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

The Network for Regional Healthcare Improvement and four of its member regional health improvement collaboratives (RHICs) in Colorado, Massachusetts, Oregon and Utah, are partnering with the National Bureau of Economic Research (NBER) and Harvard University in a study funded by the Agency for Healthcare Research and Quality (AHRQ).The goal of this study is to better understand the characteristics of delivery systems to create a national model that contributes to better health care at lower costs.

During the study, the RHICS will analyze extensive information including cost and quality data, and delivery system structures and characteristics to identify which health care delivery systems in their region or state deliver high quality, affordable care, and more importantly, how and why.

The four RHICs participating in this initiative are:

Understanding how and why variations occur locally will in turn help inform research and policy decisions at a national level.

In- and across-state comparisons: The four RHICs are analyzing insurance claims data to calculate a common set of quality and cost measures. The RHICs will calculate results at various levels of geographic and organizational granularity. Throughout the study, the RHICs will work together to grow their internal quality and cost measure-set and to establish consistency of system and measure definitions.

System characteristics impact: Using information from their provider directories and leveraging their local relationships and knowledge of the marketplace, the RHICs will identify factors that impact cost and quality variations. Factors will include: payment models, formal or informal contracting arrangements, rural versus urban settings, and system integration and consolidation.

Regional collaboration and alignment: This project is an opportunity to build regional capacity to conduct research across and within states, while accommodating and learning from local variations.

The team is currently measuring quality variations across the four states using a common measure set for pediatric, behavioral health, and preventive care. Initial measures included:

  1. Developmental screening for the first 36 months of life
  2.  Follow-up care for children prescribed Attention Deficit Hyperactivity Disorder (ADHD) medication
  3.  Adolescent well-care visits
  4.  Anti-depressant medication management
  5.  Hospital admissions for ambulatory-sensitive conditions- acute composite
  6.  Hospital admissions for ambulatory-sensitive conditions- chronic composite
  7.  Avoidance of antibiotic treatment in adults with acute bronchitis
  8.  Chlamydia screening

State specific results to be released in the Fall of 2017.


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: Stacy Donohue, Senior Director, Federal Programs, NRHI, .