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State Snapshots: State-based Information from the National Healthcare Quality Report
Jeffrey Brady, MD, MPH
Center for Quality Improvement and Patient Safety (CQuIPS)

State Healthcare Quality Improvement Workshop: Tools You Can Use to Make a Difference
December 6 and 7, 2007
Philadelphia, PA | Park Hyatt Hotel

On the top of the slide are the logos for the Department of Health & Human Services and the AHRQ logo. 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

Outline

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.

  • AHRQ Mission and the
    • National Healthcare Quality Report (NHQR)
    • National Healthcare Disparities Report (NHDR)
  • NHQR/NHDR – Background
  • Translating Data Into Change
  • A State-led Model for Action
  • State Snapshots 2006

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 bracket stretching from Developing knowledge through research to Measuring quality points to the cover images of the 2006 National Healthcare Quality Report and the 2006 National Healthcare Disparities Report.

Slide 4

Origin of the NHQR / NHDR

Mandated by Congress in Healthcare Research and Quality Act (PL. 106-129)

  • “Beginning in fiscal year 2003, the Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of health care provided to the American people.”
  • To track “prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations”

To the right of the text is a picture of the dome of the Capitol building.

Slide 5

2006 National Healthcare Quality and Disparities Reports

This slide has the cover images of the 2006 National Healthcare Quality Report and the 2006 National Healthcare Disparities Report. A white box in the upper right contains the following text: Released Jan 11, 2007

Slide 6

Why Are These Reports Useful?

  • A national overview of healthcare quality
    • 42 core (211 total) measures of quality in NHQR
    • Reveal “biggest gaps”
  • A map with information about healthcare quality in key areas
  • A compass on where we are headed
    • National and State trends from 1994 forward
  • A beacon for measure alignment across public and private quality initiatives

Slide 7

How the NHQR and NHDR Are Related

The body of this slide has a table with two columns.

The column on the left is labeled NHQR and lists: Quality of health care in America; Quality; Effectiveness, Patient Safety, Timeliness, Patient Centeredness; Variation across time & States.

The column on the right is labeled NHDR and lists: Disparities in health care in America; Quality + Access; …+ Equity; Variation across time & populations.

Slide 8

Measure Types 2006 NHQR / NHDR

  • All Measures (NHQR-211; NHDR- 250)
  • Core Measures (NHQR- 42; NHDR- 22)
  • Composite Measures (13)
  • Alternating Measures
    e.g., Breast Cancer, 2005 & Colon Cancer, 2006 (screening & mortality)
  • Process & Outcome Measures

Slide 9

Measure Types 2006 NHQR / NHDR (cont'd)

Setting of Care

  • Hospital
  • Ambulatory
  • Nursing Home/Home Health

Stages of Care

  1. Staying healthy
  2. Getting better
  3. Living with illness or disability
  4. Coping with the end of life

Slide 10

Content and Organization 2006 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. The green bracket, labeled NHQR, stretches from Effectiveness to Patient Centeredness. The orange bracket stretches across all bullet points (from Effectiveness to Priority Populations) and is labeled NHDR.

Slide 11

Data Sources

The cover images of the 2006 National Healthcare Quality Report and the 2006 National Healthcare Disparities Report are located in the center of the slide. There are four text boxes 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 12

NHQR & NHDR Not Enough

  • Books “on a shelf” do not make change happen
  • “National” policymakers not only audience
  • Practice variation across States – important message
  • NHQR data for States spread across many tables
    • Tedious to access
    • Difficult to summarize

Slide 13

A State-led Framework for Quality Improvement: Why?

  • States can play a strategic role -- designing, leading, and assessing
  • Existing models focus on providers
  • A state-focused model lays out:
    • A leadership role
    • Steps

A light blue bracket stretches from A leadership role to Steps and is labeled for State action.

Slide 14

The State-led Framework

This slide has an image of three concentric circles, which are divided into thirds. The image shows that the strategy for quality improvement rests on planning, doing, and assessing.

The process is as follows:

  • Provide leadership to create a vision
  • Work in partnership with key stakeholders
  • Implement improvement by leading partners to create interventions and assess impact

Slide 15

NHQR/DR Derivative Products for State-led Quality Improvement

State Snapshots from the:

  • 2004 NHQR – Print-format on Web for each State
  • 2005 NHQR – Interactive-format on Web for each State
  • 2006 NHQR/NHDR – Refinements (e.g., full content PDF)
  • http://statesnapshots.ahrq.gov

Diabetes Care Quality Improvement: Guide & Workbook
http://www.ahrq.gov/qual/diabqualoc.htm

Asthma Care Quality Improvement: Guide & Workbook
http://www.ahrq.gov/qual/asthmaqual.htm

Asthma Care Return on Investment Calculator
Ask Jeff Brady (AHRQ) or Ginger Carls (TH)

There is a red arrow next to “2006 NHQR/NHDR – Refinements (e.g., full content PDF)”

Slide 16

The State Snapshots

  • Online State-by-State data from the NHQR and NHDR:
    • Composite measures
    • Individual measures
    • Focus on managing diabetes

To the right of the text is a screenshot of the State Snapshots tool at: http://statesnapshots.ahrq.gov/statesnapshots/
strongest_weakest.jsp?menuId=4&state.

Slide 17

State Snapshots: Composite Measures

Summary measures – A State's performance compared to their region and the nation for:

  • All Available Measures
  • Types of Care
    • Preventive
    • Acute
    • Chronic
  • Settings of Care
    • Hospital
    • Ambulatory
    • Nursing Home
    • Home Health

To the right of the text is an 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 18

Composite Measures: State compared to Region or Nation

This slide contains two screenshots of the State Snapshots tool. There is a red circle around “All” on the left screenshot and “Pacific” on the right screenshot.

Slide 19

State Snapshots: Individual Measures

  • Five 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 20

State Snapshots: 5 Strongest & Weakest Measures

This slide contains a screenshot of the State Snapshots tool entitled California Strongest and Weakest Measures:
http://statesnapshots.ahrq.gov/stateshapshots/
strongest_weakest.jsp?menuId=4&state=CA.

Slide 21

State Snapshots: Individual Measures

This slide contains a screenshot of the State Snapshots tool entitled California 2006 National Healthcare Quality Report Ranking on Selected Measures:
http://statesnapshots.ahrq.gov/stateshapshots/
staterankings.jsp?menuId=29&state=CA.

Slide 22

State Snapshots: Focus on Diabetes

  • Process of care measures
  • Outcome of care measures
  • Disparities (by income & race/ethnicity)
  • Saving costs (for State government employees)

A picture of the aforementioned performance meter is located right of the to the top two bullet points.

Slide 23

Snapshot Focus on Diabetes: Disparities

This slide contains a screenshot of the State Snapshots tool entitled California Focus on Diabetes: Disparities in Treatment: By Income:
http://statesnapshots.ahrq.gov/stateshapshots/
diabetes.jsp?menuId=25&state=CA&level=12.

Slide 24

Snapshots Focus on Diabetes: Lives & $s – State Govt Employees

This slide contains a screen shot of the State Snapshots tool entitled California Focus on Diabetes: Lives and Expenses. There are three red circles around 12.9, $219,000,000 and 30,500 from left to right.
http://statesnapshots.ahrq.gov/stateshapshots/
diabetes.jsp?menuId=27&state=CA&level=11&page=1.

Slide 25

Snapshots Focus on Diabetes: Excess $s – State Govt Employees

This slide contains a screen shot of the State Snapshots tool entitled California Focus on Diabetes: Excess Costs Associated with Diabetes for State Government Employees. There are two red circles around $3,600,000 and $8,200,000 on the screenshot.

http://statesnapshots.ahrq.gov/stateshapshots/
diabetes.jsp?menuId=28&state=CA&level=11&page=2.

Slide 26

AHRQ State Snapshots & Commonwealth Fund State Scorecard

There are two columns on this slide. The left column is entitled AHRQ State Snapshots and contains the following:

  • State Summary
  • Strongest and Weakest Measures
  • Types of Care
    • Preventive
    • Acute
    • Chronic
  • Settings of Care
    • Hospital
    • Ambulatory
    • Nursing Home
    • Home Health
  • Care by Clinical Area
    • Cancer
    • Diabetes
    • Heart Disease
    • Maternal and Child Health
    • Respiratory Diseases
  • Focus on Diabetes
  • The right column is entitled CF State Scorecard and contains the following:
    • Overall
    • Access
    • Quality
  • Preventive Care (age 50+)
  • Avoidable Hospital Use & Costs
  • Equity
  • Healthy Lives

Slide 27

AHRQ State Snapshots & Commonwealth Fund State Scorecard

This table has two columns from left to right: AHRQ State Snapshots and Commonwealth Fund State Scorecard. The table has five rows, from top to bottom: Content, Trends, Comparisons: National, Regional, and State Ranking.

AHRQ State Snapshots
Content: 129 measures
Trends: Performance Meter Most Recent + Baseline
Comparisons: Includes National and Regional.
State Ranking: Top 5 states for 13 composites; All states for 15 individual measures

Commonwealth Fund State Scorecard
Content: 32 measures
Trends: Point in Time
Comparisons: Includes National
State Ranking: All states for 6 composites; All states for 32 individual measures

Slide 28

State Snapshots

http://statesnapshots.ahrq.gov

This slide contains an image of the State Snapshots tool on the left and the multi-colored semicircle entitled Performance Meter: All Measures on the right.

Slide 29

NHQR/NHDR Resources

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