Feds Hope to Improve Health Care With State Rankings

Which state ranks highest in giving flu vaccines to the elderly? That would be Minnesota. And which state ranks last in the percentage of women receiving prenatal care in the first three months of pregnancy? That would be New Mexico.

Such examples represent the federal government's latest effort to improve health care in the United States by making public comparisons.

Last week, the government unveiled a new Web site comparing the nation's hospitals to each other when it comes to treating patients with cancer or heart problems. On Monday, it released data from 2003 showing where states and the District of Columbia rank in 14 categories.

Besides prenatal care and flu vaccines for the elderly, the categories also include the percentage of Medicare patients hospitalized for pneumonia who got the right antibiotics and percentage of nursing home residents who have moderate to severe pain.

Officials at the Department of Health and Human Services say that showing states how they compare with their peers will bring extra emphasis in those categories where a state isn't doing well.

"As health professionals and as citizens, we should be feeling shock and awe when we see these chaotic differences in quality of care," said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality.

Officials did not compile the data in a way that would show which state did the best or the worst cumulatively for all 14 categories. Rather, they released what in effect is 51 separate reports — one for each state that shows how it fared in each of the categories against the national average.

For example, Idaho has the second-best score in the country when it comes to the number of colorectal cancer deaths per 100,000 residents. But it has the second-worst score nationally for the percentage of adults who had their blood cholesterol level checked in the last five years.

"There is no best state or worst state. Improvement is needed in every state," Clancy said.

The gap between states is not so glaring, she said, as the gap between knowledge and achievement. Health care officials know that older patients should get antibiotics promptly when they are hospitalized with pneumonia. Yet, even in the leading states only about three out of four such patients get antibiotics. And, in the lowest-performing states, less than half get antibiotics.

Don Berwick, president and CEO at the Institute for Healthcare Improvement, said he applauded the release of the data, but he said the government should also set goals and deadlines if it wants to improve health care in the United States. He said that the U.S. suffers from an "embarrassing gap" in the quality of its health care when compared to other western democracies.