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State Snapshots: State-based Information from the National Healthcare Quality Report

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On December 6, 2007, Jeff Brady made a presentation entitled State Snapshots: State-based Information from the National Healthcare Quality Report. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® File, 2.4 MB).

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


Slide 1: State Snapshots: State-based Information from the National Healthcare Quality Report

AHRQ's State Healthcare Quality Improvement Workshop
December 6, 2007
Jeffrey Brady, MD, MPH
Center for Quality Improvement and Patient Safety (CQuIPS)

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."

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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

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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.

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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.

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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.

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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.

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Slide 7: How the NHQR and NHDR Are Related

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

NHQR NHDR
Quality of health care in America Disparities in health care in America
Quality Quality + Access
Effectiveness, Patient Safety, Timeliness, Patient Centeredness ...+ Equity
Variation across time & States Variation across time & populations

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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

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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

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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.

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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
IHS — 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

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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.

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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."

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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 : (e.g., strategize, commit, design), doing (e.g., convene, test, measure), and assessing (e.g., evaluate, analyze).

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.

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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)."

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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.

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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.

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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.

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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

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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/statesnapshots/strongest_weakest.jsp?menuId=4&state=CA.

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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/statesnapshots/staterankings.jsp?menuId=29&state=CA.

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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 to the right of the top two bullet points.

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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/statesnapshots/diabetes.jsp?menuId=25&state=CA&level=12.

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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."

California's estimated expenditure is 12.9%. The number of employees and dependents is 30,500, and the estimated expenditure is $219 million

http://statesnapshots.ahrq.gov/statesnapshots/diabetes.jsp?menuId=27&state=CA&level=11&page=1.

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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."

The average savings is $2.9 million and the best savings is $5.1 million.

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

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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

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Slide 27: AHRQ State Snapshots & Commonwealth Fund State Scorecard

  AHRQ State Snapshots Commonwealth Fund State Scorecard
Content 129 measures 32 measures
Trends Performance Meter Most Recent + Baseline. Point in Time

Comparisons:

National

X X
Regional
X  

State Ranking

Top 5 states for 13 composites;

All states for 15 individual measures.

All states for 6 composites;

All states for 32 individual measures.

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Slide 28: State Snapshots

http://statesnapshots.ahrq.gov
This slide also contains an image of the State Snapshots tool on the left and the multi-colored semicircle entitled "Performance Meter: All Measures" on the right.

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Slide 29: NHQR/NHDR Resources

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The information on this page is archived and provided for reference purposes only.

 

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