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On July 9, 2009, Foster Gesten made a presentation in a Web Conference entitled AHRQ State Snapshots: New York. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® File, 341 KB).
Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10
Slide 1: AHRQ State Snapshots: New York
Foster Gesten, MD
Medical Director, Office of Health Insurance Programs
New York State Department of Health
fcg01@health.state.ny.us
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Slide 2: Medicaid Reform: NY
- Movement of investment from inpatient to outpatient/ambulatory care:
- Historic imbalance
- Broad promotion of primary care
- Importance of "value"
- Prevention Quality Indicators (PQIs):
- Comparative data from states within chronic disease grant (CHCS)
- State Snapshots: benchmarking:
- Supported new Medicaid benefit: Certified Diabetes and Asthma Educators
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Slide 3: Overall Health Care Quality for New York
All-State Comparison
In the center of the slide 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, which indicates the baseline year, is on the center of the average section and a solid arrow, which indicates the most recent data year, is located on the line dividing the weak and average segments.
Regional Comparison
In the center of the slide below the first image 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, which indicates the baseline year, is on the left side of the average section, and a solid arrow, which indicates the most recent data year, is located just to the left of the dotted arrow.
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Slide 4: New York's Dashboard on Health Care Quality Compared to All States
Types of Care
In the top left of the slide is an image of a semi-circle labeled "Performance Meter: Preventive 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 solid arrow, which indicates the most recent data year, and the dotted arrow, which indicates the baseline year, are at the same place in the average segment.
In the top center of the slide is an image of a semi-circle labeled "Performance Meter: Acute Care 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, which indicates the baseline year, is on the average segment, and a solid arrow, which indicates the most recent data year, is on the weak segment.
In the top right of the slide is an image of a semi-circle labeled "Performance Meter: Chronic Care 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, which indicates the baseline year, and a solid arrow, which indicates the most recent data year, are located on the line dividing the weak and average segments.
Settings of Care
In the center left of the slide is an image of a semi-circle labeled "Performance Meter: Hospital Care 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 solid arrow, which indicates the most recent data year and the dotted arrow, which indicates the baseline year, are at the same place in the weak segment.
In the center of the slide is an image of a semi-circle labeled "Performance Meter: Ambulatory Care 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, which indicates the baseline year, is on the left side of the average segment, and a solid arrow, which indicates the most recent data year, is on the weak segment.
In the center right of the slide is an image of a semi-circle labeled "Performance Meter: Nursing Home Care 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. Both the dotted arrow, which indicates the baseline year, and a solid arrow, which indicates the most recent data year, are on the strong segment.
In the bottom center of the slide is an image of a semi-circle labeled "Performance Meter: Home Health Care 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. Both a dotted arrow, which indicates the baseline year, and a solid arrow, which indicates the most recent data year, are on the weak segment.
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Slide 5: Care by Clinical Area
In the top center of the slide is an image of a semi-circle labeled "Performance Meter: Diabetes 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, which indicates the baseline year, is left of the center of the average segment, and a solid arrow, which indicates the most recent data year, is on the right of the weak segment.
In the bottom center of the slide is an image of a semi-circle labeled "Performance Meter: Respiratory Diseases 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 solid arrow, which indicates the most recent data year, and a dotted arrow, which indicates the baseline year, are at the same place in the weak segment.
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Slide 6: New York's Weakest Measures
Weakest Measures are those in which the State performed below the all-State average and are weakest among their measures relative to all reporting States. These measures highlight some of the opportunities for improvement.
Note: The best result for each measure can be either the highest or lowest value. The direction representing best is noted in the “Best” column.
Measure Short Name: Asthma Admissions for Children
Measure Long Name: Pediatric asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system and transfers from other institutions per 100,000 population, ages 2-17.
Best: Lowest
Measure Short Name: Home health care — plus urgent care
Measure Long Name: Percent of home health care patients who needed urgent, unplanned medical care.
Best: Lowest
Measure Short Name: Avoidable hospitalizations — diabetes, uncomplicated
Measure Long Name: Admissions for uncontrolled diabetes without complication (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age 18 and over.
Best: Lowest
Measure Short Name: Avoidable hospitalizations — diabetes, long-term complications
Measure Long Name: Admissions for diabetes with long-term complications (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age 18 and over.
Best: Lowest
Measure Short Name: Home health care — hospitalization
Measure Long Name: Percent of home health care patients who had to be admitted to the hospital.
Best: Lowest
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Slide 7: New York State Snapshot 2007: Focus on Clinical Preventive Services
What is the Clinical Preventive Services quality performance compared to all States?
In the center of the slide is an image of a semi-circle labeled "Performance Meter: Clinical Preventive Services." 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 solid arrow, which indicates the most recent data year, is on the strong segment. Compared to all States, for the most recent data year, the performance for New York for clinical preventive services measures is in the strong range. Performance for the baseline year is not available because of insufficient data.
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Slide 8: Challenges in NY
- Large health care investments yet "average to weak"
- Corroborated with other national report cards
- Focus on gaps in chronic care:
- Data not Medicaid specific, but still viewed as relevant:
- Newer reports with more Medicaid/low income breakouts
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Slide 9: From Snapshot to Support for Diabetes/Asthma Educators
- Executive, budget, and legislative support required for new benefits and expenditures
- Clinical evidence for effectiveness uneven and not always clear
- State Snapshots provide "benchmark" to catalyze policy and investment:
- Prioritize and focus
- Disparities
- Costs
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Slide 10: Next Steps
- Better tools and analysis to understand State differences on measures:
- What is behind the "best" results?
- Relationship between measures:
- Structure/process and outcomes
- Which measures have greatest "impact"?
- Expand integration of disparities data and State Snapshots
- Customizing peer group and comparisons
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