About the Data
Where do the data come from?
Most of the data in this report come from health care facility claim records. Health care facilities (facilities for short) in this report include Utah hospital and freestanding ambulatory surgery centers. Utah facilities are required by law to submit a standard set of information about each inpatient who spends at least 24 hours in the facility and about each outpatient who spends up to 24 hours in the facility to the Office of Health Care Statistics, Utah Department of Health, for the Utah Hospital Discharge Database. The Agency for Healthcare Research and Quality (AHRQ), a federal agency in charge of quality of care, provided national information. For further information visit the AHRQ Web site….
Have the data been verified by others?
Yes. Utah facilities review the data for accuracy during a review period of at least 30 days while the report is being developed. They also review the completed report before it is released. Facilities may submit comments to be posted online as part of the report.
Why use these indicators/measures?
SB 132 mandates that the comparison reports use nationally recognized quality standards. A federal agency charged with overseeing health care quality, the Agency for Healthcare Research and Quality (AHRQ), developed the Inpatient Quality Indicators (IQIs). The IQIs allow comparison among Utah facilities with similar patients nationwide. This report shows one IQI for inpatient laparoscopic gallbladder removal. Read more information on the AHRQ IQIs.
The IQIs are designed to be used for inpatients, so outpatients are not included in the report’s IQI table. Based on research in the 1990s, AHRQ includes rate of laparoscopic gallbladder removal among its quality indicators, as higher rates indicate adoption of a new procedure that is usually less expensive and less traumatic to patients than open gallbladder removal. However, many experts now suggest that 100% laparoscopic gallbladder removal should not be a goal for optimal health care. For some patients, laparoscopic gallbladder removal is not possible or is too risky. Such patients require more extensive procedures, such as open gallbladder removal. This report includes the IQI for laparoscopic gallbladder removal as a utilization measure.
The measure for average charge is an All Patient Refined Diagnosis Related Group (APR-DRG) for similar, though not identical, conditions and procedures among inpatients. For outpatients, the measure is the ICD-9-CM procedure code 51.23, as outpatients do not have APR-DRGs.
Many factors affect a facility’s performance on utilization measures. Such factors include the facility’s size, the number of gallbladder patients treated, available specialists, teaching status and especially the medical history of the facility’s patients and how ill those patients are. Facilities that treat high-risk (very ill) patients may have higher percentages of open surgeries than facilities that transfer these patients. Facilities also may report patient diagnosis codes differently, which could impact the comparison of utilization measurement among facilities. Utilization indicators adjust for how ill each facility’s patients are, but the adjustment may not capture the full complexity of the patient’s condition. The Utah Hospital Discharge Database includes up to nine diagnoses and up to six procedures for each patient. Some patients have additional diagnoses and procedures that are not included in this database. As a result, the measures of inpatient illness may not be complete.
The average charge shown in this report differs from “costs,” “reimbursement,” “price” and “payment.” Different payers have different arrangements with each facility for payment. Many factors will affect the cost of your facility stay, including whether you have health insurance, the type of insurance and the billing procedures at the facility. This report excludes outlier (unusually high) charge cases and length of stay cases from the calculation of average charge for inpatients. It does not exclude outlier charge for outpatients (see Glossary). While APR-DRGs do consider levels for each inpatient’s severity of illness, these levels may not completely reflect the complexity of the inpatient’s condition.
Outpatients do not have levels for severity of illness, whereas inpatients do have levels for severity of illness.