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Step-by-Step User's Guide
The State Snapshots, produced annually by the Agency for Healthcare Research and Quality, provide State-specific quality information, including strengths, weaknesses, and opportunities for improvement. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State. This section provides step-by-step instructions for using the State Snapshots online.
Contents
Overview
State-level information used to create the State Snapshots is based on data collected for the National Healthcare Quality Report (NHQR). AHRQ produces this report to monitor improvements in health care quality across the country and to provide benchmarks against which improvement can be measured.
As in the NHQR, information on health care quality measures for each State in the State Snapshots focuses on measures of effectiveness, patient safety, timeliness, and patient centeredness. This section provides instructions for accessing the State Snapshots online and highlights the relevant links, resources, and data tables for each section of the State Snapshots site.
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Performance Meters
All State-level estimates available within the NHQR were grouped into summary measures. For many of the summary measures, the State Snapshots feature performance meter graphics that display your State's performance in comparison to all States or your State's performance in comparison to its region. The Methods section provides details on the summary measures and the calculations for the performance meters.
Example Performance Meter: The performance meters answer these questions: “What is the State's performance compared to all States or the State's region?” and “How has that performance changed?” Arrows indicate the State's overall performance compared to all States or the region. A solid arrow represents the most recent data year; a dashed arrow represents the baseline year. A missing arrow means there were insufficient data to create the summary measure.
An example performance meter is provided below, along with a discussion on the placement of the arrows on the meter.
In this example:
- The solid arrow is in the “average” range. Compared to all States or the region, the State is “average” on measures for the most recent data year.
- The dashed arrow is in the “average” range. Compared to all States or the region, the State is “average” on all measures for the baseline year.
- Because the solid arrow is to the right of the dashed arrow, the State's performance compared to all States or the region, has improved from the baseline to the most recent data year.
To view individual measures or to determine the approximate number of years between the most recent data year and the baseline year, select the meter or a link under the meter called, “What performance measures make up this meter?” A table will appear with data on all the health care quality measures that make up the meter for the State. Measures for which the State is “Better than Average,” “Average,” and “Worse than Average” are grouped together. Scan the years in the table of measures. The number of years may vary from measure to measure for a meter.
A second example performance meter is provided below, along with a discussion on the placement of the arrows on the meter.
In this example:
- The solid arrow is in the “weak” range. Compared to all States or the region, the State is “weak” on measures for the most recent data year.
- The dashed arrow is in the “strong” range. Compared to all States or the region, the State is “strong” on all measures for the baseline year.
- Because the solid arrow is to the left of the dashed arrow, the State's performance compared to all States or the region, has declined from the baseline to the most recent data year.
To view individual measures or to determine the approximate number of years between the most recent data year and the baseline year, select the meter or a link under the meter called, “What performance measures make up this meter?” A table will appear with data on all the health care quality measures that make up the meter for the State. Measures for which the State is “Better than Average,” “Average,” and “Worse than Average” are grouped together. Scan the years in the table of measures. The number of years may vary from measure to measure for a meter.
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Different State Comparisons
For many of the summary measures, you can compare the State's performance to all States or to the region by selecting the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
You can also compare the State with the best performing states for the summary measure by selecting the “Best Performing and All Other States” link in the “My State Compared to” box. You will go to a table that presents the State's score and the scores of the five States with the highest scores for the selected summary measure. Examine the table to learn how the State compared to the best performing States. The State's score is listed in the first row. A table listing the scores for all States alphabetically for the selected summary measure is also featured on this page, enabling you to compare the State with all States in addition to the best performers.
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How To Use the State Snapshots
2009 State Snapshots Home
On the State Snapshots home page, the navigation bar on the left side of the screen gives the overall contents (Figure 1). As you move between various sections, this toolbar expands, indicating which section of the Snapshots you are currently accessing.
Figure 1. Navigation bar
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1. Select State Selection Map
To begin, select the State Selection Map, either from the left navigation bar or the State Selection Map link on the home page.
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2. Select Your State of Interest
From the State Selection Map, you can choose a State of interest by selecting from:
- A drop-down menu with States listed alphabetically, or
- A map of the United States.
Example: Select a State. You will go to the State Dashboard page that displays the overall health care quality performance meter for the State compared to all reporting States and graphics summarizing health care quality in three broad areas: types of care, settings of care, and care by clinical area. Once you select a State, any pages you view will show information for that State until you select a different State. For example, if you select Texas, any pages you view will pertain to Texas until you make a change.
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3. Select State Dashboard
The State Dashboard provides an overview of the selected State's performance compared to all States in overall health care quality and on subsets of measures related to types of care, settings of care, and care by clinical area. By visiting the State Dashboard, you can quickly gain an understanding of your State's performance. To learn more about performance on particular measures, visit the applicable sections of the Web site by using the left navigation bar.
- Example Dashboard Graphics: The State Dashboard displays an Overall Health Care Quality performance meter answering these questions: “What is the overall health care quality performance compared to all States?” and “How has that performance changed?” Below the Overall Health Care Quality performance meter are graphics summarizing the State’s performance for specific types of care, settings of care, and care in clinical areas. In these graphics, the State's performance for the most recent data year is described by a solid triangle; a hollow triangle describes the baseline year. A missing triangle means there were insufficient data to create the summary measure. Example State Dashboard graphics are provided below.
To determine the approximate number of years between the most recent data year and the baseline year, select any of the State Dashboard graphics and scan the years in the table of measures for the summary measure. The number of years may vary from measure to measure for each graphic.
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4. Select Overall Health Care Quality
The State Overall Health Care Quality page displays a performance meter answering these questions: “What is the overall health care quality performance compared to all States or the region?” and “How has that performance changed?” To compare the State's overall health care quality performance within its region or with that of the best performing or all other States, select the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
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5. Select Strongest and Weakest Measures
This page lists the best and worst performing measures in the State of interest for the given year. At least five of these measures are listed, more if the fifth measure is tied with others of identical value.
- Example: Select “Strongest and Weakest Measures” on the left navigation bar. A page will appear that lists the State's strongest and weakest measures relative to all States.
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6. Select Types of Care
These pages provide information on how the selected State performs on a number of health care measures related to preventive care (or staying healthy), acute care (or getting better), and chronic care (or living with illness) (Figure 2).
Figure 2. Navigation bar, Types of Care expanded
- Example: Select “Types of Care” on the navigation bar. Then select “Preventive Care.” A meter will appear indicating how providers in the State perform on preventive measures compared to all reporting States. To compare the State's preventive care performance within its region or with that of the best performing or all other States, select the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
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7. Select Settings of Care
These pages provide information on how the selected State performs in a number of health care settings—hospital care, ambulatory care, nursing home care, and home health care (Figure 3).
Figure 3. Navigation bar, Settings of Care expanded
- Example: Select “Settings of Care” on the navigation bar. Then select “Hospital Care.” A meter will appear indicating how providers in the State perform on hospital care measures compared to all reporting States. To compare the State's hospital care performance within its region or with that of the best performing or all other States, select the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
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8. Select Care by Clinical Area
These pages provide information on how the selected State performs in five clinical areas: cancer, diabetes, heart disease, maternal and child health, and respiratory diseases (Figure 4).
Figure 4. Navigation bar, Care by Clinical Area expanded
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Example: Select “Care by Clinical Area” on the navigation bar. Then select “Cancer.” A page will appear with a meter indicating how the State's cancer care performance compared to all reporting States. To compare the State's cancer care performance within its region or with that of the best performing or all other States, select the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
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9. Select Focus on Diabetes
These pages provide information on how the selected State performs on a set of diabetes measures. The diabetes measures include: prevalence, quality of care (for processes and outcomes of diabetes care); quality improvement in care (impact on lives and expenses, impact on excess costs of diabetes); and disparities in treatment (by income and race/ethnicity) (Figure 5).
Figure 5. Navigation bar, Focus on Diabetes expanded
Prevalence
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Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select “Prevalence.” A national map will appear that presents adult self-reported diabetes prevalence by State.
Quality of Care
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Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select ”Quality of Diabetes Care-Processes of Care.” A page with a meter will appear indicating how the State's performance on process-of-care measures for diabetes compared to all reporting States. To compare the State's diabetes process-of-care performance within its region or with that of the best performing or all other States, select the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
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Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select “Quality of Diabetes Care-Outcomes of Care.” A bar graph will appear showing how the State's hospitalization rates for complications related to diabetes compare to the regional average and the U.S. average.
Quality Improvement
- Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select “Lives and Expenses.” A bar graph will appear that highlights the State's estimated share of health expenditures on State government employees for diabetes-related care.
- Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select “Excess Costs of Diabetes.” A page will appear with information on potential savings that might result from a diabetes quality improvement program.
Disparities in Treatment
- Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select “Disparities in Diabetes Treatment-by Income.” A national map will appear that highlights how the State's hemoglobin A1c (HbA1c) testing rates compare for low-income and high-income groups.
- Example: From “Focus on Diabetes” on the left navigation bar or from the main page of “Focus on Diabetes,” select “Disparities in Diabetes Treatment-by Race/Ethnicity.” A national map will appear that highlights how the State's HbA1c testing rates compare between Blacks and Whites.
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10. Select Focus on Asthma
These pages provide information on how the selected State performs on a set of asthma measures. The asthma measures include: prevalence, quality of care (potentially preventable asthma hospitalizations), and quality improvement (potential returns on investment of an asthma care quality improvement program) (Figure 6).
Figure 6. Navigation bar, Focus on Asthma expanded
Prevalence
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Example: From “Focus on Asthma” on the left navigation bar or from the main page of “Focus on Asthma,” select “Prevalence.” A national map will appear that presents adult self-reported asthma prevalence by State.
Quality of Care
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Example: From “Focus on Asthma” on the left navigation bar or from the main page of “Focus on Asthma,” select “Quality of Care.” A bar graph will appear that highlights the rates of potentially preventable hospitalization for children, adults and individuals age 65 and over in the State, region and U.S. Select the bar graph to display a table of asthma admissions per 100,000 population by State, region, and U.S. for three age groups.
Quality Improvement
- Example: From “Focus on Asthma” on the left navigation bar or from the main page of “Focus on Asthma,” select “Quality Improvement.” A page displaying six possible target audiences for an asthma care quality improvement program will appear. Select “Medicaid children with asthma and at least one acute care visit within the past year.” Two bar graphs which highlight costs and savings per participant resulting from the hypothetical quality improvement program will appear, as well as a text box indicating the program’s return on investment.
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11. Select Focus on Healthy People 2010
A data table will appear that features the State's performance on measures included in the Healthy People 2010 initiative of the U.S. Department of Health and Human Services. The measures belong to categories of Leading Health Indicators that are used to help identify and set national goals for reducing preventable disease and to measure the Nation's performance.
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12. Select Focus on Clinical Preventive Services
The performance meter on this page indicates the selected State's performance on clinical preventive services recommended by the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practice. These two expert bodies use the best research evidence available to make recommendations on preventive services for people without symptoms of disease.
- Example: Select “Focus on Clinical Preventive Services” on the left navigation bar. A meter will appear indicating how providers in the State perform on clinical preventive services compared to all reporting States. To compare the State's performance on clinical preventive services within its region or with that of the best performing or all other States, select the appropriate link in the “My State Compared to” box in the upper right corner of the screen.
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13. Select Focus on Disparities
These pages provide information on how the selected State performs on quality of care among racial, ethnic and socioeconomic groups (Figure 7). Information on disparities in the quality of care in clinical areas including respiratory care, heart disease, and diabetes and on measures of inpatient mortality and potentially avoidable complications among these groups are presented.
Figure 7. Navigation bar, Focus on Disparities expanded
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Example: Select “Focus on Disparities” on the left navigation bar then select “All Races.” Three graphics will appear showing the State's performance in quality of care for Hispanics (All Races), Blacks (Non-Hispanic), and Asian/Pacific Islanders compared to Whites (Non-Hispanic). In these graphics, the State's performance for the most recent data year is described by a solid triangle. A missing triangle means there were insufficient data to create the summary measure. Select any of the graphics, or scroll down to the table below the graphics, to review the individual measures that make up the summary measure and the State's rate for each measure by race/ethnicity. Example graphics are provided below.
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Example: Select “Focus on Disparities” on the left navigation bar then select “Blacks (Non-Hispanic).” A meter will appear indicating how the disparity between quality of care for Blacks (Non-Hispanic) and quality of care for Whites (Non-Hispanic) in the State compared to the disparity for all reporting States in the Nation. For example, examine the arrow on the meter below. The solid arrow represents the most recent data year.
- The solid arrow indicates that the State's disparity compared to the Nation is “weak,” meaning that the number of measures for which the State has a larger disparity in the quality of care than the U.S. is greater than the number of measures for which the State has a smaller disparity in the quality of care than the U.S.
- To determine how the quality of care for Blacks (Non-Hispanic) compared to the quality of care for Whites (Non-Hispanic) in the State and in the Nation for each of the measures included in the summary meter, select the meter or scroll down to the table below the meter. This table also indicates whether the State disparity for each measure was smaller, larger, or similar to the U.S. disparity for the measure and shows the relative rates for each measure.
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14. Select Focus on Payer
These pages provide information on how the selected State performs on quality of care by expected primary payer (Figure 8). Information on hospital care measures that refer to inpatient mortality and potentially avoidable complications are presented for each expected primary payer including privately insured, Medicare, Medicaid, and the uninsured. A comparison of Medicare, Medicaid, and the uninsured to the privately insured is also featured.
Figure 8. Navigation bar, Focus on Payer expanded
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Example: Select “Focus on Payer” on the left navigation bar. A pie chart will appear showing the distribution of all inpatient hospitalizations by expected primary payer in the State. An example pie chart is provided below. The blue segment represents Medicare, orange is Medicaid, yellow is the privately insured, red is the uninsured, and green is all other insurers.
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Example: Select “Focus on Payer” on the left navigation bar and then select “All Payers.” Three graphics will appear showing the State's performance compared to the U.S. in quality of care for Medicare, Medicaid, and the uninsured compared to the privately insured. In these graphics, the State's performance for the most recent data year is described by a solid triangle. A missing triangle means there were insufficient data to create the summary measure. Select any of the graphics to review the individual measures that make up the summary measure and the State’s rate for each measure. Example graphics are provided below.
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Example: Select “Focus on Payer” on the left navigation bar and then select “Medicare.” A meter will appear indicating how the quality of care for Medicare hospitalizations in the State compared to the U.S. For example, examine the arrow on the meter below. The solid arrow represents the most recent data year.
- The solid arrow indicates that the State's performance compared to the U.S. is “average,” indicating that the state is “average” on measures for the most recent data year.
- To view individual measures, select the meter or a link under the meter called, “What performance measures make up this meter?” or scroll to the table below the meter. The table shows all the measures that make up the meter for the State. This table also indicates how the State compared to the U.S. and shows the relative rates for each measure.
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15. Select Focus on Variation Over Time
These pages show the high degree of variation across States and over time in potentially avoidable adult and pediatric hospital admissions for composites of acute and chronic conditions. (Figure 9). The composite measures that are featured in this section refer to hospital admissions that evidence suggests could have been avoided, at least in part, through high-quality outpatient care.
Figure 9. Navigation bar, Focus on Variation Over Time expanded
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Example: Select “Focus on Variation Over Time” on the left navigation bar then select “Adult.” Three graphs are featured showing how the State compares to the U.S and other States on potentially avoidable hospitalizations for acute and chronic illnesses in the years 2000, 2004, and 2006. On the graphics, the State is represented by red triangles, blue diamonds represent the U.S., and gray circles represent other reporting States. An example graph is provided below. Select any of the graphs, and a table will be shown indicating the rate for the State, the U.S., and the State compared to the U.S for each measure. The rate for States with the lowest and highest number of admissions for each year is also shown. From this table, select one of the links, “Select to view rates for all States,” for rates on each measure for all States.
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16. Select State Rankings for Selected Measures
This page shows how well the State of interest is performing relative to all States on selected measures from the 2009 National Healthcare Quality Report.
- Example: Select “State Rankings for Selected Measures” on the left navigation bar. A table will appear with the all-State average rate, the State rate, and the State's rank among all States and the District of Columbia for 18 important quality measures.
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17. Select Contextual Factors
This page displays dials on how the selected State compared to all States on 13 factors that represent the State's context or environment related to demographics of its population, health status of the population, and health care resources. The dials may aid in interpreting the State's performance on health care quality.
- Example: Select “Contextual Factors” on the left navigation bar. Dials will appear for 13 contextual factors. For example, examine the dial below.
The black arrow (on top of the orange wedge) represents the State's value (a percent or rate) for the factor selected. The orange wedge shows the spread of values across all the States. The side of the wedge with the lowest value represents the State with the lowest value on the factor. The side with the highest value represents the State with the highest value.
- Note: To compare the State's contextual factors with those of its region, select the region link in the “My State Compared to” box in the upper right corner of the screen.
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18. All-State Data Tables for All Measures
This page allows you to download a data table that includes all measures for all States from the 2009 National Healthcare Quality Report and a data table including contextual factors for all States. Both data tables are downloadable in either Excel or XML format.
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19. Snapshot Print Version
This page provides State Snapshots data for the current and prior years in Adobe Acrobat PDF format. The State Snapshots PDFs assemble for each State all available data represented on this Web site for that State in a format that can be printed easily.
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For Additional Information
- Select Interpretation of Results on the left navigation bar for additional information on data and performance measurement issues, including types of measures available and factors that might affect performance rates.
- Select Methods on the left navigation bar if you want more details on how AHRQ develops the State Snapshot summary measures, classifies and scores State performance, and derives the calculations used in developing the measures.
- Select Technical Assistance on the left navigation bar for e-mail and Web site addresses to get help in using this tool or to send questions or comments about the State Snapshots.
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