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Complete Indicator Report of Ambulatory Care Sensitive Conditions: Diabetes Hospitalization Among Adults

Definition

Ambulatory care sensitive (ACS) conditions refer to those conditions for which hospitalizations could have been avoided, or conditions that could have been less serious, if they had been treated early and appropriately. Good outpatient management dramatically reduces the risk of hospitalization. For diabetes, an ACS condition refers to uncontrolled diabetes (type 1 and type 2), diabetes short-term and long-term complications, and amputations of lower extremities due to diabetes among adults aged 18 years and older.

As of November 2004, the IBIS diabetes information is based on four diabetes indicators (PQI 1, PQI 3, PQI 14, PQI 16) developed by the Agency for Healthcare Research and Quality Prevention Quality Indicators. National Healthcare Quality and Research provided the values for the national rate based on the National Inpatient Sample.

Numerator

Number of hospitalizations among persons aged 18 years and older with diabetes complications as the principal or secondary diagnosis code. Maternal, newborn, and transfer cases are excluded.

Denominator

Number of Utah residents aged 18 years and older.

Data Interpretation Issues

The four Agency for Healthcare Research and Quality Prevention Quality Indicators for diabetes use both principal and secondary ICD-9-CM diagnosis codes for hospitalization, include all adults (aged 18 years and older), but exclude cases that may result in over counting of diabetes cases. Specifically maternal, newborn, and transfer cases are excluded from uncontrolled diabetes, diabetes long-term complications, and diabetes short-term complications. Diabetes lower extremity amputation also excludes trauma cases. The Utah diabetes rate is risk-adjusted by age and gender so that comparison with the national rate is more meaningful. 95% confidence intervals are the criterion for statistical significance, that is, they indicate whether differences are real or due to "noise" in the data.

Why Is This Important?

Ambulatory care sensitive (ACS) conditions are conditions for which effective outpatient care can prevent hospitalizations. Diabetes is a disease for which regular physician visits can help to control blood sugar (glucose), fats (lipids), and blood pressure; screen for diabetes-related eye, foot, and kidney problems; and provide early treatment and patient education in self-management. Physician visits and early treatment can prevent otherwise avoidable hospitalizations and serious illness and injuries to patients. Diabetes complications include loss of consciousness, heart disease, stroke, circulation, kidney and nerve damage, impotence, blindness, amputation of extremities, and death.

Other Objectives

Similar to HP2020 Objective D-4: Reduce the rate of lower extremity amputations in persons with diagnosed diabetes.

How Are We Doing?

From 2000 through 2012, the annual risk-adjusted rate of Utah residents aged 18 years and older hospitalized for diabetes with short-term complications has generally increased. However, in years 2004 and 2009, short-term rate decreases were reported. Only the decrease in 2009 was considered statistically significant, in comparison to the preceding year. On the contrary, the risk-adjusted rate has generally decreased from 2000 to 2012 for diabetes with long-term complications, uncontrolled diabetes, and amputation of lower extremities.

How Do We Compare With U.S.?

Based on four adult diabetes indicators (short-term complications, long-term complications, lower extremity amputations, and uncontrolled), the annual risk-adjusted rate for Utah residents aged 18 years and older hospitalized for diabetes from 2000 through 2011 (the most recent available national data), the was significantly lower than the national annual rate, which was obtained from the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project (AHRQ/HCUP).

Utah rates for 2000 through 2012 are significantly lower than the annual national rates most years (except 2002 and 2003 for short-term complications), based on the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project.

What Is Being Done?

The Utah Diabetes Prevention and Control Program has been merged into the Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) Program. The EPICC Program places a high priority on diabetes self-management education and is working to increase the number of adults who have ever received it. However, EPICC funding no longer supports state-certification of Diabetes Self-Management Education Program and staff is assisting all state-certified programs obtain recognition from the American Diabetes Association or certification through the American Association of Diabetes Educators.

Evidence-based Practices

Glycemic control (average preprandial glucose for diabetics: 90-130 mg/dl, average normal: <110 mg/dl) results in significant reductions in the incidence and rate of progression of retinopathy, albuminuria, and clinical neuropathy.

A1c tests show a diabetic's average glycemia over the preceding 2-3 months. A1c tests should be performed at least twice per year in patients who are meeting treatment goals and at least quarterly in patients who are not meeting glycemic goals.

Diet and exercise have been shown to help diabetics with glycemic control.

Diabetics have increased risk of cardiovascular disease. Lowering risks, such as hypertension (diastolic >=90 mmHG or systolic >=140 mmHG) are especially important for diabetics. (http://care.diabetesjournals.org/content/25/1/213.full)

Available Services

The EPICC Program holds monthly webinars for health care professionals interested in learning the latest techniques and research for diabetes management. Information and registration is available at:
http://www.choosehealth.utah.gov/healthcare/continuing-education/diabetes-webinar-series.php

Diabetes care manuals for patients are available in multiple languages are available at:
http://www.choosehealth.utah.gov/healthcare/physician-resources/diabetes-manuals.php

A list of self-management education programs taught by health care professionals is available at:
http://www.choosehealth.utah.gov/your-health/lifestyle-change/dsme.php

A list of free community diabetes self-management workshops taught by members of the community is available at:
http://www.choosehealth.utah.gov/your-health/lifestyle-change/living-well.php

A diabetes self-management course is also available online at:
http://www.ncoa.org/improve-health/chronic-conditions/better-choices-better-health.html

Please see the National Diabetes Education Program for more information about diabetes prevention and management at www.yourdiabetesinfo.org.

Other Program Information

A1c levels less than 7% indicate good glucose control. The Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) Program and the Office of Health Care Statistics collect HEDIS (Healthcare Effectiveness Data and Information Set) information on frequency of A1c exams for members of health plans throughout the state. The EPICC Program also conducts chart reviews to obtain A1c levels for a sample of health plan members.
See http://health.utah.gov/diabetes/



Related Indicators

Relevant Population Characteristics

The majority of hospitalizations for ACS conditions are for ketoacidosis, a life-threatening condition that develops when a person's cells cannot get enough glucose (sugar). Ketoacidosis generally occurs to people who develop diabetes at a younger age and have type 1, or insulin-dependent, diabetes. Hyperosmolar coma, a life-threatening condition that develops when a person has very high blood sugar, is uncommon and not often seen in people less than 65 with diabetes.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Primary preventive care and regular office visits to a health care provider are essential for maintaining good blood sugar control. People who lack health insurance are less likely to have access to outpatient services that could decrease the risk of acute diabetes complications. Diabetes education can also help prevent complications through improved participation in self-management techniques.

Related Health Care System Factors Indicators:


Risk Factors

Lack of access to preventive health care services, such as routine doctor visits and diabetes education, increases the risk of hospitalization for people with diabetes. Ketoacidosis is one of the most common reasons for hospitalization among the younger population with type 1 diabetes; however, it is also one of the most avoidable. Among older adults, the most common ACS condition is hyperosmolar coma. The risk of hyperosmolar coma increases with age.

Related Risk Factors Indicators:


Health Status Outcomes

ACS conditions develop quickly and may become life-threatening in a short period of time. The most common type of diabetes-related ACS condition is ketoacidosis, a critical situation that occurs when the body's insulin supply is depleted. This condition is generally confined to type 1 patients (type 2 patients generally produce at least a small amount of insulin). If not treated promptly, ketoacidosis can lead to severe complications and death.

Related Health Status Outcomes Indicators:




Graphical Data Views

Adult Hospitalizations due to Diabetes, Short-term Complications, Utah, 2000-2012 and U.S., 2000-2011

::chart - missing::
confidence limits

Overall, Utah's annual rate has been decreasing since 2000. The 2010, 2011, and 2012 rates are significantly higher than the rate for 2009, based on 95% confidence intervals. From 2000 through 2011 (the most recent available national data), the Utah annual rate was significantly lower than the national annual rate, which was obtained from the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project (AHRQ/HCUP).

Utah vs. U.S. Year Risk-adjusted Discharges per 100,000 Adults Lower Limit Upper Limit
Record Count: 34
Utah 2000 36.9 28.8 45.0
Utah 2001 40.2 31.9 48.5
Utah 2002 45.2 36.5 53.9
Utah 2003 46.3 37.6 55.0
Utah 2004 36.8 33.9 39.8
Utah 2005 44.3 40.7 48.1
Utah 2006 44.3 40.6 48.0
Utah 2007 47.7 44.0 51.3
Utah 2008 47.5 43.9 51.2
Utah 2009 37.3 34.5 40.1
Utah 2010 40.0 36.6 43.5
Utah 2011 47.3 43.8 50.8
Utah 2012 48.6 45.2 52.0
U.S. 2000 50.8 49.4 52.2
U.S. 2001 51.6 50.4 52.9
U.S. 2002 53.9 52.5 55.2
U.S. 2003 55.2 53.7 56.7
U.S. 2004 54.5 53.2 55.8
U.S. 2005 55.4 54.0 56.9
U.S. 2006 58.7 57.0 60.3
U.S. 2007 58.7 57.2 60.2
U.S. 2008 60.2 58.6 61.7
U.S. 2009 63.7 61.9 65.4
U.S. 2010 68.3 66.4 70.3
U.S. 2011 71.7 70.0 73.4

Data Notes

Numerator for Diabetes, Short-term Complications (PQI 1), includes principal diagnosis codes for diabetes, short-term complications (250.10-250.13, 250.20-250.23, 250.30-250.33).

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalizations due to Diabetes, Long-term Complications, Utah, 2000-2012 and U.S., 2000-2011

::chart - missing::
confidence limits

Overall, Utah's annual rate has been decreasing since 2000. The annual rate increased in 2011, but did not significantly differ from 2010. From 2000 through 2011 (the most recent available national data), the Utah annual rate was statistically significantly lower than the national annual rate, which was obtained from the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project.

Utah vs. U.S. Year Risk-Adjusted Discharges per 100,000 Lower Limit Upper Limit
Record Count: 34
Utah 2000 79.0 72.4 85.6
Utah 2001 78.2 71.7 84.7
Utah 2002 76.9 70.5 83.3
Utah 2003 77.2 70.9 83.6
Utah 2004 76.2 70.0 82.5
Utah 2005 71.0 64.8 77.1
Utah 2006 75.8 69.8 81.9
Utah 2007 73.4 67.5 79.4
Utah 2008 65.2 59.3 71.0
Utah 2009 60.5 54.7 66.2
Utah 2010 55.2 49.5 60.9
Utah 2011 59.3 53.7 65.0
Utah 2012 50.4 45.3 55.5
U.S. 2000 126.4 123.3 129.5
U.S. 2001 125.6 122.8 128.3
U.S. 2002 129.6 126.8 132.5
U.S. 2003 129.0 125.6 132.5
U.S. 2004 133.7 130.4 137.1
U.S. 2005 130.8 127.3 134.3
U.S. 2006 135.3 131.4 139.1
U.S. 2007 131.0 127.7 134.3
U.S. 2008 128.5 125.0 132.0
U.S. 2009 121.4 117.8 124.9
U.S. 2010 123.1 119.9 126.4
U.S. 2011 127.0 123.6 130.5

Data Notes

For Diabetes, Long-term Complications (PQI 3), the numerator includes principal diagnosis codes 250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93.

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalizations due to Diabetes, Uncontrolled, Utah, 2000-2012 and U.S., 2000-2011

::chart - missing::
confidence limits

Overall, Utah's annual rate has been decreasing since 2000. From 2000 through 2011 (the most recent available national data), the Utah annual rate was statistically significantly lower than the national annual rate, which was obtained from the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project.

Utah vs. U.S. Year Risk-adjusted Discharges per 100,000 Lower Limit Upper Limit
Record Count: 34
Utah 2000 8.6 6.0 11.2
Utah 2001 6.1 3.5 8.7
Utah 2002 6.8 4.3 9.4
Utah 2003 4.5 2.0 7.0
Utah 2004 4.3 1.8 6.7
Utah 2005 4.0 1.6 6.4
Utah 2006 3.8 1.4 6.2
Utah 2007 3.7 1.3 6.0
Utah 2008 4.3 1.9 6.6
Utah 2009 4.0 1.7 6.3
Utah 2010 3.9 1.7 6.2
Utah 2011 3.6 1.3 5.8
Utah 2012 3.0 1.0 5.0
U.S. 2000 29.1 28.1 30.2
U.S. 2001 27.9 26.7 29.1
U.S. 2002 26.4 25.5 27.3
U.S. 2003 24.8 23.5 26.1
U.S. 2004 23.0 22.1 23.9
U.S. 2005 21.2 20.4 22.1
U.S. 2006 22.4 21.3 23.5
U.S. 2007 21.8 20.9 22.7
U.S. 2008 23.0 21.7 24.2
U.S. 2009 22.9 21.8 24.0
U.S. 2010 20.0 19.2 20.7
U.S. 2011 19.8 19.1 20.5

Data Notes

For Diabetes, Uncontrolled (PQI 14), the numerator includes principal diagnosis codes for diabetes uncontrolled, type 1 or type 2 (250.03, 250.02).

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalizations due to Diabetes, Lower Extremity Amputations, Utah, 2000-2012 and U.S., 2000-2011

::chart - missing::
confidence limits

Overall, Utah's annual rate has been decreasing since 2000. From 2000 through 2011 (the most recent available national data), the Utah annual rate was statistically significantly lower than the national rate, which was obtained from the Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project.

Utah vs. U.S. Year Risk-adjusted Discharges per 100,000 Lower Limit Upper Limit
Record Count: 34
Utah 2000 14.0 11.5 16.5
Utah 2001 14.1 11.6 16.5
Utah 2002 13.2 10.8 15.7
Utah 2003 13.0 10.6 15.4
Utah 2004 12.3 9.9 14.7
Utah 2005 10.6 8.3 12.9
Utah 2006 11.3 9.0 13.6
Utah 2007 10.9 8.7 13.2
Utah 2008 9.2 7.0 11.4
Utah 2009 9.6 7.4 11.7
Utah 2010 8.2 6.0 10.3
Utah 2011 7.9 5.8 10.0
Utah 2012 6.6 4.7 8.6
U.S. 2000 25.2 24.4 26.0
U.S. 2001 23.5 22.8 24.2
U.S. 2002 23.6 22.9 24.3
U.S. 2003 22.5 21.8 23.2
U.S. 2004 22.3 21.6 23.0
U.S. 2005 19.2 18.6 19.8
U.S. 2006 19.6 19.0 20.2
U.S. 2007 18.3 17.7 18.8
U.S. 2008 17.6 17.0 18.2
U.S. 2009 17.0 16.5 17.6
U.S. 2010 16.5 15.9 17.0
U.S. 2011 18.1 17.5 18.8

Data Notes

For Diabetes, Lower Extremity Amputation (PQI 16), the numerator includes principal or secondary diagnosis codes for: (1) uncontrolled diabetes (250.00-250.03), (2) diabetes short-term complications (250.10-250.13, 250.20-250.23, 250.30-250.33), (3) diabetes long-term complications (250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93), plus ICD-9-CM procedure codes for lower extremity amputation (84.10-84.19, toe amputation - except due to trauma - through abdominopelvic amputation).

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalization Rate for Diabetes, Short-term Complications by Patient County of Residence, Utah, 2012

::chart - missing::
confidence limits

For 2012, Cache and Davis counties had a rate significantly lower than Utah overall, based on 95% confidence intervals, and Box Elder, Carbon, and Tooele counties had a rate significantly higher than Utah overall.

County Risk-adjusted Rate per 100,000 Adults Lower Limit Upper Limit
Record Count: 30
Beaver **
Box Elder 83.6 57.4 109.8
Cache 24.3 7.7 40.9
Carbon 96.8 57.6 136.0
Daggett **
Davis 33.8 23.5 44.2
Duchesne 45.5 3.0 88.0
Emery **
Garfield **
Grand **
Iron 74.6 48.9 100.2
Juab 72.7 13.9 131.6
Kane **
Millard 71.4 18.2 124.7
Morgan **
Piute **
Rich **
Salt Lake 57.2 51.7 62.7
San Juan **
Sanpete 38.7 4.7 72.6
Sevier 41.7 1.0 82.3
Summit **
Tooele 85.0 60.9 109.0
Uintah 66.8 35.3 98.4
Utah 39.3 31.4 47.1
Wasatch **
Washington 34.6 19.5 49.7
Wayne **
Weber 58.1 46.3 69.8
State 48.6 45.2 52.0

Data Notes

**Some counties data may not appear due to small occurrence rates.

Numerator for Diabetes, Short-term Complications (PQI 1), includes principal diagnosis codes for diabetes, short-term complications (250.10-250.13, 250.20-250.23, 250.30-250.33).

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalization Rate for Diabetes, Long-term Complications by Patient County of Residence, Utah, 2012

::chart - missing::
confidence limits

For 2012, no county rate was significantly lower or higher than the overall rate for Utah based on 95% confidence intervals.

County Risk-adjusted Rate per 100,000 Adults Lower Limit Upper Limit
Record Count: 30
Beaver **
Box Elder 32.9 0.0 69.3
Cache 36.7 9.4 63.9
Carbon 79.6 27.4 131.8
Daggett **
Davis 40.8 25.2 56.3
Duchesne 65.9 5.4 126.4
Emery 62.5 0.0 137.0
Garfield **
Grand **
Iron 24.3 0.0 63.5
Juab **
Kane 72.1 0.0 152.1
Millard 52.6 0.0 121.0
Morgan **
Piute **
Rich **
Salt Lake 54.7 46.4 63.0
San Juan **
Sanpete 49.0 0.0 98.1
Sevier 51.0 0.0 104.2
Summit 22.6 0.0 63.6
Tooele 49.3 13.4 85.3
Uintah 49.7 2.7 96.7
Utah 47.1 33.8 60.4
Wasatch **
Washington 50.7 31.2 70.2
Wayne **
Weber 70.3 53.2 87.4
State 50.4 45.3 55.5

Data Notes

**Some counties data may not appear due to small occurrence rates.

For Diabetes, Long-term Complications (PQI 3), the numerator includes principal diagnosis codes 250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93.

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalization Rate for Diabetes, Uncontrolled by Patient County of Residence, Utah, 2012

::chart - missing::
confidence limits

For 2012, no county rate was significantly lower or higher than the overall rate for Utah based on 95% confidence intervals.

County Risk-adjusted Rate per 100,000 Adults Lower Limit Upper Limit
Record Count: 30
Beaver **
Box Elder **
Cache **
Carbon **
Daggett **
Davis **
Duchesne **
Emery **
Garfield **
Grand **
Iron **
Juab **
Kane **
Millard **
Morgan **
Piute **
Rich **
Salt Lake 3.5 0.3 6.8
San Juan **
Sanpete **
Sevier **
Summit **
Tooele **
Uintah **
Utah 2.2 0.0 7.3
Wasatch **
Washington **
Wayne **
Weber **
State 3.0 1.0 5.0

Data Notes

**Some counties data may not appear due to small occurrence rates.

For Diabetes, Uncontrolled (PQI 14), the numerator includes principal diagnosis codes for diabetes uncontrolled, type 1 or type 2 (250.03, 250.02).

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.



Adult Hospitalization Rate for Diabetes, Lower Extremity Amputation by Patient County of Residence, Utah, 2012

::chart - missing::
confidence limits

For 2012, no county rate was significantly lower or higher than the overall rate for Utah based on 95% confidence intervals.

County Risk-adjusted Rate per 100,000 Adults Lower Limit Upper Limit
Record Count: 30
Beaver **
Box Elder **
Cache **
Carbon **
Daggett **
Davis 5.7 0.0 11.6
Duchesne **
Emery **
Garfield **
Grand **
Iron **
Juab **
Kane **
Millard **
Morgan **
Piute **
Rich **
Salt Lake 6.2 3.0 9.3
San Juan **
Sanpete **
Sevier **
Summit **
Tooele **
Uintah **
Utah 3.5 0.0 8.6
Wasatch **
Washington 9.8 2.8 16.8
Wayne **
Weber 8.8 2.4 15.1
State 6.6 4.7 8.6

Data Notes

**Some counties data may not appear due to small occurrence rates.

For Diabetes, Lower Extremity Amputation (PQI 16), the numerator includes principal or secondary diagnosis codes for: (1) uncontrolled diabetes (250.00-250.03), (2) diabetes short-term complications (250.10-250.13, 250.20-250.23, 250.30-250.33), (3) diabetes long-term complications (250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93), plus ICD-9-CM procedure codes for lower extremity amputation (84.10-84.19, toe amputation - except due to trauma - through abdominopelvic amputation).

Risk-adjusted rates are adjusted for age and gender.

Data Sources

U.S. Census, County Intercensal Estimates (2000-2010). Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health. National Healthcare Quality and Research. Healthcare Cost and Utilization Project (HCUP), AHRQ.


References and Community Resources

National Diabetes Education Program
Internet http://yourdiabetesinfo.org

American Diabetes Association
800-342-2383 or 800-DIABETES for diabetes information
Internet http://www.diabetes.org, http://care.diabetesjournals.org/content/25/1/213.full

For more information on the ACS conditions, see AHRQ Quality Indicators, Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions, Department of Health and Human Services, Agency for Healthcare Research and Quality, October 2001 (AHRQ Pub. No. 02-R0203)

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 11/25/2014, Published on 12/09/2014
The information provided above is from the Utah Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.utah.gov). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Mon, 22 December 2014 14:58:29 from Utah Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.utah.gov".

Content updated: Tue, 9 Dec 2014 11:22:46 MST