Local Health System Performance Report

A Commonwealth Fund report shows widely divergent results on measures of health care quality across the United States.   (Commonwealth Fund Report)   For analysis purposes the country was divided into the 306 hospital referral regions and 43 measures in dimensions such as access, prevention & treatment, potentially avoidable hospital use and cost and healthy lives were assessed in each region for the time period of 2008 to 2010.  Three of the four top performing regions were in Minnesota and most of the bottom ten are in the south, however, results do not appear to be adjusted for regional socio-demographics or health habits.  The data was drawn from a variety of sources, including Medicare files and a large database of privately-insured individuals.  There was very substantial variation across regions on almost all of the measures, for example, the rate of potentially preventable deaths before age 75 varied by a factor of more than three from the highest performing to worst performing region.  The results suggest a connection between access to care difficulties and lower quality and outcomes.

As might be expected, parts of Massachusetts have the lowest percent of people without insurance and parts of Texas have the highest percent, at almost half the population.  Unsafe medication prescribing among Medicare beneficiaries was as high as 44% in a region in Louisiana, compared to only 11% in a New York region.  Hospital admission rates for common conditions such as diabetes and pneumonia were also enormously variable.  Even within states there can be great swings in performance among different referral regions.  Spending for Medicare and privately-insured persons both showed great variation, but not by the same pattern; a high-spending Medicare region is not necessarily a high-spending private insurance one.  There is also significant change in performance in different sub-areas of the same large city.  And while the demographics of an area shows some relation to performance, even some poor areas had good results.  The report is interesting and should help especially poor-performing regions focus on the need to take action.