Future Directions for the National Healthcare Quality and Disparities Reports (2010) / Chapter Skim
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6 Improving Presentation of Information
6 Improving Presentation of Information
Pages 111-136
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From page 111... ...
The committee underscores the importance of integrating disparities reduction into quality improvement by enhancing the relationship between the structure of the two national healthcare reports. Finally, suggestions are made on improving data displays and the statistical quality of quality reporting.
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From page 112... ...
The committee believes that a summary of state performance should be part of the Highlights section of the reports and would be of interest to legislators and policy makers at the state and national levels. A one- to two-page summary of state performance, perhaps in a scorecard fashion, should be included, and AHRQ could compile this from the information it already provides in the State Snapshots (e.g., ratings from very strong to very weak on overall health care quality, preventive measures, acute care measures, chronic measures, hospital care measures, cancer care measures)
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From page 113... ...
partners for dissemination, disease-specific or priority population topics in the NHQR and NHDR. media, public State Snapshots State government; health care Provides expanded measure set sortable by core measures, Healthcare [refinement of existing product]
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From page 114... ...
An HIV/AIDS measure reported TABLE 6-2 Sections Recommended for Future National Healthcare Reports NHQR NHDR Highlightsa New focus New focus Effectiveness ✓ ✓ Patient safety ✓ ✓ Timeliness ✓ ✓ Patient-centeredness ✓ ✓ Efficiency ✓ New Access New ✓ Care coordination New New Health systems infrastructure New New Priority populationsb New (women, children, elderly) ✓ Disparities summaryb New State performance summaryb New New ✓ Currently in the report.
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From page 115... ...
The committee expects further inclusion of children's quality measures in the future as a result of the findings from AHRQ's National Advisory Council Subcommittee on Quality Measures for Children in Medicaid and Children's Health Insurance Programs, and the ongoing AHRQ- and CMS-funded IOM study of Pediatric Health and Health Care Quality Measures (AHRQ, 2009c; IOM, 2010)
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From page 116... ...
The committee finds it logical to convey the same information in both locations. Expanding and Sustaining Interest Through Derivative Products AHRQ provides online access to the national healthcare reports and State Snapshots, to a few report-related fact sheets, and to an online data query system (NHQRDRnet)
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From page 117... ...
Nevertheless, the committee urges further development. For example, the State Snapshots do not show any data on access measures, and the committee believes these data are important to have at the state-level.
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From page 118... ...
, more localized data can inform readers about variation within states. Such detail could be presented in the State Snapshots to show substate variation, particularly when it is readily available in the datasets AHRQ already uses, and perhaps as a derivative product similar to the Atlas of Mortality Personal communication, Ernest Moy, Agency for Healthcare Research and Quality, November 18, 2009.
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From page 119... ...
Such data access was previously recommended to AHRQ by the IOM in the 2001 report Envisioning the National Health Care Quality Report. Further, AHRQ should provide tools for analysts who want to replicate AHRQ's methods to produce comparative data for their locale or population cohort.
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From page 120... ...
health care system is important and historical data certainly play a role in forming a comprehensive picture of health care quality and disparities, users of the national healthcare reports have indicated that the performance of past years (especially more than 5 years ago) is not necessarily helpful for assessing where and how quality improvements can be made today (Lansky, 2009; Martinez-Vidal and Brodt, 2006)
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From page 121... ...
The committee believes benchmarking is a key tool for continuous quality improvement. Thus, it is expected that benchmarks will change over time depending on the frequency of obtaining updated data from the sources for the national healthcare reports.
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From page 122... ...
Currently, AHRQ links State Snapshots to other measure report cards in specific states and should continue such nonfederal linkages. In addition to the Health Innovation Exchange, AHRQ might link with sources such as the Robert Wood Johnson Foundation's (RWJF's)
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From page 123... ...
In health care quality improvement, best practices can occur at various levels of the health care system, including at the individual physician level (Kiefe et al., 2001) ; at the service provision level, such as in intensive care units (Zimmerman et al., The HealthyPeople 2010 targets are, in almost all cases, higher than the currently achieved national progress or even the best performing state.
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From page 124... ...
For example, a benchmark might provide information on the best performance rate among states, the best performance rate among hospitals, the best performance rate among large hospitals, or the best performance rate for care received by Hispanics in any state. Although it is technically true that AHRQ could choose any "class" from which it would designate a "bestin-class" benchmark, the committee finds that in the context of the national healthcare reports, where much of the analysis is done at the state level, setting benchmarks by state may appeal to a number of relevant audiences and may be most feasible given data availability.
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From page 125... ...
Denoting a best-in-class benchmark is as important for measures in the NHDR as it is for measures in the NHQR, and the committee concludes that for each measure, the benchmark used in the NHDR should mirror the benchmark used in the NHQR. The goal of quality improvement efforts should not be to strive just for the Hispanic population to receive care at the rate of the non-Hispanic population.
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From page 126... ...
Additionally, strong graphical displays avoid legends whenever possible because legends require 10 Because the State Snapshots were initially developed to supplement measures in only the NHQR, access measures are not included in the State Snapshots; in accordance with the committee's recommendation to integrate access in the quality portfolio of measures, it is important for AHRQ to include access measures in the State Snapshots. 11 Howard Wainer's paper, "Commentaries on the 2008 National Healthcare Quality Report, the 2008 National Healthcare Disparities Report and State Snapshots," was provided directly to AHRQ staff and archived in the IOM public access file for the Future Directions project.
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From page 127... ...
is visually cluttered: the graph contains a multitude of data points, a y-axis that is not descriptive, a caption that does not convey findings, and labels that are far from the data points. The reader is less readily able to discern which age groups performed best, which performed worst, and if any age groups had improved in the percentage of patients that received the recommended care.
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From page 128... ...
20 18 Black Nursing home residents with pressure sores (%) 16 AIAN 14 Hispanic TOTAL 12 White API 10 National 8 bench mark: 7.5% 6 4 2 0 1999 2000 2001 2002 2003 2004 2005 2006 SOURCE for the "Before" Graph: AHRQ, 2009d, p.
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From page 129... ...
Alternative Data Displays In addition to displaying trend data in graphs, AHRQ might consider utilizing alternate visual displays. For example, Figure 6-2 below, which was created by the CDC, succinctly presents information to readers, including readers who may not be data experts.
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From page 130... ...
The text refrains from providing additional analyses and provides minimal direction on methods that could be used to improve quality or eliminate disparities. Refining the Presentation of Summarized Information Summary and composite measures are useful tools for conveying information about complex constructs, such as the multiple elements of appropriate care for a stage of life (e.g., end-of-life care)
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From page 131... ...
. AHRQ's State Snapshots present such summary measures to report the performance of single and combined states on measures for different types of care (i.e., preventive, acute treatment, chronic care)
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From page 132... ...
For instance, data on the individual constituent measures for the reported composite measures are sometimes unavailable or not easily accessible. Likewise, some methodological information is provided online for the summary measures used in the State Snapshots,14 but much of the above information is also missing for those measures.
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From page 133... ...
The low disparity rate is principally because the performance metrics of Arkansas's White population are lower than the corresponding data for the White population in other states. Meanwhile, the quality data attributed to Arkansas's Black or African American population are in line with the corresponding national measures.
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From page 134... ...
2008a. Fact sheet: Selected findings on child and adolescent health care from the 2007 National Healthcare Quality and Disparities Reports.
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From page 135... ...
Agency for Healthcare Research and Quality. Presentation to the IOM Com mittee on Future Directions for the National Healthcare Quality and Disparities Reports, February 9, 2009.
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From page 136... ...
2009. Final report: Usability evaluation of the Agency for Healthcare Research and Quality (AHRQ)
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