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On April 28, 2008, Jeff Brady and Rosanna
Coffey presented the AHRQ 2007 State Snapshots on an audio conference. This
is the transcript of the event's presentation.
Part 1 of 2 (files split due to size of full-length recording)
(MP3 File, 25 minutes, 7.3
April 28, 2008
1:00-2:15 PM ET
Part 1 of 2
Operator: Good day, ladies and gentlemen, and welcome to
the AHRQ State Snapshots audio conference. At this time, all participants are
in a listen-only mode. Later, we will conduct a question-and-answer session
and instructions will follow at that time. If anyone should require assistance
during the conference, please press star, then zero on your touchtone telephone.
As a reminder, this conference call is being recorded.
I would now like to introduce your host for today's conference, Ms. Margie
Shofer, from the Agency for Healthcare Research and Quality. Please proceed.
Margie Shofer: Hello, everyone. I'm Margie Shofer in the
Office of Communications and Knowledge Transfer at the Agency for Healthcare
Research and Quality. We're delighted to be hosting this audio conference on
the State Snapshots tool, and hope you find it useful.
This audio conference is the first of three featuring AHRQ tools shared at
workshops we held this past December and January. We see these audio conferences
as a first step in what we hope to be a series of follow-on technical assistance
opportunities. So, if after hearing more about the snapshots today you're interested
in further assistance from AHRQ and using them, please let us know.
So, today we will be showcasing the updated version of the AHRQ State Snapshots
tool, which was released on March 26 of this year. The tool allows you to see
how you compare to other states in the nation as a whole across many quality
indicators. The latest version of this tool uses updated data, includes several
new features which we will be sharing with you today.
We're hosting this audio conference in response to the interest in the State
Snapshots tool expressed by the participants from both workshops. We know that
some of you attended one of the workshops, whereas others may have had less
time to interact with the tool. As such, we'll spend some time reviewing the
basics of the tool, but then we'll jump into a discussion of some recent modifications
to the tool, as well as some specific questions that surfaced during the workshop.
We would appreciate your active participation in this call, as the primary
purpose is to address any questions you might about the tool, collect your
suggestions for future tool enhancements or modifications, and learn how you
envision using the tool and for what purposes.
And, again, related to this last point, we really hope you'll tell us more
about the types of technical assistance that you might need in order to make
full or better use of the State Snapshots tool. That's really a big aim of
The presentation today will be given by Drs. Jeff Brady and Rosanna Coffey.
Jeff Brady is the Acting Director of the U.S. National Healthcare Reports here
at AHRQ. He is an M.D. with a background in primary care and also preventive
medicine and public health, and he oversees the National Healthcare Quality
and Disparities Reports and all derivative products, which include the State
Rosanna Coffey is Vice President of Thomson-Reuters Healthcare, formerly Thomson
Healthcare, which was formerly MedStat. Rosanna and her team support the work
of the National Healthcare Quality and Disparities Reports and have developed
a number of derivative products including the design of the State Snapshots.
She is a Ph.D. economist with 30 years of health services research experience.
The presentation is going to start today with a brief overview and then pause
about halfway through for some quick clarifying questions. The second half
of the presentation will focus on the specific questions raised by state participants
at the recent workshop. And then the operator is going to open the audio conference
up to your questions, ideas and suggestions.
So, without further ado, I am going to hand this over to Jeff.
Jeff Brady: Good afternoon, everybody. There is a slide presentation
that I'm going to work through, and I'll actually refer to the page numbers
of that presentation as I talk, so you can sort of follow along. In the middle
of that presentation I'll be turning it over to Dr. Coffey, and we'll let you
know where we are at that point as well.
As Margie mentioned, this follows the two state workshops that are provided,
at which the State Snapshots was described in more detail there. So, we're
hoping to go beyond that and provide some more information and have a more
in-depth discussion about how we can hopefully improve the tool for you all,
which you really represent a key audience and key users of the report.
So, I'm now on the second slide, slide No. 2, where I'll just quickly talk
about the plan for today. I'm going to briefly overview the larger effort on
which the State Snapshots is based, and that larger effort is the National
Healthcare Quality Report and Disparities Report. So, a brief overview of that.
Then I'll turn it over to Dr. Coffey, where she will go more in-depth into
the State Snapshots tool itself, and focus in particular on some new features
that we've added in 2007. Again, that was released last month, in March.
And then as was already mentioned, we'll have some general questions. And
then there's a section of the presentation just to help guide us where we really
are looking for input from you all on the phone.
So, moving to slide 3 now, the reports, the National Healthcare Quality Report
and Disparities Report really have a particular place within the Agency for
Healthcare Research and Quality that represents not completely the mission
of the agency, but a large part of it.
The mission of AHRQ is to improve the efficiency, effectiveness, quality,
safety and equity of healthcare, and these topics are all addressed in varying
levels of detail in both of the reports. We feel at AHRQ that not only the
agency itself, but the reports have a particular niche which can be described
in a few different ways. One is to develop knowledge through a search. Another
big part of our efforts at AHRQ is to disseminate the evidence that is produced
not only at AHRQ but elsewhere.
And then where the reports play a key role is in measuring quality. There
are some other measurement activities at AHRQ which many of you are well aware.
The scope of the reports themselves is quite broad, and it's really quality
of healthcare at the national level.
And then, finally, and this is an important point, because this is the sort
of aspect of our niche and the reports niche out of which the State Snapshots
grew. We ultimately hope with all of these efforts that we are facilitating
So, moving on to slide 4, the reports were released in early March. Both reports
released on the same day, and these were the fifth year that AHRQ has produced
the reports, and those are available online. The website is later in the presentation.
Moving on to slide No. 5, there are various measures types in the Quality
and Disparities Report. These are just some high level ways in which those
are grouped, by setting of care, different places where care is delivered,
and then as well by stages of care.
And then moving on to slide 6, you can see in a little more detail some of
the content that's included in the reports. This is a representation of the
tables of contents for each report, and you can see how the content compares
for the Quality Report and the Disparities Report, with the Disparities Report
picking up these extra additional topics of "Access to Healthcare" and "Priority
Populations" as a way to organize information about healthcare disparities.
And then the final point I want to make on slide No. 7 is that the reports
themselves and as well the State Snapshots tool are based on really a multitude
of data sources. And this is one way of considering or grouping those different
data sources. We have information that comes out of provider and facility sample
surveys, and you can see examples of those. Many of those come from our sister
agency, the CDC, National Center for Healthcare Statistics, and then you can
see the specific surveys. For example, the National Ambulatory Medical Care
Survey is one.
Other types of data sources are surveillance and vital statistics information.
Again, our sister agency, CDC, supplies a lot of that. But there are others
in the form of NIH and the cancer data that comes from SEER.
Another big group is Population Sample Surveys. This is where much of the
AHRQ data sort of falls in the form of the Medical Expenditure Panel Survey
that AHRQ manages, as well as the CAP Survey. But in addition, some other examples
of data sources.
And then finally organizational data systems and in particular some of note
are the healthcare -- the HCUP Project, and then our other -- another sister
agency, CMS, provides quite a bit of data that falls into this category.
So, with that, I'm going to make sure we save enough time for questions. But
before that, I'm going to turn it over to Dr. Coffey for sort of an overview
of the State Snapshots tool.
Rosanna Coffey: All right. Thank you, Jeff. This is Rosanna
Coffey. On slide 8, you can see, we're going to start talking now about the
State Snapshots. We're going to give you a quick overview of this.
If you're at your computer and you want to take a tour through the Snapshots
while I'm talking, the URL is at the top of this slide. It's http://statesnapshots.ahrq.gov.
So, the State Snapshots are really developed for people like you, state policymakers,
so that you could look at all of the information on healthcare quality that's
been assembled in the Quality Report and the Disparities Report. It's a state-by-state
view, and you will find in there summary performance measures. And for every
one of these summary measures, which is a different dimension of healthcare,
you can click on usually a meter and you'll find the individual measures that
lie behind the summary measure.
There are also focus areas, clinical issues, that are particular focus areas.
And this year we've added some information about the context of your state
environment in which the results on quality occur. And, as always, we have
detailed methods and some interpretation guides.
So, if you're in the website and you can get to the State Selection Map, which
is a link on the homepage, and you see a map like this one that I have on the
screenshot, just click on a state you're interested in and it will take you
to some of the measures. And you'll be able to follow along in this left-hand
menu for the areas that I'm going to talk about.
So, on slide 9, before we actually go into those left menu items, I thought
I'd give you a little bit of an idea about how the snapshots have already been
used. And for those of you at the workshop, you heard about Arkansas Center
for Health Improvement. They really took the opportunity of the State Snapshots
to get a view of their state. They pulled together stakeholders and all united
behind the view that things were as bad as they thought they were for their
particular state. And this information allowed them to jumpstart quality improvement.
In fact, their Employee Benefits Division used the metrics and some of the
analyses out of the State Snapshots to look at their own data for state government
employees in Arkansas.
Maine has taken a different approach in using the State Snapshot. They tacked
onto the information technology and wanted the same look and feel for their
own project on hospital transparency. And they asked AHRQ for the information
program -- or the technology program behind the Snapshots, and AHRQ provided
those -- asked us to provide those, which we did. And then they decided they
would like us to help them develop. So, we went off into a slightly different
direction. We had different kinds of methodological problems, but was very
exciting and fun working with Maine on this particular application on the State
And the last two items here are newspaper articles that came out after this
most recent release of the Snapshots. One in Florida on discussing why Florida
's hospital rates were so much lower than the norm. And that was interesting
to hear people around -- to read about people around the states viewing their
own measures. And also the AP wire service looked at the big huge decline in
physical restraints used in nursing homes, and did a piece on that.
Slide 10 is the first sort of layout of all of the information in the State
Snapshots. This meter is a tool that we use visually for all of this different
dimension. So, the dimensions here, the types of care, the settings of care,
and the care by clinical area each have one of these meters. And the meter
is a relative kind of performance. It tells about your state compared to the
nation, or compared to the region, and it gives you a previous and a baseline,
dash line, and a solid line current information.
On slide 11, I have laid out a little bit more information about what's behind
each meter. We have detailed information and the methods that you can go to
read all of this. But to give you an overview, to develop one of these meters,
we take a subset of the NHQR measures. So, if we're doing the hospital setting,
we'll take all of the hospital measures. We'll classify each state's performance
on each of those hospital measures.
First, we'll calculate the all state or the regional average, and then we'll
determine if a state is statistically better than average, average, or worse
than average compared to that group. And for every measure in the subset, we'll
give the state a score. If that measure is better than average, it gets one
point; if it's average it gets a half a point; and if it's worse than average,
it gets no points. You sum up those points and divide by the number of measures.
So, in effect, when you have a needle that's way over in the very strong range,
that says that all or nearly all of your measures are above average. If that
needle is in the very weak range, it says that all or nearly all of your measures
are below average. So, that's the concept.
Slide 12, now it talks about the individual measures. So, if you click on
any meter, you'll be taken directly to a list of measures that are behind that
meter. And in addition, we have some other layouts of individual measures.
The first one listed there, there are five strongest and five weakest measures
for each state compared to all states reporting. And we also have a state ranking
table. I'm going to show you those two.
The last one I'm not going to show to you, but you need to know about it.
Because if you want to have something done differently, you want to look at
different measures and combine them together, or you want to do a totally separate
analysis with some of your own data, you need to know that all the measures
for all the states are in a big huge, humongous table that you could give to
an analyst and have them -- tell them where it is and they can download the
information and analyze it themselves in whatever way they want to analyze
Slide 13 is just a screenshot for California. We selected to do the screenshot.
It's the five strongest and five weakest measures. You've got a short name,
you've got the longer names. It's much more descriptive, and it tells you which
direction that measure is better, whether it's the highest measure is the best
or the lowest measure is the best.
The next slide 14 looks at the ranking on selected measures that go across
the states, and here we have the short name, long name, and again this time
we have the all state average, the state rate that you're looking at -- in
this case, it's California -- and then the rank of that state on that measure.
This was something that was put together in our first snapshot to get some
media attention. Okay.
Slide 15, now we're turning to some of the clinical information. And while
most of the clinical areas that we have information on are these meters, this
particular one goes into more depth.
So, we have process of care measures that are in a meter format. We have outcomes
of care measures, which are bar charts of avoidable hospitalization. And we
have disparities by income and race and ethnicity that come out of the Disparities
Report with some additional analysis. And we have some cost savings for state
government employees. So, I'm going to jump to the latter two and show you
the screen shots on those.
This map for California, this is an old map, actually. We didn't have the
updates in the State Snapshots website at the time we prepared these slides.
So, when you click on that, you're going to see a different configuration of
color. But let me explain what these are.
These represent the gap between the high and low income groups in different
states compared to the gap for all states. So, if your state is red, it's saying
that your gap between high and low income for HbA1c testing is worse than the
gap between high and low income across U.S. in general.
And if you're green, you're better, you have a narrower gap, and if you're
yellow, it's at the average of the whole U.S. The white states are those for
which we don't have data or the data were insufficient.
Okay. Then on slide 17, we're looking at a configuration where we try to estimate
for state government employees the share of the state's health expenditures
that go -- on state government employees that go towards diabetes care. And
this compares to the region as well as to all states. And those red circles
that I have here on the screen shots are where we have estimated expenses of
dollars that are spent.
This particular information and also the next slide, which is slide 18, comes
out of work that was done for AHRQ using a return on investment calculator
on diabetes. It was developed by the Lewin Group, and these estimates are new
estimates this year because they have revised their calculator, somewhat lower
than they were before. And you will -- if you go to the Excess Cost of Diabetes
on the left-hand menu under "Focus on Diabetes," and scroll down.
I can't do it here with this screen shot, but you can. You'll see all of the
caveats about whether you like really experience these savings and what they
Okay. And slide 19, this is just a summary of the new features of the State
Snapshots. We have now, because of state -- what were they -- they were state
work groups that Academy of Health put together to evaluate the Snapshots.
They said, "Gee, can't we have all of these meters in one place? So, we've
done a dashboard and that's on the left-hand menu pretty close to the top.
And so you'll be able to see, once you understand what this meter is, you can
read this. You'll see everything in one place.
We've also added two clinical sort of state performance goals. One comes out
of Healthy People 2010, and the other out of Clinical Preventive Services Task
Force. And then finally these contextual dials. I'm going to show you the dashboard.
Here's the slide 20 is sort of a little bit of a snippet of the dashboard.
Slide 21 is the focus on Healthy People 2010. And this is just in a table
format, so you can look and see your information compared to those targets,
both for the most recent year in the baseline.
And then on slide 22, we have the Clinical Preventive Services measures, and
a state's performance on just those measures. This one we did do in a meter
format the same kind of methodology that I talked about before.
And then slide 23 shows the state contextual factors, and these are simply
-- usually percents. We look at demographics, health status and resources in
the state, and the needle is your state's values, whatever state you're looking
at. And each range is the range across all the states. So, it gives you a sense
of where you lie compared to all the other states. And it's important to understand
that states have different kinds of circumstances and populations and resources,
and that does certainly affect what we'd expect to see in quality of healthcare.
So, that is a quick overview. We could open the lines now and take any quick
clarifying questions before we go into some specific questions that we've had.
Operator: Thank you. Ladies and gentlemen, if you have a
question at this time, please press the 1 key on your touchtone telephone.
If your question has been answered or if you wish to remove yourself from the
queue, please press the pound key.
Rosanna Coffey: Okay. I see a question from Tom Dyeson, Washington
Tim Dyeson: Yes. This is Tim Dyeson from Washington State.
Rosanna Coffey: Yes, sorry, Tim.
Tim Dyeson: How are you separating out state government employees?
Rosanna Coffey: On the diabetes, it's only on that diabetes
focus, where we're looking at the lives and expenses. We got state government
employees out of a -- I have to go back and look at the actual source on that,
but we've got it from a standard national source. Is that what you mean?
Tim Dyeson: Well, I would have been more likely the one to
complete for the State of Washington, so I'm just trying to figure out if --
did I give you that or not?
Rosanna Coffey: No, we didn't actually go to states for this
information. It is -- you would have provided it through the some association
of budget officers. Are you familiar with that?
Tim Dyeson: Yes. Yes.
Rosanna Coffey: I'm sorry I don't have all the details at
my fingertips, but that's where it came from.
Tim Dyeson: That's right, okay.
Rosanna Coffey: And then that goes into this calculator that
I was talking about that the Lewin Group developed.
Tim Dyeson: Okay, gotcha. Thank you.
Operator: Again, if you have a question at this time, please
press the 1 key on your touchtone telephone.
Rosanna Coffey: Okay, I don't see anymore questions.
Operator: There are no further questions at this time.
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