Benchmarks for Public Reports Ernest Moy

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 Disparities Report Snapshot & trends in quality of health care in America Snapshot & trends in disparities in health care Effectiveness, safety, timeliness, patient centeredness, care coordination, efficiency, health system infrastructure, access Differences across race, ethnicity, & socioeconomic status Variation across states Variation across populations

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Institute of Medicine Recommendations Align the NHQR and NHDR with nationally recognized priority areas. 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. 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. Affirm that achieving equity is an essential part of quality improvement. Increase the reach and usefulness of AHRQ’s family of report-related products. 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. 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. Identify measure and data needs to set a research and data collection agenda.

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. 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. Too High Too Low Just Right

Benchmark Methods Setting Achievable Benchmarks of Care 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 Calculating Time to Benchmark – Linear regression of data points – 4+ data points make a trend (or change in trend)

ABC Ex.: Pneumococcal Vaccine among Elderly by Race/Ethnicity 2008 Achievable Benchmark = 63.9% 14 yrs Time to Benchmark 87 yrs 8 yrs 2 yrs

ABC Example: Screening Lower Endoscopy by State MD US 2008 Achievable Benchmark = 72.5% Time to Benchmark ½ yr 5 yrs

Progress in State Snapshots: Michigan No. 14 / 17 / 11 / 27 Every State performs well in some areas and poorly in others.

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

Privately insured in VA do well; Medicaid less well.

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