Due to confusion in reading a chart, an earlier version of this story incorrectly referred to increases in pressure ulcers and pain levels at nursing homes and to a drop in re-hospitalizations of residents.
A state-by-state scorecard by the Commonwealth Fund Commission on a High Performance Health System rates Rhode Island as middling at best, with relatively high scores for prevention and for access to care, but low scores for avoidable hospital use and costs.
The scorecard also shows Rhode Island is slipping on several fronts, both in absolute terms and in comparison with other states, though it also improved in 16 of the 34 indicators.
Some of the most dramatic changes involve elder care, with dramatic drops in the share of high-risk nursing home residents with pressure ulcers (bedsores) – down 26.2 percent from the 2007 scorecard – and a 35-percent drop in the share of long-stay nursing home residents in moderate to severe pain, for example, but also a 20.2-percent increase in the 30-day re-hospitalization rate for nursing home residents.
Compared with other states, Rhode Island did best on access measures, ranking No. 1 for the share of at-risk adults who have gotten a checkup in the past two years – 93 percent in 2006/07, the best in the nation, versus a median of 84.1 – and for the share of children with both a medical and a dental preventive care visit in the past year, 85.3 percent versus a median of 71 percent.
Rhode Island did worst – ranked No. 49 – for the total single premium per enrolled employee at companies that offer insurance, $4,930 in 2008 versus a national median of $4,360. Ironically, however, the national median was up 17.6 percent from 2004, whereas the Rhode Island premium dropped by 12.9 percent.
Rhode Island also ranked 49th for Medicare hospital admissions for conditions that respond well to ambulatory care, with 8,893 per 100,000 beneficiaries in 2006/07, versus a national median of 6,291. The state is also improving on that front, however, with an 8.7 percent drop in the rate since 2003/04, the scorecard shows.
Overall, the scorecard shows large variations from state to state, with states that led in 2007 still generally continuing to lead and often setting new benchmarks. But across the country, health insurance coverage for adults declined, health care costs rose, and quality improved in areas where outcomes were reported to the public.
The report, “Aiming Higher: Results from the 2009 State Scorecard on Health System Performance,” identifies Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire as the nation’s top performers overall. A related report offers profiles of seven “high-performing” states.
“Leading states have raised the bar for better access, quality of care, and reducing disparities,” said study co-author Cathy Schoen, senior vice president of the Commonwealth Fund. “Where you live in the U.S. matters in terms of your health care, and it shouldn’t. These wide and persistent gaps among states highlight the need for national reforms and federal action to support states. National leadership has been critical for children – particularly for states with historically high rates of children uninsured – so we know that strong national efforts can make a real difference even in struggling states.”
The scorecard also quantifies the impact that could be made if all states reached the levels achieved by the top-performing states in each category. For example, 29 million more people would have health insurance, cutting the number of uninsured by more than half, and nearly 78,000 fewer adults and children would die prematurely every year from conditions that could have been prevented with timely and effective health care.
In addition, the report estimates that $5 billion could be saved each year by avoiding preventable hospital admissions and re-admissions for elderly and disabled residents.
The full report is available at www.commonwealthfund.org.
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I’m surprised this is considered “mixed results.” We are ranked 11th out of 50 states, which actually seems pretty good. We dropped in the rankings from 8th in 2007, but we improved performance on the majority of quality indicators measured. (Minnesota, Wisconsin, and North Dakota simply improved more than Rhode Island did.)
The report noted: “Thirteen states [including Rhode Island] again rose to the top quartile of the overall performance rankings. . . THough specific rankings shifted, these are the same group of states identified as top performers in the first State Scorecard two years ago. Many have been leaders in reforming and improving their health systems — for example by targeting efforts to reduce rates of uninsured adults and children.”
Surely this is something to be pleased about, and not “middling at best.”