Menu

Please note, pages have been optimized for Chrome, Firefox, Edge, and Safari.

NHQDR Methodology Report

Methods Used on the Website of the National Healthcare Quality and Disparities Reports

Contents

 

Overview


return to contents      next section

The integrated National Healthcare Quality and Disparities Reports (NHQDR, previously NHQR/NHDR) website provides comprehensive information about healthcare developments and overviews for policymakers, legislators, and reporters. It also contains detailed data tables for researchers. Comparative information, such as trends over time and current distance from achievable benchmarks, is easily accessible. The user can also "drill down" to more detailed information to demonstrate connections between the broader and more elemental levels.

The design of this website was based on recommendations from the National Academy of Medicine (NAM) (formerly Institute of Medicine [IOM]) on how to improve upon the NHQDR reports and related products. The aim was to facilitate greater impact regarding quality improvement and disparities elimination. A few key goals served as the foundation of the integrated NHQDR website design:

  • Bring together the NHQDR and related products in a way that produces a cohesive story about healthcare quality.
  • Present information in forward-looking and action-oriented formats.
  • Highlight equity as an integral part of overall quality, rather than as a separate storyline.
  • Present data as a solution to healthcare disparities, with prospects for evidence-based practices.
  • Improve overall navigation and usability of the site for various audiences.

The NHQDR website integrates information that was previously accessible from three different websites: National Healthcare Quality Report, National Healthcare Disparities Report, and State Snapshots. 

The following features were added to address the NAM recommendations:

  • Benchmarks based on performance of the top 10 percent of States, to encourage achievable goals
  • Displays that provide consistent definitions and comparisons across national and State levels
  • Displays of racial and ethnic comparisons, as a part of the larger quality evaluation
  • Provision of subject areas and topics that simplify access to the data and information

This Methods Report includes the following sections:

  • An overview of the organization and presentation of materials
  • An introduction to each of the five sections of the integrated NHQDR website—Reports, National View, State View, Data Query, and Resources
  • A description of the methods behind the various graphics and data presentations within the five sections


return to the top of this section

What’s New


return to contents      next section

This section covers major changes on the website, data, and analysis methods, with the newest changes first.

2021 Report

In calendar year 2021, the Agency for Healthcare Research and Quality (AHRQ) decided to rename the reports to reflect the year in which they are published. Previously, the report year was the year before the report. Therefore, the most recent report is the 2021 NHQDR, which was prepared and published during 2021. The 2019 NHQDR was prepared and published in 2020. There is no report titled the 2020 NHQDR.

National View and State View: More population subgroups were added to the Priority Population subject area. Starting in 2021, the Priority Population subject area includes age (children, young adults, middle aged adults, and elderly adults), gender (female and male), race/ethnicity (American Indian/Alaska Native, Asian, Black, multiple races, Native Hawaiian/Pacific Islander, Hispanic), and disability status of adults (with or without disability).

Income: Prior to 2021, low income and high income topics were under the Priority Population subject area, where "low income" referred to people living in households with incomes below the Federal Poverty Line (FPL). Starting in 2021, income is defined as a separate subject area with four levels. In most of the source data, poor (or negative/poor) refers to household incomes below the FPL; low income (or near poor/low) refers to incomes from the FPL to just below 200% of the FPL; middle income refers to incomes from 200% of the FPL to just below 400% of the FPL; and high income refers to incomes 400% of the FPL and over.

Residence Location: Prior to 2021, residents of rural areas topic was under the Priority Population subject area. Starting in 2021, Residence location is defined as a separate subject area with six levels: large central metro, large fringe metro, medium metro, small metro, micropolitan, and noncore. Source data with only metropolitan statistical area (MSA) and Non-MSA are excluded. Residence location is based on the 2013 NCHS Urban-Rural Classification Schemas for Counties (URCSC) for data from 2016. Data from earlier years were based on the 2006 NCHS URCSC. For more information, visit http://www.cdc.gov/nchs/data_access/urban_rural.htm.

Disability Status: Prior to 2021, adults with basic activity limitations and adults with complex activity limitations were measured by activity limitations. Basic activity limitations refer to problems with mobility and other basic functioning, including problems with self-care, domestic life, and activities dependent on sensory function. Complex activity limitations refer to limitations encountered when the person, in interaction with his or her environment, attempts to participate in community life, including limitations experienced in work; and in community, social, and civic life. These two categories are not mutually exclusive; people may have limitations in basic activities and in complex activities.

Starting in 2021, adult disability status was defined using the methodology of the American Community Survey, which was different from the activity limitation definition used in the 2007-2018 NHQDRs. Adults were defined as with disability if they reported a serious difficulty in hearing, serious difficulty in vision, serious cognitive difficulty, serious difficulty in walking or climbing stairs, difficulty in dressing or bathing, or difficulty in doing errands. Adults without any of the difficulties were defined as without disability. The disability status data for the 2021 report are limited to Medical Expenditure Panel Survey (MEPS) and National Health Interview Survey (NHIS) data only.

Data Limitations and Changes: In 2021, the Healthcare Cost and Utilization Project (HCUP) State data were included for 27 core measures. Therefore, overall State dashboard and benchmark comparison results under the State View may have changed in 2021, as compared with 2017-2019 when the HCUP State data were not unavailable due to the transition from ICD-9 to ICD-10 coding standards that occurred on October 1, 2015. The HCUP benchmark values were available for benchmark comparisons under the National View in 2019. About 40 HCUP-based core measures were still not included in the 2021 national trend analysis because less than 4 years of ICD-10 claims data were available.

In 2021, 18 core measures based on the MEPS data were excluded from trend analysis because of the 2018 MEPS redesign in 2018. Of the 18 measures, 4 NHQDR measures were removed from the report because the survey items they are based on were dropped from MEPS and the NHQDR and 7 measures were converted to supplemental measures due to survey questionnaire changes. These 11 measures were also excluded from all trend and subgroup analysis. Another seven measures were excluded from the trend analysis, but included in the subgroups comparison, due to survey question changes and large differences between the 2018 data and earlier data.

Ten core measures based on 2019 NHIS data were excluded from trend analysis because of the 2019 NHIS was redesigned. Measures with 2019 data were included in the subgroup comparisons within the 2019 data. Due to the changes in questionnaires (e.g., altered skip patterns), 2019 data were not available for an additional eight core measures. For these eight measures, 2018 data were used for subgroup comparisons and 2000-2018 data were included in the trend analysis.
 

More details about the HCUP, MEPS, and NHIS measures are available in the data "Analysis Limitations" section in the Introduction and Methods document.

2019 Report

Data Limitations and Changes: Before 2018, the NHQDR had about 50 core measures using HCUP data. However, the HCUP State data and trend data were not available for the 2019 report due to the change from ICD-91 diagnosis codes to ICD-10 codes and changes to the AHRQ Quality Indicators (same as the 2018 report). Different from the 2018 report, HCUP risk-adjusted benchmarks were used for some of the Quality Indicators for subgroup comparisons under the National View panel. National data and State data are available for the two HCUP opioid measures.

Behavioral Risk Factor Surveillance System data became available for the 2019 report and were included in all analyses.

MEPS activity limitation data were not available for the 2019 report nor for the website.

2018 Report

The "Opioids" panel was new for the 2018 report. This panel provides data, analytic results, charts, and State quartile maps for measures related to opioid use or abuse. Users can select a measure on the first page and look for more details by selecting demographic areas. The 2018 report has seven opioid measures; two are core measures and five are supplemental measures. The supplemental measures are included in the website analysis, not in the report.

Data Limitations and Changes: Before 2018, the NHQDR had about 50 core measures using Healthcare Cost and Utilization Project (HCUP) data. However, the HCUP State data and trend data were not available for the 2018 report due to the change from ICD-9 diagnosis codes to ICD-10 codes and Quality Indicator changes. Only 2016 national data were included on the website.

Data for about 20 nursing home care measures and 30 home health care measures were not available for the 2016 and 2017 reports. For the 2018 report, 2013-2016 data were available and were included in the comparisons as well as trend analysis.

Data availability may affect the analysis results for various reasons, including differences in properties of measures and source data and in population subgroups in the data tables.

Consistency Between the Report and the Website: Since 2016, we have been trying to make the analysis methods and results consistent between the website and the report. However, inconsistencies still exist. For 2018, nursing home data became available after the report was prepared and we decided to include them in the website data analysis. We also decided to include all data for the opioid supplemental measures in the website data analysis because opioid-related issues are a Department of Health and Human Services priority.

Benchmark Year: The benchmark year for the 2018 report did not move forward by 1 year. In previous years, the benchmark year usually moved forward by a year. The benchmark year was 2014 for the 2016 report, and 2015 for the 2017 report. For 2018, the benchmark year was still 2015. Because of this change, more measures, States, and subgroups reached the benchmark in 2018 compared with previous years.

2017 Report

Starting with the 2017 report, data for about 200 supplemental measures are included on the Data Query page. These measures are grouped in two additional subject areas and a number of topics:

  • Other Primary Measures
    • Composite Measures
    • Other Measures
  • Supplemental Measures
    • Access to Care
    • Person-Centered Care
    • Care Coordination
    • Effective Treatment
    • Healthy Living
    • Care Affordability
    • Patient Safety

1 ICD-9 is the International Classification of Diseases, Ninth Revision. ICD-10 is the 10th revision.
return to the top of this section

Organization of the NHDQR Measures Within the Integrated NHQDR Website


return to contents      next section

The NHQDR reports include approximately 250 core measures and 200 supplemental measures that are collected from more than three dozen organizations, including AHRQ, the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), and the Centers for Medicare & Medicaid Services (CMS). The term measure is used to define a specific metric, such as “Adults who received a blood cholesterol measurement in the last 5 years” or “Deaths per 1,000 adult hospital admissions with congestive heart failure.”

To facilitate the evaluation of comprehensive overviews and trends, the measures are categorized into 10 subject areas-

  • Priority Areas
  • Access to Care
  • Diseases & Conditions
  • Type of Care
  • Setting of Care
  • Priority Populations
  • Health Insurance
  • Income
  • Residence Location
  • Supplemental Measures

Supplemental measures are typically new measures, have limited data availability, or lack clear direction of preferred outcome. Data for the supplemental measures can be found on the Data Query page. Supplemental measures were excluded from all types of analysis. In general, the word "measures" indicates core measures only, excluding the supplemental measures.

"Residence Location" was excluded from State analysis because only two measures had valid data.

Each subject area is further divided into topics, which are provided in Table 1.

Table 1. NHQDR Integrated Website Subject Areas and Topics, 2021

Priority Areas

 

Patient Safety

Person-Centered Care

Care Coordination

Effective Treatment

Healthy Living

Care Affordability

Access to Care

 

Structural Access

Utilization

Diseases & Conditions

 

Cancer

Cardiovascular Disease

Chronic Kidney Disease

Diabetes

HIV and AIDS

Mental Health and Substance Abuse

Musculoskeletal Disease

Respiratory Diseases

Types of Care

 

Acute Care

Chronic Care

Prevention

 

Setting of Care

 

Ambulatory

Home Health-Hospice

Nursing Home

Hospital

Priority Populations

 

Children

Young Adults

Middle Aged Adults

Elderly Adults

Female

Male

American Indian/Alaska Native (AI/AN)

Asian

Black

Multiple Races

Native Hawaiian/Pacific Islander (NHPI)

White

Hispanic

Non-Hispanic White

With Disability

Without Disability

Health Insurance

 

Private

Public

Uninsured

 

Income

 

Poor

Low Income

Middle Income

High Income

Residence Location

 

Large Central Metro

Large Fringe Metro

Medium Metro

Small Metro

Micropolitan

Noncore

Supplemental Measures

 

Access to Care

Person-Centered Care

Care Coordination

Effective Treatment

Healthy Living

Care Affordability

Patient Safety

 

 

Measures are often included in more than one subject areas and topic areas. For example, the measure “Adults who received a blood cholesterol measurement in the last 5 years” is included under the Cardiovascular Disease within Diseases and Conditions, under Prevention within Type of Care, and under Ambulatory within Setting of Care.

For all of the subject areas except Priority Populations, Health Insurance, Income, and Residence Location, the topic areas align with the chapters in the annual NHQDR publication. The measures that are reported under Priority Populations, Income, Residence Location, and Health Insurance are limited to those that have sufficient data to include them as a reporting category.


return to the top of this section

Available Comparisons


return to contents      next section

Within the different subject areas and topics, the integrated NHQDR website presents three types of comparative information-

  • National and State-level comparisons with achievable benchmarks
  • National trends over time
  • State-level comparisons with the national overall estimates (i.e., State Snapshots)

National trends are always highlighted in the NHQDR reports. State-level comparisons with national overall estimates had been highlighted in the State Snapshot. The addition of the comparison with achievable benchmarks was based on the IOM recommendations to promote best-in-class achievement at both the national and State levels.


return to the top of this section

National and State-Level Comparisons With Achievable Benchmarks


return to contents      next section

Comparisons with achievable benchmarks are made against standards based on the performance of the top 10% of States. These standards are considered achievable because they have already been attained by the best performing States.

State-level benchmarks are only determined for NHQDR measures that have State-level data for at least 30 States. The benchmark for a measure is calculated as an average of the top 10% of reporting States. For example, if data from 50 States are available for a measure, then the benchmark is the average of the measure estimate across the best five States. States without 2013 or later data were excluded from the benchmark calculation for the 2016 report. For the 2017 and 2018 report, 2015 data were selected first if available; otherwise, 2016 or 2014 data were selected.

Measure estimates for the national overall, national topics, State overall, and State topics are compared with the State-derived benchmark for that measure. Based on this comparison, national and State-level measure estimates are assigned to one of three categories: achieved the benchmark or better, close to the benchmark, or far away from the benchmark. These categories are defined below.

  • Achieved the benchmark or better. The value for a measure is at least 90% of the benchmark value. This includes the case in which the measure's value is equal to or better than the benchmark.
  • Close to the benchmark. The value for a measure is between 50% and 90% of the benchmark (i.e., the value for a measure is at least 50% of the benchmark value but has not reached the 90% criterion for having achieved the benchmark).
  • Far away from the benchmark. The value for a measure has not achieved 50 percent of the benchmark.

When comparing estimates with the benchmarks, one critical consideration is the direction of the outcome. Specifically, a low value is the desired outcome for some measures, such as mortality, unmet needs, and communication problems. In contrast, a high value is the desired outcome for other measures, such as receiving recommended tests or reporting good communication. Consider a measure in which a low number is desired, such as “Adults who needed to see a specialist in the last 12 months who found it difficult to see a specialist.” If the benchmark is 18.1 and the national estimate is 14.6, then the measure achieved the benchmark—its value is 19% lower than the benchmark (the preferred direction). If the national estimate is 22.0, then it would be considered close to the benchmark—its value is 20% higher than the benchmark. If the national estimate is greater than 27.2, the measure would be considered far away from the benchmark—its value is more than 50% larger.


return to the top of this section


return to contents      next section

National trends are determined for NHQDR measures with at least 4 years of data. The time span can vary across measures depending on how frequently data for the measures are collected. For example, measures based on data collected annually can be reported as trends after 4 years, while measures based on data collected every other year can be reported as trends after 8 years. Beginning with the 2016 report, the average annual percent change (AAPC) has been estimated using unweighted log-linear regression.

Model: ln(M) = β0 + β1Y,
where ln(M) is the natural logarithm of the aligned rate, β0 is the intercept or constant, and β1 is the coefficient corresponding to year Y

  • Interpretation:
    • Improving = Average annual percentage change >1% per year in a favorable direction and p <0.10.2.
    • Worsening = Average annual percentage change >1% per year in an unfavorable direction and p <0.10.
    • No Change = Average annual percentage change ≤1% per year or p ≥0.10.


return to the top of this section

State Snapshot Comparisons


return to contents      next section

Under State View Snapshot, each State’s overall performance is compared with the national overall estimate. State performance for a priority population (e.g., women, children) is also compared with the national overall estimate, not the national estimate for the priority population. This approach is in contrast to the comparison with an achievable benchmark in which the comparison is with the average of the top 10% of States.

The national overall estimate is the estimate from micro data. If it is not available, the all-State average is calculated as the national overall estimate.

For each measure, State performance is categorized as better-than-average, average, or worse-than-average relative to the national overall estimate.

These comparison categories are defined based on a statistical test for differences:

  • Better-than-average. The State rate on an NHQDR measure is better than the national overall estimate, and that difference is statistically significant.
  • Average. The State rate on an NHQDR measure is not statistically different from the national overall estimate.
  • Worse-than-average. The State rate on an NHQDR measure is worse than the national overall estimate, and that difference is statistically significant.

Beginning with the 2016 report, two criteria have been used to define the difference between the State rate and the national overall estimate:

  • The absolute difference must be statistically significant with p <0.05 on a two-tailed test.
  • The relative difference must be at least 10% when framed negatively.

Across a group of measures within a subject area and topic, each State receives a performance meter score. First, points are assigned to each measure as follows:

  • 1 point for each State-level measure that was better than the national overall estimate
  • 0.5 points for each State-level measure that was average, relative to the national overall estimate
  • 0 points for each State-level measure that was worse than the national overall estimate

Next, the points are combined into a meter score:
((A*1) + (B*0.5) + (C*0)) * 100 A + B + C
2. A probability of 0.10 was selected as the significance level because the magnitude of the standard errors varied considerably by type of data.

Where
A = number of better-than-average NHQDR measures in the summary
B = number of average NHQDR measures in the summary
C = number of worse-than-average NHQDR measures in the summary

Example: North Dakota has 37 better-than-average measures, 61 average measures, and 11 worse-than-average measures. Thus, A = 37, B = 61, and C = 11.

(37 * 1) + (61 * 0.5) + (11 * 0)) * 100/(37 + 61 + 11)) = (37 + 30.5 + 0) * 100/109 = 67.5 * 100/109 = 6,750/109 = 61.93

Meter scores range from 0 (all measures are worse than average) to 100 (all measures are better than average). Scores between 0 and 100 represent the mix of measures that are worse than average, average, and better than average. Higher scores represent better performance, because the score increases with the number of measures that are average and increases more rapidly with the number of measures that are better than average.

A 180-degree colored semicircle divided into five categories is used for visual presentation of the data. The five categories are:

  • Very Weak: 0 ≤ score < 20
  • Weak: 20 ≤ score < 40
  • Average: 40 ≤ score < 60
  • Strong: 60 ≤ score < 80
  • Very Strong: 80 ≤ score ≤ 100

The meter score for a given measure is depicted on the semicircle as a performance meter arrow as shown in Figure 1. A solid arrow is used for the most recent year of available data, if at least five measures are available. A dashed arrow is used to show performance for the baseline year, when the baseline has more than two-thirds of the measures available in the most recent year. This criterion is applied to ensure similar comparisons between the baseline and the most recent year. For the 2016 report, measures with the latest year before 2013 were excluded from the most recent year’s comparison.

The State overall meter scores are more reliable and stable than the State topic scores mainly because the number of measures with valid data for each topic within a State is usually much smaller than that for the State overall. The number of data years and measure types with valid data may also affect the meter scores. Please keep these factors in mind when interpreting the meter scores and check the underlying data for details.

Figure 1: Performance Meter

Performance Meter showing an average score for most recent data year and baseline year
 

return to the top of this section

National View


return to contents      next section

The National View section of the NHQDR integrated website provides an overview of performance across NHQDR measures. This perspective shows areas of strengths and weaknesses at a glance. This section provides two types of comparative information:

  • Comparison with “achievable benchmarks” for current data
  • Trends over time

This information is available across all NHQDR measures and by subject area and topic if data are available.

Comparisons With Achievable Benchmarks

On the National View page, there are comparisons with achievable benchmarks across all measures, which are organized in several categories, by measure areas, and by topics. The methods for the benchmark comparison are detailed under the section of this report titled National and State-Level Comparisons With Achievable Benchmarks.

The first summary graphic displays the total frequencies of each category of achievement (Figure 2). If a measure does not have an available benchmark (i.e., no State data from which to calculate a benchmark), it is not represented in the summary graphic. In the example in Figure 2, benchmarks are available for 137 measures: 22 measures that are far away from the benchmark, 47 measures that are close to the benchmark, and 68 measures that have achieved or performed better than the benchmark.

Figure 2: National View Benchmark Summary, All Measures

National View Benchmark Summary - All Measures

The second summary graphic displays the total frequencies of each category of achievement by race and ethnicity (Figure 3). For measures that report data, the comparison to benchmarks is provided for individuals who are American Indian/Alaska Native, Asian, Black, Native Hawaiian/Pacific Islander, White, Hispanic, and non-Hispanic White.

Figure 3: National View Benchmark Summary, by Race and Ethnicity

National View Benchmark Dashboard - By race and Ethnicity

The third (final) summary graphic displays the total frequencies of each category of achievement by income (Figure 4). For measures that report data, the comparison with benchmarks is provided for people living in poor, low- income, middle- income, and high- income households or communities.

Figure 4: National View Benchmark Summary, by Community Income

National View Benchmark Dashboard - by Community Income

 

The user can obtain information about (1) which measures are included in the different benchmark achievement categories and (2) the value of the achievable benchmarks, by using the Benchmark Achievement filter and reviewing data under “View Underlying Data” An example is provided in Figure 5.

Figure 5: Data Table Underlying the Achievable Benchmark Bar Charts

Data Table Underlying the Achievable Benchmark Bar Charts

return to the top of this section

Trends Over Time


return to contents      next section

Within the National View, the user may also view summary results of trending over time over all measures and by measure areas and topics. The methods for the trend comparison are detailed under the section of this report titled National View. Since the 2016 report, the trending method is the same as for the report.

The trends summary graphic displays the total frequencies of each category of achievement. Measures that do not have at least 4 years of data to document the trend are shown in the “Data Not Available” column. Select a topic to get the trend summary graphic for each topic. In Figure 6, there are 92 measures showing improvement over time, 72 measures with no change, and 16 measures worsening over time. There is no trending information for 59 measures, which represent 24.6 percent of all of the measures in this figure— 59/(59 + 92+72+16). 

Figure 6: National View Summary of Trends in Measures Over Time

National View Summary of Trends in Measures Over Time

The user can obtain information about (1) which measures are included in the different achievement categories and (2) the annual average percent change, by using the Trend filter or viewing the “View Underlying Data” table. An example is provided in Figure 7.

Figure 7: Data Table Underlying the Trend Bar Charts

Data Table Underlying the Trend Bar Charts

return to the top of this section

State View


return to contents      next section

The State View section of the NHQDR integrated website is similar to the National View in that it provides an overview of performance across NHQDR measures and by measure areas and topics. In addition, it provides an overview of a State’s overall performance and a State’s performance for each topic. This approach allows the user to see each State’s areas of strengths and weaknesses at a glance. This section provides two types of comparative information:

  • Comparison with “achievable benchmarks” for current data
  • State Snapshot comparisons with national estimates

This information is available across all State-level measures and by subject area and topic.

Users begin by selecting a State from the State filter drop-down box (Figure 8).

Figure 8: State View State Selection 

State View - State Selection

return to the top of this section

State Comparisons With Achievable Benchmarks


return to contents      next section

Similar to the National View page, the first comparative graphic under State View is a summary of quality measures compared with achievable benchmarks. Three summaries are available: across all State-specific measures, by race and ethnicity, and by income. Summary by race/ethnicity is also available by default. Select a measure area, then a topic for summary results for a particular topic.

The methods for the benchmark comparison are detailed under the section of this report titled National and State-Level Comparisons With Achievable Benchmarks.

The first summary graphic displays the total frequencies of each category of achievement, where State-specific data and benchmarks are available (Figure 9). If a measure does not have an available benchmark, it is not represented in the summary graphic. In the example in Figure 8, benchmarks are available for 129 measures reported for the State: 27 measures that are far away from the benchmark, 33 measures that are close to the benchmark, and 69 measures that have achieved or performed better than the benchmark.

Figure 9: State View State Summary Graphic Compared With Benchmarks

State View State Summary Graphic Compared With Benchmarks

The second summary graphic displays the total frequencies of each category of achievement by race and ethnicity (Figure 10). For measures that report data for the selected State, the comparison with benchmarks is provided for individuals who are White, Black, Hispanic, and Asian and Pacific Islander.

Figure 10: State View Benchmark Summary, by Race and Ethnicity

State View Benchmark Summary by Race and Ethnicity

The third (final) summary graphic displays the total frequencies of each category of achievement by community income (Figure 11). For measures that report data for the selected State, the comparison with benchmarks is provided for people living in poor, low- income, middle- income, and high- income households or communities.

Figure 11: State View Benchmark Summary, by Community Income

State View Benchmark Summary by Community Income

The user can obtain information about (1) which measures are included in the different achievement categories and (2) the value of the achievable benchmarks, by selecting the Population Group, and Achievement Benchmark viewing the “View Underlying Data.” table. An example is provided in Figure 12.

Figure 12: Data Table Underlying the Achievable Benchmark Bar Charts

Data Table Underlying the Achievable Benchmarks Bar Charts

return to the top of this section

State Snapshot


return to contents      next section

The State Snapshot Dashboard provides insight into a selected State’s performance overall or by topic within a State by comparing it with the national average for the available measures. The methods for the State Snapshot are detailed under the section of this report titled State Snapshot Comparisons.

Figure 13 shows the State Snapshot performance meter for a sample State. The user can see that the State performed better in the most recent data year than it had performed in the past (baseline year) for the "Adult hemodialysis patients who use arteriovenous fistulas as a primary mode of vascular access" measure. The most recent score was 69.8, which is better than its baseline score of 65.7. In addition, the State’s performance is in the “average” range relative to the comparisons with the all-State averages. Beneath the performance meters, there is a table that lists the meter score based on the filter selections. The data table can be filtered by State. Select a measure area and a topic under “Subject Area” and "Topic" for summary results for a particular topic.

Figure 13: State Snapshot Performance Meter

State Snapshot Performance Meter

The user can obtain information about (1) which measures are included in the performance meter score and (2) the average annual percent change, by sorting the Recent Performance column in the “View Underlying Data” table. An example is provided in Figure 14.

Figure 14: Data Table Underlying the State Snapshot Performance Meter

Data Table Underlying the State Snapshot Performance Meter

return to the top of this section

State Dashboard


return to contents      next section

The State Snapshot Dashboard provides “snapshot” information across all subject areas and topics on one web page. The first graphic is the State Snapshot performance meter across all available State-level measures. Next, rectangular versions of the performance meter present information on each subject area and topic. The methods for the State Snapshot meters are detailed under the section above called State Snapshot Comparisons.

Figure 15 shows a portion of a sample State Snapshot Dashboard. The inverted triangles (black) indicate performance in the most recent data year; the regular triangles (translucent) indicate performance in the baseline year. The State’s performance improved in the areas of cancer and chronic kidney disease. Performance declined for mental health and substance use disorders.

For cancer, the State’s performance improved from the weak range to the average range from the baseline to the most recent year. Quality performance in the areas of respiratory diseases has not changed from the baseline year to the most recent year, as indicated by two triangles in the same location. The meters for HIV/AIDS and for diabetes do not have a baseline year for comparisons. If a topic is not displayed this is because the State has no data on these measures.

Figure 15: Example of a State’s Dashboard Meters

State Snapshot Dashboard for Maryland by Diseases & Conditions with Chronic Kidney Disease selected depicted in a shaded bar graph

return to the top of this section

Data Query


return to contents      next section

The data query section of the NHQDR integrated website provides capabilities that allows the user to view individual measures rather than summaries of performance. Figure 16 shows a view of the "Data Query Tool" filter selections available. The user has options to view measures available for National Trends, National Categories, National Disparities, State Trends, and State Categories. 

  • Geographic area - National or a State is noted on the buttons for selection, including National Trends, National Categories, National Disparities, State Trends, State Categories.  
  • Subject Area - filter by diseases and conditions, priority populations, health insurance, access to care, types of care, or settings of care
  • Topic - filter within a Subject Area. 
  • Measure - filter by specific measures available. Type keyword text within the box directly to locate measures with specific text. 
  • Category - Refine table and graph results using Categories available per measure for National Categories, National Disparities, and State Categories. 

These selections define the list of available measures. Only one measure can be selected at a time. The user can choose to examine the measure over time (Trending) or by Categories as well as a Dispartities focus. The available categories and filters depend on the available data reported to the NHQDR from the original data source. 

Figure 16: Data Query Filters

Data Query Filters

Based on the user’s selections, the data query dashboard will return an underlying data table of the information. The information is a subset of the rows in the full NHQDR data table for the chosen measure. The results of a query on the National measure “Adult current smokers with a doctor's office or clinic visit in the last 12 months who received advice to quit smoking” are shown in Figure 17. 

Links for the measure source and specification are available by selecting the “Download Data” button under the data table. 

Figure 17: Data Query Table Results

Data Query Results

Users can view a graphical depiction of the selected data query above the data table. When the query is specific to trends over time, a line graph is displayed (Figure 18). When one or two categories are selected, bar graphs are used to depict the data.

Figure 18: Data Query Graphic for Results by Category

Data Query Graphic for Results by Category

return to the top of this section

Reports

return to contents      next section

The Reports section of the integrated NHQDR website allows access to the following:

This section links to the files of the most recent NHQDR and to the web pages for previous reports. Chartbooks include focused data on the NHQDR priority areas and various priority populations. The section on Related Reports links to reports from IOM, AHRQ, CDC, and the National Academy for State Health Policy that relate to access, disparities, and other issues germane to the NHQDR.

Data Spotlights present data on specific areas of interest, such as infant mortality. Fact Sheets include additional information on AHRQ research topics and programs, such as children's health, computers and medical informatics, coronary artery disease, diabetes, healthcare costs, health literacy and cultural competency, hypertension, and patient-centered care.

return to the top of this section

Opioids

return to contents      next section

The "Opioids" section was added in the 2018 report to facilitate access to data, trend results, graphs, and State quartile maps of measures related to opioid use. The bar chart on the front page is the national overall trend result, showing the number of measures that have been getting worse, staying the same, or getting better. The analysis method is the same as the national trend analysis described under the section of this report titled National Trends Over Time.

For detailed data by population characteristic or by State, graphs, and state maps, users can select an individual measure under the Opioid Resources table below. Supporting tables, measure specifications, and data source descriptions are also linked for each measure.

Figure 19: Opioid Measures National Overall Trend Results

Opioid Bar chart Graphic for Measures Getting Worse and Better

 

Opioid Measures Table with Estimates for those Getting Worse; Staying the Same; Getting Better; and No Trend Data

 

return to the top of this section

Resources

return to contents

The Resources section of the NHQDR integrated website contains a catalog of publications and web tools. These resources provide information that is useful to quality improvement and disparities reduction activities. They are categorized into seven focal areas— 

  • Raising awareness
  • Collecting data
  • Analyzing data
  • Reporting data
  • Identifying best practices
  • Tracking success
  • Focusing on specific vulnerable populations

The source, title, and a brief description are provided for each resource. Figure 20 shows an example of the resources for addressing disparities and improving quality under Focusing on Specific Vulnerable Populations.

Figure 20: Selection of Resources for Addressing Disparities and Improving Quality "Focused on Specific Vulnerable Populations"

Graphic image depicting the Resources Information feature.

 

return to the top of this section

Z-Test Calculator

ESTIMATE 1
 
ESTIMATE 2

 

 
RESULTS
Standard Error:
z Statistic:
p-value (two-tail):