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The National Healthcare Reports Ernest Moy Ernest.firstname.lastname@example.org 301-427-1329 www.ahrq.gov/qual/qrdr09.htm http://statesnapshots.ahrq.gov Origins of NHQR & NHDR Health and Human Services Secretary required to submit annual report to Congress: – National trends in health care quality (National Healthcare Quality Report, or NHQR) – Prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations (National Healthcare Disparities Mandated by Congress in Report, or NHDR) Healthcare Research and Quality Act (PL. 106-129) First reports released in 2003. Reporting Assumptions & Trade-offs Assumptions – 1º Audience: Policymakers; NOT QI – 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 Organization of NHQR & NHDR Effectiveness – Cancer – Diabetes – End Stage Renal Disease (ESRD) – Heart Disease – HIV & AIDS – Maternal and Child Health – Mental Health & Substance Abuse NHQR – Lifestyle Modification – Functional Status Preservation & Rehabilitation NHDR – Supportive & Palliative Care Patient Safety Timeliness Patient Centeredness Efficiency Access to Health Care Priority Populations 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 Linkage Between NHQR & NHDR NHQR NHDR Snapshot of quality of Snapshot of disparities health care in America in health care in America Quality: Safety, Quality + Access: Equity effectiveness, across race, ethnicity, timeliness, patient SES centeredness, efficiency Variation across States Variation across populations New in 2009 QR & DR – Focus on the uninsured – New Healthcare-associated infections Care coordination – Improved Retired measures Lifestyle modification Functional status preservation & rehabilitation Supportive & palliative care QR – Patient safety culture in hospitals – More efficiency measures DR – Financial burden of health care costs 2009 NHQR Key Findings Quality is improving, but the pace is slow, especially for preventive care and chronic disease management. 2009 NHQR Findings Health care quality needs to be improved, particularly for uninsured individuals who are less likely to get recommended care. Private No insurance insurance Measure (%) (%) Difference Women ages 40-64 who had a mammogram in the last 74.2 38.3 35.9 2 years Children ages 2-17 who had a dental visit in the 59.6 27.9 31.7 calendar year Adults ages 40-64 with diagnosed diabetes who 64.1 35.4 28.7 received a dilated eye examination in the calendar year Adults ages 50-64 who ever received a colonoscopy, 47.5 20.7 26.8 sigmoidoscopy, or proctoscopy Adults with obesity who received advice from a 61 41.2 19.8 provider to exercise 2009 NHQR Findings Some areas merit urgent attention, including patient safety and health care-associated infections. 2009 NHDR Key Findings Disparities are common and not improving. Core Measures Getting Worse Topic Measure Blacks Asians AI/ANs Hispanics Adults age 50 and over who report they ever received a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood * * * * Cancer test Cancer deaths per 100,000 population per year for colorectal cancer * * Hospital patients with heart failure Heart disease who received recommended hospital care * * Adults age 65 and over who ever Respiratory diseases received pneumococcal vaccination * * Hospital patients with pneumonia who received recommended hospital care * * * * The National Healthcare Reports: Focus on Maryland Ernest Moy Ernest.email@example.com 301-427-1329 www.ahrq.gov/qual/qrdr09.htm http://statesnapshots.ahrq.gov Reports ≠ Better Health Care How? Local QRDR QI Benchmarks Know Plan Do Better Make it Health See it happen Help it happen happen Care Health Policy Makers Providers Organizations Target States with Poorest Care: State Snapshots Web tool for State policymakers to view NHQR/NHDR health care quality, State-by-State: Summary performance meters Individual measures Focus on clinical issues State context Methods & Interpretation Guides Screening Lower Endoscopy by State 80 Time to 2008 Achievable Benchmark = 72.5% Benchmark 70 ½ yr 5 yrs 60 MD 50 US 40 30 2001 2002 2004 2006 2008 Flu Shot among Elderly by State 80 Time to 2008 Achievable Benchmark = 77% Benchmark 70 17 yrs MD 21 yrs US 60 50 2001 2002 2003 2004 2005 2006 2007 2008 Black-White Differences in Flu Shot among Elderly by State 35 Worst 30 25 U.S. 20 State Gap MD 15 10 Best 5 0 Best MD U.S. Worst Hispanic-White Differences in Mammography by State 25 Worst 20 State Gap 15 10 5 U.S. 0 Best MD U.S. Worst -5 MD -10 -15 Best -20 Pneumococcal Vaccine among Elderly by Race/Ethnicity 70 Time to 2008 Achievable Benchmark = 63.9% Benchmark 2 yrs 60 8 yrs 50 14 yrs 40 87 yrs 30 Total Hispanic 20 Black 1999 2000 2001 2002 2003 2004 2005 2006 2007 White Pneumococcal Vaccine among Elderly by Insurance 70 2008 Achievable Benchmark = 63.9% Time to Benchmark 3 yrs 60 8 yrs 3 yrs 50 22 yrs 40 Total Medicare & private 30 Medicare & public Medicare only 20 99 00 01 02 03 04 05 06 07 19 20 20 20 20 20 20 20 20 Conclusions Many trade-offs in developing national reports; QRDR driven by 1º assumptions. QRDR not designed to direct action but can – Make case for action – Identify QI opportunities: Populations, services, communities – Benchmark against best States Quality and disparities problems are apparent at the national and States levels. Local teams with local data do the actual improvement.
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