Benchmarks for Public Reports

Select to access the PowerPoint® presentation (1.8 MB).

Slide 1

Benchmarks for Public Reports

Ernest Moy
Ernest.moy@ahrq.hhs.gov
301-427-1329

www.ahrq.gov/qual/qrdr11.htm

http://statesnapshots.ahrq.gov

Images: The covers of the 2011 National Healthcare Quality and Disparities reports are shown.

Slide 2

National Healthcare Reports

Annual reports to Congress from Secretary since 2003 mandated by 1999 Healthcare Research and Quality Act.

Unified team, Interagency Work Group, framework, data, methods, quality measures.

Quality Report:

• Snapshot & trends in quality of health care in America.
• Effectiveness, safety, timeliness, patient centeredness, care coordination, efficiency, health system infrastructure, access.
• Variation across States.

Disparities Report:

• Snapshot & trends in disparities in health care.
• Differences across race, ethnicity, & socioeconomic status.
• Variation across populations.

Slide 3

Happy 9th Birthday

Image: A photograph shows the AHRQ staff responsible for the National Healthcare Quality and Disparities reports celebrating the reports' "birthday" with a chocolate cake.

Slide 4

Institute of Medicine Recommendations

• Align the NHQR and NHDR with nationally recognized priority areas.
• Select measures that reflect health care attributes or processes that are deemed to have the greatest impact on population health.
• Affirm that achieving equity is an essential part of quality improvement.
• Increase the reach and usefulness of AHRQ's family of report-related products.
• Analyze and present data in ways that will inform policy and promote best-in-class achievement for all actors.
• Identify measure and data needs to set a research and data collection agenda.

Image: The cover of the Institute of Medicine report, Future Directions for the National Healthcare Quality and Disparities Reports, is shown.

Slide 5

IOM Recommendation 7

• The reporting of each measure in the NHQR and NHDR measure set should include routinely updated benchmarks that represent the best known level of performance that has been attained.

Image: A chart shows the Healthy People 2010 target, 90%, noted as "Too High," the National Average, 57.3%, as "Too Low," and the National benchmark, 74.3%, as "Just Right."

Slide 6

Benchmark Methods

• Setting Achievable Benchmarks of Care:
  • Same in QR and DR.
  • Top 10% States.
  • 30+ States with reliable estimates.
  • Exclude Territories.
  • Reset when achieved overall.
• Calculating Time to Benchmark:
  • Linear regression of data points.
  • 4+ data points make a trend (or change in trend).

Slide 7

ABC Ex.: Pneumococcal Vaccine among Elderly by Race/Ethnicity

Image: A line graph shows pneumococcal vaccine rates for Hispanic, Black, and White elderly persons from 1999 to 2007. For Blacks, the rate rises from ~30% to 45%. For Hispanics, it remains around 30%. For Whites, the rate rises from above 50% to above 60%. The 2008 Achievable Benchmark is 63.9%. The projected time to achieve this benchmark is 14 years for Blacks, 87 years for Hispanics, and 2 years for Whites. The total is 8 years.

Slide 8

ABC Example: Screening Lower Endoscopy by State

Image: A line graph shows lower endoscopy screening rates for all 50 States and the United States in total from 2001 to 2008. The rate rises for most States. Maryland is highlighted. The 2008 Achievable Benchmark is 72.5%. The projected time to achieve this benchmark is ½ a year for Maryland, and 5 years for the United States in total.

Slide 9

Progress in State Snapshots: Michigan No. 14 / 17 / 11 / 27

Image: Screenshots from the State Snapshots Web site show scores from Michigan's Dashboard on Health Care Quality Compared to All States. On Overall Health Care Quality, Michigan is Average; the State is Average on Preventive Measures, Strong on Acute Care Measures, and Weak on Chronic Care Measures.

Slide 10

PA has more racial/ethnic, fewer income-related disparities.

Image: Screenshots from the State Snapshots Web site show scores from Pennsylvania's Dashboard. Pennsylvania's Disparities scores show that the State is Very Weak with regard to Health Care Quality for Blacks and Hispanics compared to Whites, but Strong with regard to Asians/Pacific Islanders. Pennsylvania is Average with regard to Health Care Quality for Low-Income Communities.

Slide 11

Privately insured in VA do well; Medicaid less well.

Image: Screenshots from the State Snapshots Web site show scores from Virginia's Dashboard. Virginia is Average-to-Strong for Health Care Quality for the Privately Insured, Average for the Uninsured and those on Medicare, and Weak for those on Medicaid.

Slide 12

Conclusions

• Benchmarks are critical in public reports.
  • Spur quality improvement & disparities reduction.
  • Provide realistic targets & standards for comparison.
• Methods can be complex.
• Future work: More benchmarks for disparities:
  • Race/Ethnicity.
  • Insurance.
  • Other?