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Who's the Best? Web site Ranks Most States in Quality Measures

 |  By HealthLeaders Media Staff  
   June 30, 2009

The Agency for Health Research and Quality recently expanded its "State Snapshots" to illustrate with colorful graphics the wide variation in care provided from state to state across the country.

"Every state has areas where it does well, as well as opportunities for improvement. We generally think this is a good 'get people going' kind of tool," says Ernest Moy, MD, medical officer for the Agency for Health Research and Quality, which produced the Web-based application.

Hospitals, state health officials and other providers can now see both how their states are performing relative to data collected in previous years as well as how they compare with other states. "From our perspective, comparison with other states has the greatest potential for the use of this data," Moy said.

Here are a handful of the findings:

  • Maryland had the worst hospital post surgical sepsis infection rate of any other state, but Oregon had the best.
  • Texas and California had the worst track records in giving surgical patients antibiotics at appropriate times, while South Dakota and Maine had the best performance rates in this category.
  • Utah had among the lowest rates of death per 1,000 adults admitted with conditions or diseases associated with low-mortality, but Iowa had among the highest.
  • Minnesota had the lowest rates of "iatrogenic pneumothorax," or incidents in which hospital procedures provoked air accumulation in the pleura of the lung, but Vermont had the highest.

The agency does not speculate on why such great variations in quality measures vary so much.

The state snapshots Web site shows data that ranks each participating state in more than 100 quality measures based on the place of care (preventive, acute, or chronic care) setting, such as a hospital, ambulatory, nursing home, or home health care setting, and by type of condition, such as cancer, diabetes, heart disease, maternal and child health, and respiratory disease.

Included are several new scoring areas, such as the prevalence in each state of adult asthma rates and the numbers of potentially preventable hospitalizations for children, adults, and the elderly.

Each participating state's performance is marked with a pink, yellow, and green performance meter, which illustrates state scoring with two needles, one that shows how the state is doing compared to a prior year, and the other shows how it compares with other states.

AHRQ collects but does not publish data from about eight states–depending on the category–because it's not statistically significant or because of concerns that small numbers may identify a patient or provider, Moy says.

But some states have declined to participate in some categories, he adds. "They just never thought about doing it, or they're too small, or they have other bizarre kinds of restrictions. A couple of states have rules that prohibit collecting such information or if it does collect it, prohibits the state from sending it to us." In the case of one state, a movement is afoot in the state Legislature to change that rule.

Such ranking tools will doubtless become more important as the federal government looks more seriously at finding ways to measure care with an emphasis on comparative effectiveness as a way of determine best outcomes and quality.

Each measure was rated on a bell curve, so that some states did well while others did poorly. Massachusetts, Moy says, is in the top 10 for more than half the quality measures that were tracked, but did not do well in home health or nursing home measures.

"On the flip side, we highlight Nevada, which is at the bottom 10 for a big chunk of the quality measures, but does fairly well in home health care," Moy says. "New England states tend to do well, but southwest and south central states tend to be the worst."

This is the first year AHRQ has published information on rates of sepsis among patients admitted to hospitals for elective surgery. Moy says some hospitals and states may be worried about the kind of feedback they might get, and are concerned about how these rankings may reflect on the quality of care delivered in hospitals in that state.

Other measurements ranked by this Web site include the percentage of heart attack patients for whom medication was given within 30 minutes, the percentage of hospitalized patients with pneumonia who had blood cultures collected before antibiotics were administered, and the percentage of nursing home patients who spent all or most of their time in a bed or a chair.

The data also filters general information on state performance by disease category. For example, for each state, one can see rankings on cancer, diabetes, end stage renal disease, heart attack care, maternal and child health, mental health, respiratory diseases, HIV and AIDS, surgical care, nursing home care, patients' ability to get timely appointments, and patient experience of care.

The expansive data file is available in Excel under the heading "All state data tables for all measures."

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