The slide is blue with a background of an artistic image of the head of a horse. A logo for Kentucky is at the bottom of the slide. The logo consists of the word ' Kentucky ' and beneath it is the phrase, "Unbridled Spirit." On the top of the word, ' Kentucky ' is the artistic image of the horse head.
Slide 1
Trudi Matthews et al.
The presentation uses a template with a blue header and a footer with the Kentucky logo.
A photograph is shown of five men and Trudi Matthews, who stand in front of a banner that reads, " Kentucky e-Health Summit, Mapping the Future"
Slide 2
Kentucky Legislation and Policy
• 2005 law (HB 278): Secretary's Advisory Committee on Transparency
• Transparency: 2006 law (HB 380) on public release of cost and quality data
• Health Care Information Center Website:
-Launched March 2007
-Data on avoidable hospitalizations & inpatient quality
-Consumers can compare KY hospitals on quality
- http://chfs.ky.gov/ohp/healthdata/
Slide 3
A screen shot is shown of the Web page for the Kentucky Cabinet for Health and Family Services. The Web page displayed is about the Health Care Information Center. On the screen shot, the header of the Web page consists of the phrase, " Kentucky, Cabinet for Health and Family Services" and the image of two children walking-each with their arm around the other's shoulder. Along the left rail of the page consists of links on the Website, and in the center of the page is a description of the Health Care Information Center. An image of a female physician with a stethoscope is on the right side of the page.
Slide 4
How did KY Staff use the AHRQ Tools?
• AHRQ Diabetes Guide and Workbook helped direct staff to:
-Look at chronic diseases & focus on diabetes
-Assemble most recent data in formats of the Diabetes Guide
-Be productive in the analysis phase
-Interpret data with better understanding
-Achieve credibility by using national measures and AHRQ methods
Slide 5
Data Sources
The Kentucky CHFS collects:
• UB-92 inpatient records:
-600,000 per year
-All Kentucky hospitals
• Outpatient surgery records:
-Hospital-based
-Some ambulatory surgery centers
• Public Health Data - BRFSS, Vital Statistics, etc.
• Medicaid & State employee claims
To the right of the UB-92 inpatient records and Outpatient surgery records bullet points is a bracket that includes the following points:
• Procedures & Diagnoses
• Volume
• Length of stay
• Charges
• HCUP Partner
Slide 6
Quality Measures
• Non-proprietary consensus-based sources:
-AHRQ: Agency for Healthcare Research and Quality
-CMS: Centers for Medicare and Medicaid Services
-Others (JCAHO, NQF, etc.)
• Measures being used now:
-Prevention Quality Indicators
-Inpatient Quality Indicators
-Patient Safety Indicators
- CMS Hospital Compare
To the right of the "measures being used now and its sub-bullets is a bracket that reads, "AHRQ Quality Indicators."
Slide 7
Kentucky and Health Status
• Kentucky: among worst health outcomes in US:
-2nd highest death and disability rates
-6th highest obesity prevalence
• Diabetes:
-7th highest adult diabetes prevalence
-Some Eastern counties nearly double national diabetes rates
Slide 8
Obtained from Diabetes Guide: KY Compared to Worst/Best-in-Class States
This slide is of a bar graph of the percent of the population with diabetes. Along the x-axis are selected states. Along the y-axis is percent of the population.
- Kentucky is slightly above 5%
- Tennessee is slightly above 6%
- Missouri is at 5%
- Alaska is approximately 2.7%
- Utah is approximately 2.8%
- Colorado is approximately 3.2%
- Minnesota is approximately 3.3%
Slide 9
Obtained from the Diabetes Guide
This slide is of a bar graph of the Estimates of the Direct, Indirect and Total Cost (in billions) of the Burden of Diabetes. Along the x-axis are selected states. Along the y-axis are total costs in billions of dollars.
- Kentucky is slightly below $3,000 total (Approximately $2200 is direct medical costs and approximately $700 is indirect costs).
- Tennessee is slightly below $5,000 total (Approximately $3700 is direct medical costs and $1200 is indirect costs)
- Missouri is at $4,000 total (Approximately $3,000 is direct medical costs and $1000 is indirect costs)
- Alaska is approximately $300 (Approximately $250 is direct medical costs and $50 is indirect costs)
- Utah is approximately $950 (Approximately $850 is direct medical costs and $100 is indirect costs)
- Colorado is approximately $2000 (Approximately $1600 is direct medical costs and $400 is indirect costs)
- Minnesota is approximately $2400 (Approximately $1900 is direct medical costs and $500 is indirect costs).
Slide 10
Estimated Using Ideas from the Diabetes Guide + HCUP data
The slide is a bar graph on hospital admission rates for uncontrolled diabetes in 2006. Along the x-axis is the year and along the y-axis is "Per 10,000 KY residents age 18 and over."
-In 2002 (sample size of 1022), there were 3.3 admissions per 10,000 KY residents,
-In 2003 (sample size 1002), there were 3.2 admissions per 10,000 KY residents,
-In 2004 (sample size 902), there were 2.86 admissions per 10,000 KY residents,
-In 2005, (sample size 851) there were 2.67 admissions per 10,000 KY residents
-In 2006 (sample size 2.71) there were 2.71 admissions per 10,000 KY residents
Slide 11
New Display Using Diabetes Guide Data
The slide is a bar graph of the comparison of hospital admission rates for uncontrolled diabetes for the U.S., KY, and best performing states. Rates are risk-adjusted for age and gender. Along the x-axis are selected states for the years 2002 and 2003. Along the y-axis is "per 100,000 residents age 18 and over."
2002:
USA - 25.4
Kentucky - 32.8
Colorado - 5.3
Oregon - 8.3
Utah - 6.5
Vermont - 6.0
Washington - 7.5
2003:
USA - 23.8
Kentucky - 31.7
Colorado - 5.8
Oregon - 6.4
Utah - 4.2
Vermont - 3.3
Washington - 5.9
Slide 12
Estimated Using Ideas from the Diabetes Guide + HCUP Data
The slide is a bar graph of hospital admission rates for short-term complications of diabetes. Along the x-axis is the year from 2002-2006. Along the y-axis is "per 10,000 KY residents age 18 and over."
2002 (sample size 1887): 6.1
2003 (sample size 2018): 6.4
2004: (sample size 1995): 6.3
2005: (sample size 2092): 6.6
2006: (sample size 1997) 6.2
Slide 13
Estimated Using Ideas from the Diabetes Guide + HCUP Data
The slide is a bar graph of hospital admission rates for long-term complications of diabetes, 2006. Along the x-axis is the year from 2002-2006. Along the y-axis is "Per 10,000 KY residents age 18 and over."
2002 (sample size 3924): 12.7
2003 (sample size 3909): 12.5
2004: (sample size 3882): 12.3
2005: (sample size 3948): 12.4
2006: (sample size 3846) 12.0
Slide 14
New Display Using Diabetes Guide Data
The slide is a bar chart of the comparison of hospital admission rates for short-term complication of diabetes for the U.S., KY, and best performing states. Rates are risk-adjusted for age and gender. Along the x-axis are various states for the years 2002 and 2003. Along the y-axis is "per 100,000 residents age 18 and over."
2002:
USA - 50.9
Kentucky - 61.0
Hawaii - 31.6
Minnesota - 34.0
Nebraska - 36.0
Oregon - 40.4
Vermont - 31.0
Washington, 39.3
2003:
U.S. - 51.1
Kentucky - 64.6
Hawaii - 36.6
Minnesota - 35.8
Nebraska - 38.1
Oregon - 37.8
Vermont - 30.1
Washington, 40.2
Slide 15
New Display Using Diabetes Guide Data
The slide is a bar graph of the comparison of hospital admission rates for long-term complication of diabetes for the U.S., KY, and best-performing states. Rates are risk-adjusted for age and gender. Along the x-axis are selected states for the years 2002 and 2003. Along the y-axis is "per 100,000 residents age 18 and over."
2002:
U.S. - 113.8
Kentucky- 125.9
Colorado - 81.7
Iowa - 78.0
Nebraska - 79.5
Oregon - 74.7
Utah - 71.2
Vermont - 64.0
Washington - 67.2
2003:
U.S. - 115.4
Kentucky- 123.2
Colorado - 69.6
Iowa - 78.6
Nebraska - 69.3
Oregon - 70.2
Utah - 70.3
Vermont - 61.2
Washington - 66.9
Slide 16
County-Level Quality Improvement Data
GIS Mapping: Using HCUP Data & AHRQ Mapping Software
Slide 17
Uncontrolled Diabetes Admission Rate (PQI 14)
Based on Kentucky Hospital Inpatient Discharge Claims
January 1, 2006 to December 31, 2006
The slide is a map of Kentucky, broken down by county. The map is color-coded to reflect the risk-adjusted rates (considering margin of error) of uncontrolled diabetes admission. Ten counties are colored green, indicating that they are "below the national average." In these ten counties includes the cities of Louisville, Frankfort, and Lexington. The bulk of the counties in the state are colored yellow, indicating that the counties are comparable to the national average. A smattering of counties is colored red, indicating that they are above the national average. These counties are located mostly on the eastern side of the state or on the southwestern border.
The national rate per 1000 population (age 18 and over) is 22. The state rate per 1000 population (age 18 and over) is 27.
This data was last revised in May 2007. The source is the Nationwide Inpatient Sample, 2004, AHRQ website, http://www.qualityindicators.ahrq.gov
Slide 18
Diabetes Short-Term Complications Admissions Rate (PQI 1)
Based on Kentucky Hospital Inpatient Discharge Claims
January 1, 2006 to December 31, 2006.
The slide is a map of Kentucky, broken down by county. The map is color-coded to reflect the risk-adjusted rates (considering margin of error) of diabetes short-term complications rate of admission. Seven counties are colored green, indicating that they are "below the national average." The bulk of the counties in the state are colored yellow, indicating that the counties are comparable to the national average. A smattering of counties is colored red, indicating that they are above the national average. These counties are located throughout the state.
The national rate per 1000 population (age 18 and over) is 55. The state rate per 1000 population (age 18 and over) is 63.
This data was last revised in May 2007. The source is the Nationwide Inpatient Sample, 2004, AHRQ website, http://www.qualityindicators.ahrq.gov
Slide 19
Diabetes Long-Term Complications Admission Rate (PQI 3)
Based on Kentucky Hospital Inpatient Discharge Claims
January 1, 2006 to December 31, 2006
The slide is a map of Kentucky, broken down by county. The map is color-coded to reflect the risk-adjusted rates (considering margin of error) of diabetes short-term complications rate of admission. Several counties are colored green, indicating that they are "below the national average," none of which are on the far eastern part of the state. The bulk of the counties in the state are colored yellow, indicating that the counties are comparable to the national average. 15 counties is colored red, indicating that they are above the national average. These counties are located mostly on the eastern part of the state.
The national rate per 1000 population (age 18 and over) is 1.27. The state rate per 1000 population (age 18 and over) is 1.16.
This data was last revised in May 2007. The source is the Nationwide Inpatient Sample, 2004, AHRQ website, http://www.qualityindicators.ahrq.gov
Slide 20
Adult Asthma Admission Rate (PQI 15)
Based on Kentucky Hospital Inpatient Discharge Claims
January 1, 2006 to December 31, 2006
The slide is a map of Kentucky, broken down by county. The map is color-coded to reflect the risk-adjusted rates (considering margin of error) of adult asthma rates of admission. Several counties are colored green, indicating that they are "below the national average," located primarily in the northern part of the state. About half of the counties in the state are colored yellow, indicating that the counties are comparable to the national average. Nearly half of the counties are colored red, indicating that they are above the national average.
The national rate per 1000 population (age 18 and over) is 1.21. The state rate per 1000 population (age 18 and over) is 1.46.
This data was last revised in May 2007. The source is the Nationwide Inpatient Sample, 2004, AHRQ website, http://www.qualityindicators.ahrq.gov
Slide 21
New Display Using Diabetes Guide Data
This slide is a bar graph of the percent of adults in 2001 who received the following: HbA1c testing, a retinal eye examination, a foot examination or a flu vaccination. Along the x-axis are the aforementioned preventive health measures, broken down by the state of Kentucky, the national average, the "best-in class average," and the Healthy People 2010 goal. Along the y-axis is the percentage of adults.
HbA1c Testing
Kentucky: 67%
National Average: 63%
Best-In Class Average: 82%
Healthy People 2010 Goal: 50%
Retinal Eye Examination
Kentucky: 71%
National Average: 67%
Best-In Class Average: 81%
Healthy People 2010 Goal: 75%
Foot Examination
Kentucky: 60%
National Average: 65%
Best-In Class Average: 82%
Healthy People 2010 Goal: 75%
Flu Vaccination
Kentucky: 37%
National Average: 38%
Best-In Class Average: 58%
Flu vaccination and foot examination are indicated as "target areas" on the graph.
The source of the data is the BRFSS & Diabetes Guide.
Slide 22
Conclusion
• Governor committed to transparency efforts
• Transparency (Data & Measurement) is first step to quality improvement
• Diabetes Guide critical tool for how best to present our data
• KY must take more steps to facilitate quality improvement
• The Guides give us credibility in our QI efforts
Slide 23
Contact Information
"I'm sorry I couldn't be with you." -Trudi Matthews
tlmatthews@juno.com
859-333-8067 (cell)
Slide 24
For Policy Discussion Roundtable: States Involved in AHRQ Activities on Asthma
• Learning Partnership - Disparities in Pediatric Asthma
-Pilot testing state-led model: AZ, MD, MI, NJ, OR, RI
-Activities with States:
• Learning institutes
• Planning support
• Technical assistance (e.g., Cultural competency training)
• Specific Examples:
- Michigan Asthma Coalition:
• Trained on asthma disparities; collecting data on children's disparities
• Stimulated asthma ROI calculator -- decision on county program
- Oregon:
• Used GIS mapping to target high prevalence counties to reduce asthma disparities among low-income children (for telemedicine?)
- Rhode Island
• Rhode Island Healthy Homes: Developed assessment tool to identify children with asthma in low-income housing (w/ housing authority) & refer to community health centers and DOH)
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