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Enhancing Healthcare Quality: An Overview of State Snapshots and NHQR/NHDR Insights

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This web conference focuses on the National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR), emphasizing their role in improving healthcare quality through data-driven insights. Presenters from AHRQ and Thomson Reuters will discuss the development and content of State Snapshots, demonstrating its application in quality improvement. The session highlights key findings, performance metrics, and examples, particularly from Wisconsin, showcasing how the tool aids policymakers in understanding and enhancing health outcomes at the state level.

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Enhancing Healthcare Quality: An Overview of State Snapshots and NHQR/NHDR Insights

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  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!

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