• Intensive care unit utilization
• Home health utilization
• Obstetrics utilization
• Imaging tests
• Surgical procedures
• End-of-life care
Minimizing unwanted variability is critical in today’s cost- and quality-conscious environment. However,
health care delivery professionals must take a balanced approach that responds to unique clinical needs
and ensures that appropriate variability occurs in the context of evidence-based medicine. The
challenging tasks for hospital administrators in this regard are to identify priority areas for managing
variation in utilization, to determine what variation is acceptable and what is not, and to develop an
action plan to make any changes needed.
The following table identifies areas of major opportunity, types of utilization data that would enable the
organization to identify and define problems, and illustrative objectives for that area.
Areas of Major Opportunity
Intensity of Hospital
Services
Matching the type and amount of
care provided to the severity or
urgency of the patient’s
condition
End-of-Life Care
Treatment decisions and care
provided for terminal patients
Outpatient/Ambulatory
Services
Skilled nursing or rehab facility
care, chronic disease
management programs, and/or
discharge process and planning
Utilization Data for
Problem Diagnosis
• ICU usage
• Length of stay data
• Emergency department usage
• Admissions data
• ICU usage
• ED usage by age and mortality
• Med/surg usage within last six
months of life
• Discharges to hospice
• Use of skilled nursing
programs
• Discharges to rehab facilities
or nursing homes
• Tracking of post-discharge
outcomes
• Readmissions rate
Illustrative Objectives to
Drive Improvement
• Reduce usage of ICU in favor
of step-down or med/surg
• Manage length of stay
• Improve coordination of care
• Expand chronic disease
management programs to
reduce admissions
• Reduce use of ICU at end of
life (EOL) in favor of other
care settings (e.g., hospice)
• Increase enrollment in hospice,
earlier and more consistently
• Ensure availability of patient
instructions for EOL treatment
(e.g., DNR)
• Develop support network with
family and community
organizations
• Develop and deploy skilled
nursing programs
• Improve referral process to
rehab facilities/nursing homes
• Improve discharge planning,
discharge process, and
outcomes tracking
