Health Care Delivery Systems Analysis: A study of health system variation across four states

The Network for Regional Healthcare Improvement and Regional Health Improvement Collaborative (RHIC) members in Colorado, Massachusetts, Oregon, and Utah partnered with the National Bureau of Economic Research (NBER) and Harvard University in the Comparative Health System Performance Initiative Study funded by the Agency for Healthcare Research and Quality (AHRQ). AHRQ funded 3 Centers of Excellence to study how healthcare systems promote evidence-based practices in delivering care.


  • The RHICs developed methods to comparatively study eight quality measures across systems and geographies, in addition to cost across geographies by standardizing measurement for disparate regional databases.
  • Research published in the May issue of The American Journal of Managed Care: Producing Comparable Cost and Quality Results from All-Payers Claims Databases. Read the article.
  • Development of a Uniform Data Structure (UDS) file format that can be scaled across populations, measures, and research dimensions to provide a consistent method of producing comparable findings across regions.

“Regional health improvement collaboratives are trusted, neutral conveners with rich access to, and unique knowledge of, local data,” said Craig Brammer, President and CEO, NRHI. “This project exemplifies the power of bringing RHICs together and demonstrating how their regional APCDs can be used to assess healthcare performance variation across states and regions producing data that can be used to affect healthcare policy.”

“While the CO APCD is uniquely suited to inform health care system opportunities within Colorado, there is so much more we can learn from the data when we’re able to make state by state comparisons,” says Ana English, CIVHC President and CEO. “Each state has unique health care market dynamics, demographics and public policies in place, and having the ability to make meaningful comparisons can help further Colorado’s efforts towards creating a high-value system.”

“Identifying a standard way to evaluate data between states is foundational to being able to learn from each other and make informed decisions at the state level,” states English. “This is just the beginning of many potential analyses that can positively impact the lives of Coloradans.”


NRHI and the RHICs are continuing to explore key issues to better understand delivery system variation across and within states. Current topics of study include:

  • Understanding pediatric care- quantity and quality in Colorado
  • Examination of the relationships between patient experience, care quality, cost and utilization in Massachusetts
  • Examination of the impact of “system-ness” on healthcare costs (resource utilization and price) in Oregon and Utah.


Other key work: The states assisted in administering The Dartmouth Institute’s National Survey of Healthcare Organizations & Systems (NSHOS) to health systems, hospitals, and practices in the 4 states to support the Dartmouth Center of Excellence in their goals to better understand strategies and tactics that are most important and most effective at improving health system performance.Results will be used to further the goals of this project.


This project is supported by grant number U19HS024072 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the political views of the Agency for Healthcare Research and Quality.

CONTACT: Ellen Gagnon, Executive Director, Member Services, .