Tool enables state quality comparisons

Tool represents vehicle for benchmarking

The Agency for Healthcare Research and Quality (AHRQ) has unveiled a new interactive web-based tool that provides each state a way to evaluate its health care quality, thus providing another resource for benchmarking.

The new State Snapshot tool breaks down data from the 2005 National Healthcare Quality Report (NHQR) and the 2005 National Healthcare Disparities Report (NHDR), released earlier this year, into state-specific snapshots.

There were several reasons for creating the tool, says Dwight McNeill, PhD, MPH, AHRQ's lead for the NHQR and the State Snapshot. "First, in doing the [NHQR] report, we create a lot of information —99 measures, and 33 data sources — and a lot of those are for states, so it was just wise and prudent to use those resources," he notes. "Also, the states have been very important partners in improving health care quality, and we have to do what we do through partners, as we are a small agency and do not have regulatory or financial control of things. Plus, the states are where the action is happening for reform — whether it's the Massachusetts health insurance reform or others, like Vermont or Washington, doing statewide plans to improve chronic illnesses."

Finally, he says, the states asked for it. "They saw our data, and asked us, 'What do you think the top 10 measures are that states should concentrate on?'" he shares. "We responded that we do not have all the pearls of wisdom, but if we worked together, we could get the data that's relevant for them."

A multi-layer approach

McNeill says that AHRQ has attempted to have a multi-layer approach to looking at the data. (To view the State Snapshot tool, go to www.qualitytools.ahrq.gov/qualityreport/2005/state.) "First of all, the states wanted to have a dashboard; as you know, these are currently very popular," he says. "They summarize and focus on the key information. So, we took the dashboard piece and presented the information on different 'dials' — for example, how the state did overall. Then, there are different dials if you just want to track nursing homes, for example, or just hospitals."

Under each of the major dials, the user can click down for more specificity, he explains, as different audiences are interested in different information. "For example, some of the press likes the rankings, while analysts are more interested in the data," he observes.

Interestingly enough, he continues, it's often not what the snapshots present but how it is presented that users value. "For example, we use measures that the QIOs use, but we present them in a different way; QIOs do not summarize the data," he notes. "People will tell us, 'This is not different data, but what we really like is the way you are presenting it.' This helps the data come to life; you can really see what's happening with hospital care."

Benchmarking for quality managers

For interested quality managers, the tool "does provide benchmarks for hospital data," McNeill says. "While hospital data are not uniformly available, it is possible to look at variations across the states to get an idea of benchmarks."

For example, he continues, in the areas of heart failure, heart attack, and pneumonia, it's possible to see how one state does relative to its neighbors. "You can also look at the top 10% and the bottom 10% of states, so there's a lot of comparative data you can look at," he suggests.

McNeill pulls up the state of California and reads the data to demonstrate how it might be used. "They are rated as relatively weak on hospital care nationally — and for the Pacific states, they are even worse," he observes. "Two things we found I think are relevant for hospitals: When we look at the weak measures, it's first of all a surprise to see them weak in hospital care. I found it curious that, on the one hand, they were average on admission measures but way below average on many of the discharge measures. That raises a flag."

As he drills down to the tables, he obtains benchmark data for California. "If you look at one hospital measure, the percentage of Medicare heart attack patients getting aspirin at discharge, you can see state data, regional data, and top and bottom 10%," he notes.

Looking at the numbers, he notes that 85.4% of those patients received aspirin at discharge. "The average for the region is 90%; the top 10% is 95% and the bottom 10% is 83%. So, they were clearly below average, below region, and there is a lot of room to go — 10 points to be at the level of the best performing states," he declares. "There's a lot of room for improvement, and you can see what this means in terms of lives and dollars."

For more information, contact: Dwight McNeill, PhD, MPH, Agency for Healthcare Research and Quality, 540 Gaither Road Rockville, MD 20850. Phone: (301) 427-1364.