1. Report Changes in Response to IOM Recommendations Ernest Moy Ernest.moy@ahrq.hhs.gov 301-427-1329 http://www.ahrq.gov/qual/qrdr09.htm http://statesnapshots.ahrq.gov

2. Overview Changes for 2010 Changes for 2010 - Align with IOM priority areas / updated framework - Add benchmarks Beyond 2010 Beyond 2010 - Expand fact sheets / mini-reports - Redesign webtools

3. 2010 Reports: Align with IOM Priorities & Framework National Priority AreaNHQR/NHDR Chapter Population HealthHighlights only Palliative and End-of-Life CarePalliative and Supportive Care section of the Effectiveness Chapter SafetyPatient Safety Chapter Patient and Family EngagementPatient Centeredness Chapter Care CoordinationNew Care Coordination Chapter OveruseEfficiency Chapter AccessAccess to Health Care Chapter Health System InfrastructureNew Health System Infrastructure Chapter

4. 2010 NHQR / NHDR Chapters NHQR With benchmarks, DR highlights, and priority population highlights With benchmarks, DR highlights, and priority population highlights Effectiveness Effectiveness Safety Safety Timeliness Timeliness Patient Centeredness Patient Centeredness Care Coordination Care Coordination Efficiency Efficiency Health System Infrastructure Health System Infrastructure Access Access NHDR With benchmarks, QR highlights, and priority population highlights With benchmarks, QR highlights, and priority population highlights Effectiveness Effectiveness Safety Safety Timeliness Timeliness Patient Centeredness Patient Centeredness Care Coordination Care Coordination Efficiency Efficiency Health System Infrastructure Health System Infrastructure Access Access Priority Populations Summaries Priority Populations Summaries Single Highlights with new sections on Priority Areasand State Summaries Single Intro/Methods

5. IOM Benchmark Recommendation To the extent that the data are available, 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. To the extent that the data are available, 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.

6. Benchmark Methods Setting Achievable Benchmarks Setting Achievable Benchmarks – Same in QR and DR – Top 10% States – Year specific – 30+ States with reliable estimates – Exclude Territories Calculating Time to Benchmark Calculating Time to Benchmark – Linear regression of data points – 4+ data points make a trend (or change in trend)

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

8. Pneumococcal Vaccine among Elderly by Insurance 2008 Achievable Benchmark = 63.9% 3 yrs 8 yrs 3 yrs 22 yrs Time to Benchmark

9. Benchmark Example of Improvement

10. Benchmark Example of No Improvement

11. Children ages 19-35 months who received all recommended vaccines by household income 2008 Achievable Benchmark = 82%

12. Ongoing Benchmark Challenges Should benchmarks by updated? When? Should benchmarks by updated? When? What to do when there are no State data? Population benchmark; what population? Provider benchmark? What to do when there are no State data? Population benchmark; what population? Provider benchmark? What about race-specific State-based benchmarks? What about race-specific State-based benchmarks? Is it appropriate and useful to apply State-based benchmarks to disparities? Is it appropriate and useful to apply State-based benchmarks to disparities?

13. Beyond 2010: Fact Sheets / Mini-Reports Focus on Priority Populations Focus on Priority Populations – Well-defined audiences – Reduced NHDR Priority Populations chapter – Opportunity to meet user needs better Every quarter after Report release (3/year) Every quarter after Report release (3/year) – Sustain interest – Every priority pop covered every other year Collaboration with Collaboration with – AHRQ Office of Priority Populations – Interagency Work Group

14. Integrated Web Design New integrated site will: New integrated site will: – Guide users through a cohesive national quality improvement storyline: National priorities  Sub-national targets National priorities  Sub-national targets Reporting information  Taking action Reporting information  Taking action – Include enhanced features, such as: Guiding questions Guiding questions “Step-by-step” quality improvement tools “Step-by-step” quality improvement tools Achievable benchmarks Achievable benchmarks Similar-state-, sub-population-, and payer- comparisons Similar-state-, sub-population-, and payer- comparisons Easy-to-identify navigational icons Easy-to-identify navigational icons Consistency of detail on NHQR/DR methods Consistency of detail on NHQR/DR methods Glossary of terms Glossary of terms State Snapshots NHQRDRnet NHQR NHDR

15. Integrated Components Detailed tables from Report appendices Meters and dials from State Snapshots Dynamic tables from NHQRDRnet