2007 State Snapshots: State-based Information
from the National Healthcare Quality Report
On April 28, 2008, Jeff Brady and Rosanna Coffey gave an audio conference presentation entitled 2007 State Snapshots: State-Based Information from the National Healthcare Quality Report. This is the text version of the event's slide presentation. Please click here to access the PowerPoint Slides.
Jeffrey Brady, MD, MPH
Center for Quality Improvement and Patient Safety (CQuIPS)
Rosanna M. Coffey, PhD
Thomson Reuters Healthcare
Center for Quality Improvement and Patient Safety (CQuIPS)
Quality Tools Workshop Follow-up Audio Conference
April 28, 2008
On the top of the slide are the logos for the Department of Health & Human Services and the Agency for Healthcare Research and Quality (AHRQ). The Department of Health & Human Services logo is an artistic image of an eagle with the outlined profile of faces. The AHRQ logo reads, “AHRQ – Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, www.ahrq.gov”
Slide 2
Plan for Today
This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left. The header and body of the slide are separated by a light blue horizontal line that traverses 80 percent of the slide from the left.
- NHQR/DR overview
- State Snapshots – overview / what’s new?
- Open to general questions
----------------------------
- Address specific end-user questions received to date
- Invite more user feedback
- Invite suggestions for future technical assistance
Slide 3
AHRQ Mission and Niche
- Mission: Improve the efficiency, effectiveness, quality, safety, and equity of health care
- Niche:
- Developing knowledge through research
- Disseminating the evidence
- Measuring quality
- Facilitating change
A white bracket stretches from “Developing knowledge through research” to “Measuring quality,” which points to the cover images of the 2007 National Healthcare Quality Report and the 2007 National Healthcare Disparities Report.
Slide 4
2007 National Healthcare Quality and Disparities Report
This slide contains the cover images of the 2007 National Healthcare Quality Report and the 2007 National Healthcare Disparities Report, and indicates that both reports were released on March 3, 2008.
Slide 5
Measure Types 2007 NHQR / NHDR
- Setting of Care
- Hospital
- Ambulatory
- Nursing Home/Home Health
- Stages of Care
- Staying healthy
- Getting better
- Living with illness or disability
- Coping with the end of life
Slide 6
Content and Organization 2007 NHQR/NHDR
- Effectiveness
- Cancer
- Diabetes
- End Stage Renal Disease (ESRD)
- Heart Disease
- HIV and AIDS
- Maternal and Child Health
- Mental Health and Substance Abuse
- Nursing Home, Home Health, and Hospice Care
- Patient Safety
- Timeliness
- Patient Centeredness
- Access to Health Care
- Priority Populations
To the right of the text are two brackets. A green bracket, labeled NHQR stretches from “Effectiveness” to “Patient Centeredness,” and an orange bracket, labeled NHDR stretches from “Effectiveness” to “Priority Populations.”
Slide 7
Data Sources
The cover images of the 2007 National Healthcare Quality Report and the 2007 National Healthcare Disparities Report are located in the center of the slide. There are four text boxes – one in each quadrant of the slide. Each box has a light blue arrow pointing toward the images of the reports.
The box in the upper left quadrant contains the following:
Provider/facility sample surveys
CDC,NCHS – NAMCS
CDC,NCHS – NHAMCS
CDC,NCHS – NHDS
CMS – ESRD CPMP
CSHSC – Community Tracking Study Physician Survey
The box in the upper right quadrant contains the following:
Surveillance and vital statistics
CDC – NPCR
CDC – HIV/AIDS Surveillance System
CDC – TB Surveillance System
CDC,NCHS – NVSS
NIH – SEER
The box in the lower right quadrant contains the following:
Organizational data systems
AHRQ – HCUP
CMS – Hospital Compare
CMS – Medicare Patient Safety Monitoring System
CMS – OASIS
CMS – Nursing Home Minimum Data Set
CMS – QIO
HIVRN – 2001-2003
HIS – NPIRS
NCQA – HEDIS
NIH – USRDS
SAMHSA – TEDS
The box in the lower left quadrant contains the following:
Population sample surveys
AHRQ – MEPS
AHRQ – CAHPS
CDC – BRFSS
CDC,NCHS – National Asthma Survey
CDC,NCHS – NHANES
CDC,NCHS – NHIS
CDC,NCHS – National Immunization Survey
CMS – MCBS
HRSA – Healthy Schools Healthy Communities User Visit Survey
NHPCO – Family Evaluation of Hospice Care
SAMHSA – NSDUH
U.S. Census Bureau – U.S. Census
Slide 8
State Snapshots – Overview
http://statesnapshots.ahrq.gov
Web tool for State policymakers to view NHQR/NHDR health care quality, State-by-State:
- Summary performance meters
- Individual measures
- Focus on clinical issues
- State context
- Methods & Interpretation Guides
To the right of the text is a screen shot of the NHQR State Snapshots web site:
http://statesnapshots.s-3.com/snaps07/map.jsp?menuId=2&state=CA
Slide 9
State Snapshots: How have they been used?
- Arkansas Center for Health Improvement:
- View of system, tracking baseline, analysis ideas
- Stakeholders united – “Things were as bad as we thought.”
- Quality improvement “jump started” (EBD)
- Maine:
- Adapted Snapshots IT for hospital transparency
- FL Sentinel:
- Florida’s hospital care falls below U.S. norm, studies show
- AP Wire Service:
- Nursing homes cut back on restraints
Slide 10
State Snapshots: Summary Performance Meters
- Summary meters – a State’s performance compared to its region and the nation for:
- All Available Measures
- Types of Care
- Settings of Care
- Hospital
- Ambulatory
- Nursing Home
- Home Health
- Care by Clinical Area
- Cancer
- Diabetes
- Heart Disease
- Maternal and Child Health
- Respiratory Disease
- Clinical preventive services
The center of the slide contains the image of a semi-circle labeled “Performance Meter: All Measures.” The semi-circle is divided into five even segments of red, orange, yellow, light green, and green with the corresponding labels: very weak, weak, average, strong, and very strong. A dotted arrow is on the left side of the average section and a solid arrow is located at the intersection of the average and strong segments.
Slide 11
State Snapshots: What’s behind each meter?
- A State’s relative performance compared to a group – region or nation
- A subset of NHQR measures (e.g., hospital measures)
- Classify each state’s performance for each measure:
- First, calculate all-state and regional averages
- Then, determine if state is statistically better than average, average, or worse than average
- Score state for results across all NHQR measures in subset
- Each better than average measure = 1 point
- Each average measure = 0.5 point
- Each worse than average = 0 points
- Sum points and divide by the number of measures
In the upper right is the image of the “Performance Meter: All Measures” semi-circle.
Slide 12
State Snapshots: Individual Measures
- Strongest and Weakest Measures for a State compared to all States reporting
- State Rankings for 15 Measures
- Ordinal rank on individual measures of each State’s performance out of 51 States + DC
- Table of all measures for a State and all measures for all States
Slide 13
State Snapshots: Strongest & Weakest Measures This slide contains a screenshot of the NHQR State Snapshots, California’s Strongest Measures web page: http://statesnapshots.s-3.com/snaps07/
strongest_weakest.jsp?menuId=6&state=CA. The top table lists “California’s Strongest Measures” and the bottom table lists “California’s Weakest Measures.”
Slide 14
State Snapshots: State Rankings on Core Measures
This slide contains a screenshot of the NHQR State Snapshots, California 2001 National Healthcare Quality Report, Ranking on Selected Measures web page:
http://statesnapshots.s-3.com/snaps07/staterankings.jsp?menuId=33&state=CA. The table is of reported measures, definitions, all-state average, State rate, and State rankings.
Slide 15
State Snapshots: Focus on Diabetes
- Process of care measures
- Outcome of care measures
- Disparities (by income & race/ethnicity)
- Saving costs (for State government employees)
In the upper right is the image of the “Performance Meter: All Measures” semi-circle.
Slide 16
Snapshot Focus on Diabetes: Disparities
This slide contains a screenshot of the NHQR State Snapshots, California Focus on Diabetes: Disparities in Treatment: By Income web page: http://statesnapshots.s-3.com/snaps07/diabetes.jsp?menuId=27&state=CA&level=12. This screen shot contains a color coded map of the United States entitled “For 2004-2006, the gap in HbA 1 c testing for people with diabetes and low income (under $15,000) compared to high income ($50,000 or more).” California, Utah, Wyoming, Texas, Louisiana, and Mississippi are “Worse than the all-State gap;” Washington, Idaho, Nevada, Montana, Colorado, North Dakota, Kansas, Oklahoma, Missouri, Arkansas, Indiana, Tennessee, Alabama, North Carolina, West Virginia, Maryland, Washington D.C., New Jersey, New York, and New Hampshire are “Similar to the all-State gap;” Alaska, Hawaii, Arizona, New Mexico, Nebraska, South Dakota, Minnesota, Wisconsin, Iowa, Kentucky, Ohio, Florida, Georgia, South Carolina, Virginia, Delaware, Pennsylvania, Rhode Island, Vermont, Maine, and Connecticut are “Better than the all-State gap;” and Oregon, Illinois, and Michigan are “Unknown or data insufficient.”
Slide 17
Snapshots Focus on Diabetes: Lives & $ – State Gov’t Employees
This slide contains a screenshot of the NHQR State Snapshots, California Focus on Diabetes: Lives and Expenses web page: http://statesnapshots.ahrq.gov/snapshots/
diabetes.jsp?menuId=27&state=CA&level=11&page=1.
This screenshot contains a bar graph entitled “2004 Estimated Share of Health Expenditures on State Government Employees that Relates to Diabetes Care, Compared to Pacific States and All States.” There is a red circle around 12.9 above the California bar. Two other red circles contain 30,500 and 219,000,000 in the text box next to the bar graph.
Slide 18
Snapshots Focus on Diabetes: Excess $ – State Gov’t Employees
This slide contains a screenshot of the NHQR State Snapshots, California Focus on Diabetes: Excess Costs Associated with Diabetes for State Government Employees web page: http://statesnapshots.s-3.com/snaps07/
diabetes.jsp?menuID=30&state=CA&level=11&page=2.
A red circle is around $2,900,000 in the text with an “Average Results” heading and another red circle is around $5,100,000 in the text with a “Best Results” heading.
Slide 19
State Snapshots: What’s New for 2007
- State Dashboards
- All of a State’s summary meters
- Focus on Healthy People 2010 Table
- State’s performance on goals
- Focus on Clinical Preventive Services Meter
- State’s performance on recommended services
- Contextual Dials of State’s environment:
- Demographics
- Population health status
- Health care
Slide 20
State Dashboard: Performance Meters all in one Place
This slide contains two screenshots from the NHQR State Snapshots web site:
http://statesnapshots.s-3.com/snaps07/dashboard.jsp?menuId=4&level=0&state=CA; the first shows 5 dashboards under the heading “Types of Care,” and the second shows 5 dashboards under the heading of “Care by Clinical Area.” To the right of the images is the following text: Click meter to view metrics compared to all states.
Slide 21
State Performance on Healthy People 2010 Goals
This slide contains a screenshot of the NHQR State Snapshots, California Focus on Healthy People 2010: State Performance on Measures Reported in the NHQR web page: http://statesnapshots.s-3.com/snaps07/hp2010.jsp?menuId=31&state=CA. The image is of a table with reported measures, rates, and definitions.
Slide 22
State Performance in Clinical Preventive Services
This slide contains a screenshot of the NHQR State Snapshots meter, California What is the Clinical Preventative Services Quality Performance Compared to All States? How Has That Performance Changed? web page:
http://statesnapshots.ahrq.gov/snaps07/
clinical_preventive_services.jsp?menuId=32&state=CA&level=19. The screen shot is of a dashboard labeled “Performance Meter: Clinical Preventative Services” with a solid blue arrow in the very weak segment and a dashed arrow in the average segment.
Slide 23
State Contextual Factors
This slide contains two screenshots from the NHQR State Snapshots, California State Contextual Factors web site:
http://statesnapshots.s-3.com/snaps07/contextual_factors.jsp?menuId=34&state=CA; the first is of Demographics - Percent of State Population containing four dials of various demographic factors and the second is of Health Status - Percent of State Population containing six dials of various risk factors and of health care resources. To the right of the images is the following text: Click dial to view data.
Slide 24
General Questions about Snapshots?
Slide 25
Questions about Snapshots (Workshop, Special Request)
- Can the Snapshots help states set priorities? -- which measures are most important?
- Can Snapshots be redesigned:
- Users define own state-group comparison?
- Data by payer type?
- Data by sub-state geography?
- Could severity adjustments be made for state environments (e.g., LTC patient acuity)?
Slide 26
Snapshots & Priority Setting? -- Yes
- View the dashboard
- Which settings/areas strongest? Which weakest?
- Do the sniff test: Do they confirm what you know about healthcare in your state?
- Examine measures behind the meters to determine:
- What is being measured?
- Are some particularly problematic?
- Vet the results:
- Contact subject area experts in your state
- Convene a group to discuss Snapshot results
- Are current priorities supported? Are new ones apparent?
- Next steps for your State?
- • Let AHRQ know what transpires, esp. data problems
Slide 27
Snapshots Redesign?
- Users define own state-group comparison?
- Complicates design of Web site, considerably
- Need to evaluate feasibility and cost
- One approach: Specify types of comparisons:
- Low-population-density-states comparison
- High-poverty-states comparison
- Magnet-for-tertiary-care-states comparison
- Others?
- Do you have comments on the value of this?
Slide 28
Snapshots Redesign?
- Report data by payer type?
- We think it’s feasible within state only for HCUP:
- HCUP hospital quality indicators by Medicaid, Medicare, Private Insurance, Uninsured
- Need to assess two things:
- Which data sources are all-payer?
- Then recalculate rates by paye
- Then examine cell sizes
- Which single payers (e.g.: Medicare, Medicaid) collect the same indicators?
- Then assess whether enough measures to combine them
- Do you have comments on the value of this?
Slide 29
Snapshots Redesign?
- Report data by sub-state geography?
- Depends on detail in data source:
- HCUP has ZipCode but may not identify hospitals
- BRFSS may report by county in future
- Need to assess:
- Data sets for confidentiality issues
- Meaningful groupings of counties in each state
- Major undertaking
- Do you have comments on the value of this?
Slide 30
Snapshots & Severity Adjustment
- Could severity adjustments be made for state environments (e.g., LTC patient acuity)?
- Suggest data runs to estimate/compare MDS estimates for nursing home patients by acuity level
- Beyond Snapshots
- On severity & NHQR, generally:
- Some NHQR measures incorporate severity-adjustment (e.g., AHRQ hospital quality measures)
- Typically, underlying data or methods not available for severity adjustment
- Need specialized data and research methods
Slide 31
Questions?
Feedback?
Future Technical Assistance Needs?
Slide 32
Additional Resources
NHQR/NHDR Resources:
Contact:
• Margie Shofer, Marjorie.Shofer@ahrq.hhs.gov
Senior Program Analyst, Office of Communications and Knowledge Transfer
For further details about additional follow-on technical assistance:
• http://www.academyhealth.org/ahrq/qualitytools/index.htm.
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