• Mailing Address
    Dept. of State Health Services
    Center for Health Statistics, MC 1898
    PO Box 149347
    Austin, Texas 78714-9347

    Moreton Building, M-660
    1100 West 49th Street
    Austin, TX 78756

    Phone: 512-776-7261
    Fax: 512-776-7740
    Email: thcichelp@dshs.texas.gov

Utilization Review Introduction

Texas Health Care Information Collection
Center for Health Statistics


Why are these measures important?
Why might there be variation?
What do these measures tell us?
What are Hospital Referral Regions?
What data is used for these reports?

The hospital inpatient discharge data collected from over 500 Texas hospitals allows for a regional analysis of procedures whose use varies widely across the state. This report was produced using performance measures and methodology developed by the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services. The measures are taken from AHRQ's Inpatient Quality Indicators. These area-level utilization measures reflect the rate of hospitalization for specific procedures in each geographic area. The use of these procedures varies widely across relatively similar geographic areas. All measures are applied to the adult population.

Why are these measures important?
These measures objectively present information on regional variations in the performance of seven procedures for which there are concerns about potential over-use, under-use or inappropriate use.

Why might there be variation?
A hospital in the region may be a referral center for a particular procedure and patients may be referred to the hospital from outside the area for that procedure. Or patients in a region may be receiving a greater number of procedures than expected. These variations may also be the result of patient preference or physician practice patterns.

What do these measures tell us?
The report provides useful information on variation in the use of particular procedures. The report identifies regions where a procedure may be over-used, under-used or used inappropriately. These measures can help to determine whether services are being provided appropriately. They can be used to check up on and improve the quality of health care provided by the healthcare system.

What are Hospital Referral Regions?
The geographic regions used in this report are Hospital Referral Regions, defined by the Dartmouth Atlas of Healthcare. Hospital referral regions (HRRs) represent regional health care markets for tertiary medical care. Each HRR contains at least one hospital that performed major cardiovascular procedures and neurosurgery. HRRs are defined by assigning Hospital Service Areas (HSAs) to the region where the greatest proportion of major cardiovascular procedures were performed, with minor modifications to achieve geographic contiguity, a minimum population size of 120,000, and a high localization index. Most hospital service areas contain only one hospital. Twenty-two hospital referral regions are centered in the state. Several of these HRRs extend beyond the state's borders. Likewise, the Texarkana area is assigned to the Texarkana, AR HRR, and part of East Texas is assigned to the Shreveport, LA HRR. A small portion of the Texas Panhandle is assigned to the Oklahoma City HRR. Hospitals located in this HRR are exempt from reporting inpatient discharge data to DSHS and this HRR is not included in the report. Therefore, the sums of the regions do not

What data is used for these reports?
Hospital inpatient discharge data are collected from most hospitals in the state. The data collected include information on each hospitalization. Patients can be coded differently across hospitals. Some hospitals code more thoroughly than others, making accurate comparisons across regions difficult. The codes themselves are often not specific enough to adequately characterize a patient's condition. While these data represent a rich data source that can provide valuable information, this report should be used along with other sources of information on the quality of health care.

Last updated May 25, 2011