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Utah State Case Study

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On January 17, 2008, Keely Cofrin Allen gave a presentation at the State Healthcare Quality Improvement Workshop, which outlined how the Utah Department of Health integrated HCUPnet into their health care quality improvement efforts. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® file, 1.5 MB; PDF File, 980 KB; PDF Help).

Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31


Slide 1: HCUPnet for State Policymakers - Utah's Use Case

Keely Cofrin Allen, Ph.D.
Office of Health Care Statistics
Utah Department of Health
AHRQ State Quality Improvement Workshop
January 17-18, 2008

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.

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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."

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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

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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 often used to represent medicine in the U.S.) with "Utah Health Data Committee" on the right side.

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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."

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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 the National Healthcare Quality Report and the HCUP symbol, which is a blue and white circle containing a digitalized tree.

Acknowledgement IV

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Slide 7: Background

The slide has two images. One image is of a modified caduceus. Next to this image reads, "Utah Health Data Committee." The other image is of three overlapping circles, each representing cost, quality/patient safety, and access.

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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.

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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 Ethics

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.

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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
1996: Established Emergency Department Data Reporting System
1996: Established HMO HEDIS Performance Report System
1996: Established 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.

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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.

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Slide 12: Use Case Examples

The slide has an image of page 3 of Challenges of Utah's Health Care: 2007.. The slide also shows the three cost-access-quality circles above the following text: 16 summary indicators in 3 areas.

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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 HEDIS*
    • 1 - United Health Foundation
  • 2 used Utah data and NYU methods* (Access)
  • 1 used Utah data and method* (Rx data)

* Could be available through HCUPnet in the future.

At the bottom left of the bullet points is the Utah Department of Health logo.

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Slide 14: NHQR with HCUP Data

The slide contains Utah's Overall Health Care Quality Performance Compared to All States, which is a graphic of a performance meter. On all measures, the meter indicates a rating of strong in 2006.

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

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

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Slide 15: Quality Variation by Care Type and Setting (NHQR with HCUP Data)

 

Type Setting Quality Variation
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

At the bottom left of the bullet points is the Utah Department of Health logo.

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

Slide Notes: Hospital care is based on HCUP data.

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Slide 16: Performance Summary of AHRQ Patient Safety Indicators: Utah: 2003-2005 (HCUP)

 

Compared to States with Similar Patient Population Number of Indicators Indicator Label
(3 Stars)
Better than expected
7 Decubitus Ulcer; Failure to Rescue; Selected Infections Due to Medical Care; Postoperative Physiologic & Metabolic Derangement; Obstetric Injuries, 3rd or 4th Degree Lacerations - Vaginal Delivery With Instrument; Obstetric Injuries, 3rd or 4th Degree Lacerations - Vaginal Delivery Without Instrument; Birth Injuries to Newborn
(2 Stars)
Same as expected
5 Postoperative Hip Fracture Rate; Postoperative Hemorrhage or Hematoma ; Postoperative Respiratory Failure; Postoperative Sepsis; Postoperative Wound Dehiscence
(1 Star)
Worse than expected
4 Accidental Puncture or Laceration; Complications of Anesthesia; Postoperative Pulmonary Embolism or Deep Vein Thrombosis; Iatrogenic Pneumothorax
Not Applicable (Too few cases) 4 Obstetric Injuries, 3rd or 4th Degree Lacerations Cesarean Delivery; Foreign Body Left During Procedure; Death in Low-Mortality DRGs; Transfusion Reaction

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

At the top right is the Utah Department of Health logo.

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Slide 17: Public Reporting Can Reduce Performance Variations (HCUP)

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

Numbers of three-star hospitals in the consumer reports on obstetric safety: 2004-2005:

Patient Safety Indicator 2004 2005
Obstetric Injuries, 3rd or 4th Degree Lacerations - Vaginal Delivery With Instrument 4 hospitals 6 hospitals
Obstetric Injuries, 3rd or 4th Degree Lacerations - Vaginal Delivery Without Instrument 13 hospitals 19 hospitals

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

At the top right of slide is the Utah Department of Health logo.

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Slide 18: Increased Hospitalizations by Uninsured Residents in Utah, the U.S. and Select States, 1997-2005 (HCUPnet)

The slide contains a line graph indicating the percentage of emergency department admissions for uninsured hospitalized patients. Along the x-axis is year 1997-2005. Along the y-axis is % 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. Nevada had data for 2001 to 2005, showing a decrease from 60% to 48%.

Source: Page 16, "Challenges in Utah's Health Care".

At the bottom left of slide is the Utah Department of Health logo.

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Slide 19: Trends of Hospital Charges (HCUPnet)

The slide contains a line graph indicating the percentage of annual increase in median charges for hospital admissions: Utah, Arizona, Colorado, Nevada, and the U.S.: 1998-2005. Along the x-axis is the year. Along the y-axis is the % increase of median hospital charges. The graph shows that the U.S. started in 1998 at 6%, then rose from 2000-2002, and dropped. In 2004, the U.S. had a percentage of 6.8. Arizona started out at in 1998 at approximately 5% and gradually rose to about 11% in 2004, then dropped to 8.9% in 2005. Utah started out at 6% in 1998, dropped to 4 % in 2000, gradually rose to 10% in 2003, and fell to 8.5% in 2005. Colorado started at over 6% in 1998 and rose to 10.4% in 2005. The only data for Nevada are for 2003-2005. In 2003, Nevada was at 15% and dropped to 6.7%.

Source: Page 23, "Challenges in Utah's Health Care".

At the bottom left of slide is the Utah Department of Health logo.

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Slide 20: Related Costs

The slide is a screenshot from HCUPnet. It is the screen on which the user selects outcomes and measures for number of discharges and their related costs.

Slide Note: Costs - Total charges were converted to costs using cost-to-charge ratios based on hospital accounting reports from the Center for Medicare and Medicaid Services (CMS).

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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 grew rapidly from 1997-2005, more than doubling, from about $1.7 billion to about $3.5 billion. However, when total facility cost is adjusted by CCR, the growth is much smaller, from $974 million to about $1.7 billion.

Source: Page 26, "Challenges in Utah's Health Care".

At the bottom left of slide is the Utah Department of Health logo.

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Slide 22: New York University Method: Measuring Access to Primary Care Through Emergent Care (Need from HCUPnet)

The slide contains a bar graph, which 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 % ED visits for primary care sensitive conditions.

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."

At the bottom left of slide is the Utah Department of Health logo.

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Slide 23: New York University's Classification (Need from HCUPnet)

The slide contains a map denoting 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 the same as or lower than the state rate.

Source: Page 18, "Challenges in Utah's Health Care."

At the bottom left of slide is the Utah Department of Health logo.

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Slide 24: CDC NCHS National Estimates from the Hospital Discharge Surveys (Need from HCUPnet)

The slide shows 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".

At the top right of slide is the Utah Department of Health logo.

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Slide 25: Utah's Self Rating on Trends of Quality and Patient Safety

 

Trend Highlights Page
Arrow icon pointing right Utah's overall health care quality was ranked as "Strong" in the 2006 National Healthcare Quality Report. 9
Arrow icon pointing down 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. 10
Arrow icon pointing right Baseline measures of hospital patient safety are established. 11
Arrow icon pointing up Public reporting on quality and safety can reduce performance variations among hospitals. 12
Arrow icon pointing down Utah faces huge challenges in promotion of preventive care. 13

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

At the bottom left of slide is the Utah Department of Health logo.

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Slide 26: Utah Health News

The 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."

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Slide 27: State Ranking Dynamics

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

Rank Access Quality Avoidable hospital use & cost Equity Healthy lives
Utah 38 48 1 42 1

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

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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 top right of the slide.

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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.

At the top right of slide is the Utah Department of Health logo.

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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.

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Slide 31: Thank You.

Questions?

Keely Cofrin Allen
kcofrinallen@utah.gov

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