2009 State Snapshots

1. 2009 State Snapshots Tuesday, August 10, 2010 2:30-4:00 pm EDT

2. Plan for Today’s Web Conference • Background: NHQR/NHDR • Development and content • Role in quality improvement • State Snapshots • Role in quality improvement • Overview and methods • Demonstration of Web site (http://statesnapshots.ahrq.gov/) • Questions and Comments • One State’s Use of State Snapshots -- Wisconsin • Questions and Comments

3. Today’s Presenters • Overview of State Snapshots • Ernie Moy, MD, MPH, AHRQ • Rosanna Coffey, PhD, Thomson Reuters • Wisconsin State Example of Use • Judith Nugent, MPA, Wisconsin Department of Health Services

4. National Healthcare Quality and Disparities Report: State Snapshots Tool

5. AHRQ Mission and Niche • Mission: Improve the efficiency, effectiveness, quality, safety, and equity of health care • Niche: • Develop knowledge through research • Disseminate evidence • Measure quality • Facilitate change

6. Origins of NHQR & NHDR • Health and Human Services Secretary required to submit annual report to Congress: • NHQR: National Healthcare Quality Report—national trends in health care quality • NHDR: National Healthcare Disparities Report—disparities in health care delivery • Racial and socioeconomic groups • Other priority populations • First reports released in 2003. Mandated by Congress in Healthcare Research and Quality Act (PL. 106-129)

7. Reporting Assumptions & Tradeoffs • Assumptions • 1º Audience: Policymakers; NOT direct quality improvement • 1º Use: Tracking; NOT public reporting, P4P • 1º Analytic Unit: Area; NOT individual provider • Measurement Implications • Broad & Shallow > Narrow & Deep • Consensus > Cutting Edge • Composite > Granular • Reporting Implications • Analysis: Simple > Complex • Examples: Typical > Exceptional • Products: Family > One

8. NHQR & NHDR Organization • Effectiveness • Cancer • Diabetes • End Stage Renal Disease (ESRD) • Heart Disease • HIV & AIDS • Maternal and Child Health • Mental Health & Substance Abuse • Lifestyle Modification • Functional Status Preservation & Rehabilitation • Supportive & Palliative Care • Patient Safety • Timeliness • Patient Centeredness • Efficiency • Access to Health Care • Priority Populations NHQR NHDR

9. Track 250 Measures From ~40 Databases • Survey data collected from populations (N=11) • AHRQ, Medical Expenditure Panel Survey (MEPS) • CDC-NCHS, National Health Interview Survey (NHIS) • CMS, Medicare Current Beneficiary Survey (MCBS) • SAMHSA, National Survey of Drug Use and Health (NSDUH) • Data collected from samples of health care facilities (N=8) • American Cancer Society-American College of Surgeons, National Cancer Data Base (NCDB) • CDC-NCHS, National Ambulatory Medical Care Survey (NAMCS) • CMS, End-Stage Renal Disease Clinical Performance Measurement Program • Data extracted from data systems of health care organizations (N=13) • AHRQ, Healthcare Cost and Utilization Project State Inpatient Databases (HCUP SID) • CMS, Quality Improvement Organization (QIO) program • Indian Health Service, National Patient Information Reporting System (NPIRS) • NIH, United States Renal Data System (USRDS) • Data from surveillance and vital statistics systems (N=5) • CDC-National Center for HIV, STD, and TB Prevention, HIV/AIDS Surveillance System • CDC-NCHS, National Vital Statistics System (NVSS) • NIH-National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) program

10. Companionship Between NHQR & NHDR

11. 2009 NHQR Preliminary Findings • Quality is improving • But the pace is slow, especially for: • Preventive care • Chronic disease management

12. 2009 NHQR Preliminary Findings • Some areas merit urgent attention: • Patient safety • Health care-associated infections

13. 2009 NHDR Preliminary Findings • Disparities are common and not improving

14. Reports ≠ Better Health Care How? Better Health Care 14

15. Using QRDR To Facilitate Change • Raise awareness • Standardize measures & methods • Target action • Benchmark against best performers State Snapshots

16. State Snapshots Web tool for State policymakers to view NHQR/NHDR health care quality, State-by-State: • Summary performance meters • Individual measures • Focus areas: • Clinical • Disparities • Payers • State context • User guides http://statesnapshots.ahrq.gov

17. State Snapshots Performance Meters • Summarize related State-level measures • With a statistical comparison— State estimates to all-State or regional estimates • Performance meter score method: • Denominator: Total number of measures included • Numerator: Number of measures that State is performing better + ½ times the number of measures that the State is performing similarly • Example: • Out of 60 measures: 30 are better, 20 are equal, and 10 are worse than the comparison group • Meter score would be: 67 = 100*(30 + ½*20)/60 = 100*40/60 • Range of values (0 – 100): • Very weak (0-19), Weak (20-39), Average (40-59), Strong (60-79), Very Strong (80-100)

18. State SnapshotsPerformance Meters • Overall Health Care Quality: All Available Measures • Type of Care • Preventive • Acute • Chronic • Setting of Care • Hospital • Ambulatory • Nursing Home • Home Health • Clinical Area • Cancer • Diabetes • Heart Disease • Maternal and Child Health • Respiratory Disease • Focus On • Clinical Preventive Services • Diabetes and Asthma • Healthy People 2010 • Disparities • Payers • Variation • New in 2009 Snapshots

19. 2009 State Snapshots Web Site Demonstration August 10, 2010

20. Demo of Web Site Google: ‘NHQR State Snapshots’ OR URL: http://statesnapshots.ahrq.gov/

21. State Snapshots Home Page

22. Select a State: ND

23. State Dashboard

24. Overall Health Care Quality: Performance Meter

25. Overall Health Care Quality: Data Tables

26. Strongest and Weakest Measures

27. Types of Care: Preventive Care

28. Additional Resources

29. Settings of Care: Hospital Care

30. Care by Clinical Area: Cancer

31. Select a State: FL

32. Focus on Diabetes:Prevalence

33. Focus on Asthma:Quality Improvement

34. Focus on Healthy People 2010

35. Focus on Clinical Preventive Services

36. Focus on Disparities: All Races

37. Focus on Disparities: Blacks (Non-Hispanic)

38. Focus on Payer

39. Focus on Payer: All Payers

40. Focus on Payer: Privately Insured

41. Focus on Payer: Medicaid

42. Focus on Variation Over Time: Adult Graphs

43. Focus on Variation Over Time: Adult Data Table

44. Focus on Variation Over Time: Adult Acute All States

45. Contact Information • If you have questions about the Web conference OR follow-on technical assistance opportunities, please submit them to the State Quality Tools e-mail address: quality_tools@ahrq.hhs.gov • You can view the 2009 State Snapshots at http://statesnapshots.ahrq.gov/snaps09/index.jsp. • Thank you for joining us!