On the side of the title page is a logo for the Utah Department of Health. The logo consists of a green triangle with the profile of a man's, woman's, and child's heads.

Slide 2

Acknowledgement

To those who lead, guide, or support evidence-based policymaking.

On the top right hand corner of the page is a graphic of the cover page of a document from the Utah Department of Health. The document is entitled, “Challenges in Utah 's Health Care, June 2007.”

Slide 3

LEAD the Evidence-based Policymaking

David Sundwall, MD, Exec Director, Utah Department of Health

• A leader in using health data for evidence-based policymaking
• His leadership principle #2 is science-based practice and policy

On the top right hand corner of the slide is a photograph of David Sundwall.

Acknowledgement I

Slide 4

GUIDE the Evidence-based Policymaking

  Clark Hinckley, Robert Huefner, Leslie Francis, Stephen Kroes, and other members of Utah Health Data Committee for their guidance in vision & policy analysis to transform healthcare system.

“We really are at a very exciting point in health care. Several years from now we will look back and see that the health care system that we know today has changed in sort of a revolutionary fashion.”

-Clark B. Hinckley, Chairman, Health Data Committee Summary at the HDC Biennial Retreat, July 11, 2006

Acknowledgement II

In the upper right corner is the logo for Utah Health Data Committee, which is a modified caduceus symbol with “Utah Health Data Committee” on the right side.

Slide 5

STAFF SUPPORT to the Evidence-based Policymaking

  Mike Martin, Lori Brady, Keely Cofrin Allen, Lois Haggard and Barry Nangle in Utah Center for Health Data for their efforts in development and facilitation of discussion and uses of the report

Acknowledgement III

On the lower right hand corner of the page is a graphic of the cover page of a document from the Utah Department of Health. The document is entitled, “Challenges in Utah 's Health Care, June 2007.”

Slide 6

FEDERAL SUPPORT to States' Evidence-based Policymaking

Support from 3 AHRQ Teams

• The HCUP Team
• The National Healthcare Quality Report team
• The AHRQ Public Affairs Office

On the top right hand corner of the slide are the images of the front cover of publication entitled, National Healthcare Quality Report and the HCUP symbol, which is a blue and white circle containing a digitalized tree.

Acknowledgement IV

Slide 7

Background

The slide has two images. One image is of a modified caduceus (symbol often used to represent medicine in the U.S.). Next to this image reads, “Utah Health Data Committee.” The other image is of three overlapping circles, each representing cost, quality, and access.

Slide 8

Utah Health Data Authority Act

26-33a-104

The purpose of the committee is to direct a statewide effort to collect, analyze, and distribute health care data to facilitate the promotion and accessibility of quality and cost-effective health care and also to facilitate interaction among those with concern for health care issues.

In the upper right hand corner of the slide are the overlapping cost-access-quality circles.

Slide 9

Health Data Committee

Purchasers/Business

• Clark Hinckley - Chair, Zions Bancorporation
• Stephen Kroes, Utah Foundation
• Marilyn Tang, Certified Handling Systems

Providers

• Kim Bateman, M.D. Manti Medical Clinic and HealthInsight
• Gail McGuill, R.N. Orem Community Hospital

Public Policy

• Judy Buffmire, Former Legislator
• Robert Huefner – Vice Chair, Univ. of Utah, Political Sciences
• Leslie Francis, Univ. of Utah, Health Ethnics

Patients/Consumers

• Gary Nordoff, Housing for Low Income People
• Terry Haven, Utah Children

Payers and Health Systems

• David Call, Deseret Mutual Benefits Administration
• Douglas Hasbrouck, Regence BC/BS of Utah
• Greg Poulsen, Intermountain Health Care

In the upper right hand corner is the image of the Utah Health Data Committee caduceus.

Slide 10

Health Data Building Blocks for Policy Analysis, 1990-2007

This slide is a pyramid that indicates the health data building blocks for policy analysis from 1990 to 2007.

1990-1993: Established a vision, mission, priority, and health data plan

1993: Established hospital inpatient discharge reporting system

1996: Established ambulatory surgery data reporting system, emergency department data reporting system, HMO HEDIS performance report system, and HMO enrollee satisfaction reporting system.

2001: Use ICD data to support the Patient Safety Initiative.

2002: Evaluate Medicaid Waiver Programs

2004: Health Plan Pharmacy Database

2005: Senate Bill 132: Consumer Reports

2007: House Bill 9: Healthcare cost data (all claims all patients)

To the left of the pyramid is the image of the Utah Health Data Committee caduceus.

Slide 11

Useful Data for State Policymakers

• Big pictures from a state to the nation
• Comparative summary indicators
  • State Ranking
  • Trend
• Cover all settings & types of health care
• Tied to state policy priorities
• Identify new issues
• Simple, short, & pictures

To the right of the bullet points is the Utah Department of Health logo.

Slide 12

Use Case Examples

16 summary indicators in 3 areas.

The slide contains a screenshot of 16 summary indicators. The slide also shows the three cost-access-quality circles.

Slide 13

National-Comparative Data are Useful Sources for Policymakers

16 summary indicators in the report:

• 13 used national data or methods
• 8 – AHRQ
• 2 - CMS Health Care Expenditure Report
• 1 - NCHS Hospital Survey
• 1 - NCQA HEIDS
• 1 - United Health Foundation
• 2 used Utah data and NYU methods (Access)
• 1 used Utah data and method (Rx data)

Slide 14

Utah's Overall Health Care Quality Performance Compared to All States

The slide shows a graphic of a performance meter. On all measures, the meter indicates a rating of strong in 2006.

Source: Page 9, “Challenges in Utah 's Health Care.”

In the upper left hand corner of the slide is the stylized words, “NHQR with HCUP Data.”

Slide Note: Utah is one of the 8 states in the “strong” category.

Slide 15

Quality Variation by Care Type and Setting (NHQR with HCUP Data)

Type Setting:

• Preventive Care – Two stars, On average
• Acute Care – Two stars, On average
• Chronic Care – Three stars, Strong/above average
• Hospital Care – Three stars, Strong/above average
• Nursing Home Care – Two stars, On average
• Home Health Care – Four stars, Very strong/above average

Source: Page 10, “Challenges in Utah 's Health Care.”

Slide Notes: Hospital care is based on HCUP data.

Slide 16

Performance Summary of AHRQ Patient Safety Indicators Utah: 2003-2005 (HCUP)

Compared to states with similar patient populations, Utah performed better than expected on seven indicators: 1) Decubitus ulcer, 2) Failure to rescue, 3) Selected infections due to medical care, 4) postoperative physiologic and metabolic derangement, 5) obstetric injuries – 3 rd or 4 th degree lacerations - vaginal delivery with instrument, 6) obstetric injuries – 3 rd or 4 th degree lacerations – vaginal delivery without instrument, and 7) birth injuries to newborn.

Compared to states with similar patient populations, Utah performed same as expected on five indicators: 1) Postoperative hip fracture rate, 2) Postoperative hemorrhage or hematoma, 3) Postoperative respiratory failure, 4) Postoperative sepsis, 5) Postoperative wound dehiscence

Compared to states with similar patient populations, Utah performed worse than expected on four indicators: 1) Accidental puncture of laceration, 2) Complications of anesthesia, 3) Postoperative pulmonary embolism or deep vein thrombosis, 4) Latrogenic pneumothorax

Not applicable: 1) Obstetric injuries – 3 rd or 4 th degree lacerations Cesarean delivery, 2) Foreign body left during procedure, 3) Death in low DRGs, 4) Transfusion reaction

Source: Page 11, “Challenges in Utah 's Health Care”

Slide 17

Public Reporting Can Reduce Performance Variations

A three-star hospital is one that performed better than expected than their peer hospitals in the nation that treated similar patients.

This slide contains a tale entitled Numbers of three-star hospitals in the consumer reports on obstetric safety: 2004-2005:

Patient Safety Indicator:

Obstetric Injuries, 3rd or 4th Degree Lacerations – Vaginal Delivery With Instrument

In 2004, there were 4 hospitals. In 2006, there were 6 hospitals.

Obstetric Injuries, 3rd or 4th Degree Lacerations – Vaginal Delivery Without Instrument

In 2004, there were 13 hospitals. In 2006, there were 19 hospitals.

Source: Page 12, “Challenges in Utah 's Health Care”.

Slide 18

Increased Hospitalizations by Uninsured Residents in Utah, the U.S. and Select States, 1997-2005.

The slide is a line graph indicating the percentage of emergency department admission for uninsured hospitalized patients. Along the x-axis is year 1997-2005. Along the y-axis is percent of ED admission for uninsured patients. The graph indicates Utah as the lowest percentage, rising gradually from 30% in 1997 to 42% in 2005. Colorado 's rates are relatively flat, around 45%. Arizona is gradually increasing, from 43% in 1997 to 58.5% in 2005. The U.S. rates are the highest, with over 50% in 1997 to 60% in 2005.

Slide 19

Trends of Hospital Charges

This slide contains a line graph indicating the percentage of annual increase in median charges for hospital admission Utah, Arizona, Colorado, Nevada, and the U.S.: 1998-2005. Along the x-axis is the year. Along the y-axis is the percent increase of median hospital charges. The graph shows that the U.S. started in 1989 at 6%, then rose from 2000-2002, and dropped. In 2004, the U.S. had a percentage of 6.8. Arizona started out at approximately 5% in 1989 and has gradually risen to 8.9% in 2005. Utah started out at 6% in 1989 and has gradually risen to 8.5% in 2005. Colorado started at over 6% in 1989 and has risen to 10.4% in 2005. The only data for Nevada is for 2004-2005. In 2004, Nevada was at 15% and dropped to 6.7%.

Slide 20

The slide is a screenshot from HCUPnet. It shows the select outcomes and measures for several discharges and their related costs.

Slide 21

Use Statewide Cost-to-Charge Ratio to Estimate Total Costs (HCUP-T.A.)

The slide is a line graph indicating the increased inpatient total facility charges and costs adjusted by cost-to-charge ratio (CCR) Utah, 1997-2005. Along the x-axis is year, and along the y-axis is dollars, in millions. The graph shows that total facility charges has grown rapidly from 1997-2005. However, when total facility cost is adjusted by CCR, the growth is much smaller.

Source: Page 26, “Challenges in U.S. Health Care.”

Slide 22

New York University Method: Measuring Access to Primary Care Through Emergent Care (Need from HCUPnet)

The bar graph shows the percentage of outpatient emergency department visits for primary care sensitive conditions: Utah, 2001-2005. The x-axis indicates the primary payer, and the y-axis indicates the percent of ED visits for primary care sensitive conditions. For all payers, the percentages in 2005 were higher—although comparable—than in 2001 for the percentage of ED visits.

Medicaid/CHIP
2001: 56
2005: 58

Uninsured
2001: 46
2005: 51

Medicare
2001: 47
2005: 48

State Average
2001: 44
2005: 47

Other
2001: 40
2005: 43

Source: Page 17, “Challenges in Utah 's Health Care.”

Slide 23

New York University 's Classification (Need from HCUPnet)

The slide contains a map indicating hospitalization rates for ambulatory care sensitive conditions by county in Utah, 1996-2005.

The slide is an age-adjusted rates high-low same map. The map shows that most of the counties are higher than the state rate.

Slide 24

CDC NCHS National Estimates from the Hospital Discharge Surveys (Need from HCUPnet)

The slide contains a line graph of the utilization rates of hospital inpatients, outpatient surgeries, or emergency room visits, per 100 population: Utah and U.S. 1999-2005. Along the x-axis is year. Along the y-axis is rate per 100, population. The graph shows relatively no increase or decrease in rates from 1999-2005. While inpatients, outpatient surgeries and U.S. inpatients all hover between 7-12%, ER visits are approximately 22%.

Source: Page 24, “Challenges in Utah 's Health Care”

Slide 25

Utah's Self Rating on Trends of Quality and Patient Safety

This slide contains a table summary of various trends in “Challenges in Utah 's Health Care,” and indicates what page you can find highlighted trends.

Trend: Utah 's overall health care quality was ranked as “Strong” in the 2006
National Healthcare Quality Report: page 9

Trend: Significant quality variations existed among types of care and care settings. Utah 's nursing home care quality was weaker than hospital or home health care: page 10.

Trend: Baseline measures of hospital patient safety are established: page 11.

Trend: Public reporting on quality and safety can reduce performance variations among hospitals: page 12.

Trend: Utah faces huge challenges in promotion of preventive care: page 13.

Source: Page 8, “Challenges in Utah 's Health Care.”

Slide 26

This slide is a screenshot of the Utah Health News page in the Utah Department of Health website. The shot is of an article published June 11, 2007 entitled, “Utah 1 of 8 States Rated ‘Strong' in New Health Care Report.”

UDOH released the report on the same day when AHRQ released the National Quality Report.

Slide 27

State Ranking Dynamics

Commonwealth Fund Health System Report Card (2007), released 06/13/07

The report card shows Utah 's rank on the following measures:

• Access: 38
• Quality: 48
• Avoidable hospital use and cost: 1
• Equity: 42
• Healthy lives: 1

An image of the cover of the Commonwealth Fund's report, “Aiming Higher” is displayed on the page.

Slide 28

Ranking Dynamics (cont.)

• Dr. Sundwall, Exec. Director led the investigation
• Are the indicators comparable?
• Are the methods comparable?
• Are the data comparable?
• What can we learn from the Commonwealth Fund report?
• The Utah Medical Ethics Committee (UMEC) had a rich discussion on August 28, 2007

A photograph of Dr. Sundwall is in the upper right corner of the slide.

Slide 29

UMEC Summary

The distinction between outcome measures and process measures was evident in the various ranking schemes.

The nation seems to be at a point where our measure definitions are standardized but the validity of each specific measure can't be taken for granted.

The Utah Department of Health logo is in the upper right corner.

Slide 30

Take Home Message:

• Interaction between policymakers and analysts is the starting point for evidence-based policymaking
• “Play” with HCUPnet to explore answers for your policy questions
• Ask HCUP for technical assistance, if HCUPnet doesn't have the data you need.

Slide 31

Thank You.

Questions?
Wu Xu
wxu@utah.gov