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Executive SummaryIntroductionFindingsState RankingsNational FindingsCore MeasuresBehaviorsCommunity & EnvironmentPolicyClinical CareOutcomesSupplemental MeasuresState Summaries
Alabama
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United StatesAppendixCore MeasuresSupplemental MeasuresMethodologyModel DevelopmentAdvisory GroupThe TeamCopyright
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaUnited StatesAppendixCore MeasuresSupplemental MeasuresMethodologyModel DevelopmentAdvisory GroupThe TeamCopyrightRankings Calculation
For each measure, the most recent state-level data as of March 6, 2017, were obtained from secondary sources (Tables 5 and 6) and presented as the “value.” The score for each state is based on the following formula:
This score indicates the number of standard deviations a state is above or below the national value. A 0.00 indicates a state has the same value as the nation. States with higher values than the national value have a positive score, while states that perform below the national value have a negative score. To prevent an extreme score from exerting excessive influence, the maximum score for a measure is capped at +/- 2.00. If a U.S. value is not available from the original data source for a measure, the mean of all state values is used. If a value is not available for a state, the state’s score is set to zero.
The overall score is calculated by adding the products of the score of each core measure multiplied by its assigned weight (the percentage of the total overall ranking). Each of the five model categories is assigned a different weight (Table 7) and the weight for each measure within a model category is distributed equally among all the measures in the category. The overall ranking is the ordering of each state according to the overall score. The ranking of individual measures is the ordering of each state according to the measure’s value. Ties in values are assigned equal ranks. Not all changes in rank are statistically significant.
Behavioral Risk Factor Surveillance System Measures
Behavioral Risk Factor Surveillance System (BRFSS) data are analyzed using STATA v14.2 to account for the complex survey design. Data are limited to adults aged 65 and older. Responses of “refused”, “don’t know” or “not sure” are excluded from the analysis, but are reflected in standard error and confidence interval estimates. Prevalence estimates are also calculated by sex, race, education and income subpopulations. Estimates are suppressed if the denominator is less than 50 or the relative standard error is greater than 30 percent. For calculating subpopulation estimates, the population of interest is specified in a manner that avoids deletion of cases and ensures an accurate estimation of variance.
BRFSS data are based on self-report and exclude those without a telephone and those who are institutionalized. Dental visit, falls, health screenings, pain management and teeth extractions are collected biennially.
Calculated Variables
Community support, home-delivered meals, home health care and Supplemental Nutrition Assistance Program (SNAP) reach are calculated measures based on data from two different sources (Table 5). The numerator data for community support and home-delivered meals are from the U.S. Department of Health and Human Services, Administration on Aging, State Program Reports. For home health care, the numerator data are from the U.S. Bureau of Labor Statistics. For SNAP reach, the numerator data are from the U.S. Department of Agriculture, Food and Nutrition Service. The denominator data for all four variables are from the U.S. Census Bureau’s American Community Survey for the matching data year and population characteristics (e.g., 60 years and older living in poverty). Because the numerator and denominator come from different sources, it is possible for states to have values greater than 100 percent. This occurs in SNAP reach when the estimate of eligible people (denominator) is lower than the estimate of participants (numerator). This should not be interpreted to mean that all eligible persons are participating in SNAP.
Healthcare-associated infection (HAI) policies is the percent of 24 HAI reporting and data validation policies a state has in place according to the Centers for Disease Control and Prevention’s National and State HAI Progress Report. The policies assessed in the report fall under the following four categories: State has a reporting mandate, state health department has access to the data, state checks the data for quality and completeness, and state reviews medical records to determine accuracy. To create the measure, we counted the number of policies that are in place for each of the six types of HAI: Central-line associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections (abdominal hysterectomy and colon surgery), and laboratory identified hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections and Clostridium difficile infections. The best possible score is 100 percent, meaning the state has all 24 policies in place (i.e. all four policies in place for each of the six HAI types).
Data Considerations
Data presented in this report are aggregated at the state level and cannot be used to make inferences at the individual level. Values and rankings from prior years are updated on this website to reflect known errors or updates from the reporting source. Therefore information appearing in this edition compared with prior printed editions may be different.
The prescription drug coverage data used in the 2016 edition were from 2012; the data in this edition are from 2014. A data update for home health care was not available from the Bureau of Labor Statistics prior to our 2017 data deadline.