PLACEMENT: the placement of an issue in the private (i.e., nonpublic) money markets. This private market is composed of different types of financial institutions (banks, life insurance companies, pension funds, REITs, etc.).(6)

PROTECTION LEVEL: A statistical concept used to identify the range of values for a variable that would exceed a desired probability or "protection" level. For acute bed planning, a 99 percent protection level is a common goal. Therefore, the bed levels identified would accommodate the expected bed needs 99 percent of the time.

QUEUING THEORY: a statistical model used to estimate the characteristic of a system where waiting lines (or "queues") can develop. The model estimates waiting time, average length of the queue, utilization of resources, and other areas.

REGRESSION ANALYSIS: a statistical technique designed to measure the relationship between a variable (such as admissions, patient days, ER visits, etc.) and other variables (population, average length of stay). The technique is used to attempt to predict the value for a particular variable (called the dependent variable) by using values for the other variables (called independent variables). One might wish, for example, to predict admissions based on the population of a region. Where the independent variable is time (years, etc.), the technique is called Time Series.

SERIAL BONDS : not a distinct class of bonds but rather an issue of bonds with different maturities, as distinguished from an issue where all of the bonds have identical maturities (term bonds). Serial bonds are usually retired either in equal annual amounts or on a level debt service basis.(6)

SERIES BONDS: secured by the same assets or revenue, but issued at intervals with different dates. They may or may not mature at the same time.(6)

SERVICE AREA: The Joint Committee of the American Hospital Association and the U.S. Public Health Service offered the following definition on service areas: "A geographic subdivision which by virtue of its population and economic and sociological character, is or can be expected to support a facility offering at least the basic hospital services."(4) According to John Griffith in his book­ Quantitative Techniques for Hospital Planning Control, in certain circumstances a hospital may have a portion of its demand occurring outside its own area. In these instances, a secondary service area is calculated. "This use is the total number of admissions to the hospital from outside its primary area. It is possible in some cases to calculate a secondary use rate. . .This need for a secondary service area occurs most frequently in connection with large hospitals which serve as a referral source."(5)

SERVICE ROLE: the role(s) or position(s) an institution chooses for itself in serving a group(s) of people (i.e., becoming a regional medical center, providing certain specialized care not found elsewhere in the area, etc.).

SHARED SERVICES: working in cooperation with other hospitals/institutions to jointly provide services that either organization could not provide separately. This can be achieved by hospitals sharing a common service such as laboratory work, dietary, blood banks, specialized equipment, etc. Another form is multi-hospital systems.

SHOP DRAWINGS: drawings prepared by a manufacturer, supplier or fabricator showing precise methods and details of factory or field fabrication of the various parts of the building, such as windows, roof parapets, door frames, structural components.(7)

SHORT-TERM CARE: see Hospital, Short-­Term.

SIMULATION MODELING: a mathematical technique (usually implemented through special computer programs) used to replicate the processes, policies, and utilization patterns of a system. One of the key characteristics of simulation is the ability to estimate the impact of variability in key components of a system, such as arrival patterns or room utilization times.

SITE ANALYSIS, SITE ANALYSIS DIAG­RAMS: site analysis diagrams that graphically depict the physical and jurisdictional conditions affecting the site based on a site analysis. Considerations include:- information identified on land survey drawings - legal aspects such as zoning and deed restrictions- realty factors- suitability of location transportation and access - land uses and functions such as building, vehicular circulation, parking, open space landscaping - future development - environmental factors such as sun, wind and precipitation - neighborhood and community relationships – orientation institutional image and identity.(7)

SITE DEVELOPMENT PLAN: diagrams which demonstrate the detailed design development of the site in relation to the building as shown in the sketch and final design drawings. Details of the road and parking layout, landscaping, topographical contours, phased construction (if applicable), and future building expansion are shown at 1:400 or 1:200 scale.(7)

SITE PLANS: drawings that develop preferred site plan alternatives in relation to the preferred alternatives refined in block schematics. Information shown graphically includes all that developed in the site analysis, but developed to greater detail.(7)

SITEWORKS DRAWINGS: graphic instructions concerning all construction aspects of the site at 1:50 scale. Roads, pavements and parking lots are all described fully in the form of drawings.(7)

STAFFED BEDS: see Beds, Staffed.

STANDARD DEVIATION: a statistical measure of the dispersion, or spread, of a set of numbers. The higher the value, the greater the dispersion of a distribution. As the standard deviation increases, the mean (or average) value tends to decrease in significance in understanding the characteristics of a distribution.

STANDARD METROPOLITAN STATISTICAL AREA (SMSA) : This is a concept developed for use in statistical reporting and analysis. Except in the New England states, an SMSA is a county or a group of contiguous counties containing at least one city of 50,000 inhabitants or more or "twin cities" with a combined population of at least 50,000. In addition, contiguous counties are included in character (based on criteria of labor force characteristics and population density) and are socially and economically integrated with the central city or cities.(3)

STEP DOWN: a cost-finding technique involving a single distribution of general service cost centers to both general service and final cost centers.(6)

TAX-EXEMPT BOND: a bond upon which the interest is exempt from federal income taxes.(6)

THIRD-PARTY PAYER: organized groups or governmental programs that usually pay hospitals directly for the hospital services provided to group members or program beneficiaries.(6)

TIME SERIES: see Regression Analysis.

TRAFFIC AND PARKING PLANS: diagrams that illustrate the vehicular circulation and use of the parking areas on the site in conjunction with the appropriate graphics and signposting. These diagrams are developed by the client's security and parking control units.(7)

UNDERWRITER: generally, one or more investment bankers, who, for a fee, undertake to market a debt or equity security issue for the issuing entity or, in the case of a secondary offering, for the selling shareholders.(6)

UTILIZATION RATE: the total number of patient days or discharges from a given area divided by the total population of that area. This ratio excludes newborns and newborn days and is usually expressed in terms of patient days or discharges per 1,000 population.

WORKING CAPITAL: refers to a firm's investment in short-term assets--cash, short-term securities, accounts receivable, and inventories. Gross working capital is defined as a firm's total current assets. Net working capital is defined as current assets minus current liabilities.(6)

SOURCES

1. Phillip, P. Joseph and Dombrosk, Stephen J.: Seasonal Patterns of Hospital Activity. Lexington, MS: D.C. Heath & Company, 1979.

2. Interstate Commission for Higher Education (Planning and Management Systems Division), May 1971.

3. Health, United States, 1981. Washington, DC: U.S. Department of Health and Human Services (National Center for Health Statistics), 1981.

4. Joint Committee of the AHA and PHS on Areawide Planning of Hospitals and Related Health Facilities Report USPHS, Division of Hospitals and Medical Facilities, Publication No. 855. Washington, DC, 1966.

5. Griffith, John R.: Quantitative Technique for Hospital Planning Control. Lexington, MS: Lexington Books, 1972.

6. Berman, Howard and Weeks, Lewis: The Financial Management of Hospital. Fifth Edition. Ann Arbor, 1982.

7. The Planning Process for Capital Projects. Alberta Hospitals and Medical Care, May 1979. Evaluation and Space Programming Methodology Series. Volume 2: "Surgery/Day Surgery Suite." Health and Welfare Canada, November 1978.