State ranks near top
for flu shots

But Hawaii finishes last in colon
cancer screenings, according to
a nationwide study

Only Minnesota beats Hawaii for the percentage of residents 65 and older getting flu shots, according to a national study released today.

But Hawaii is in last place when it comes to the percentage of adults 50 and older getting a sigmoidoscopy or colonoscopy for colon cancer screening.

The 2004 National Healthcare Quality Report shows how states are performing on 100 measures of health care quality. It is based on data compiled for 2003 and 2002 by health plans, hospitals, nursing homes, home health and other agencies.

Dr. Carolyn Clancy, director of the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, announced the findings at a conference in Washington, D.C., called "Improving Health Care for All Americans."

In a telephone interview, Clancy said: "What's very striking but not at all surprising is every state has areas of strength and weakness.

"Similarly, no health care organization is getting it right. They, too, have strengths and areas needing improvement. When we go in the door (of a medical facility), we can't know it's all going to work well."

Hawaii tied with Tennessee for second place, with 75.5 percent of adults 65 and older getting flu shots in the 2004 study. Minnesota had 80 percent.

Hawaii also ranked above the national average in such areas as the percentage of adults who had their blood cholesterol checked in the past five years, the percentage of Medicaid patients hospitalized for pneumonia who got a blood culture before antibiotics, a smaller share of long-stay nursing home residents who have moderate to severe pain, home health patients who get better walking or moving around, and a low rate of colorectal cancer deaths per 100,000 population per year.

"One reason we made the state data available," Clancy said, "is at the end of the day, the national report is a little bit like watching weather patterns on TV."

The only way the data can be used is to understand what is happening locally, she said. "Our hope is Hawaii and every other state will take a look at where they are doing well and not doing well."

In some cases there could be factors to explain low scores, and more recent data might show improvements, she added.

She said she would not call the national health picture dismal, but the system "needs a lot of improvement. The gap between the type of care we could be providing and what we are providing routinely is very large."

She said only a modest improvement of 3 percent was seen from 2003 to 2004.

The biggest improvement was in nursing homes, which have been monitored by the Centers for Medicare & Medicaid Services, Clancy said.

"That shows the power and impact of that kind of monitoring. It's what's going to be needed in every state."

Hawaii was one of few states that scored better than the national average in most areas of care in a report issued for nursing homes in January.

Dee Dee Nelson, Hawaii director of the Mountain-Pacific Quality Health Foundation, which works with nursing homes to improve their care, attributes Hawaii's second-place ranking for senior flu shots to "a whole community working on it."

It is a collaboration between quality improvement organizations, the state Health Department and all providers, she said.

"What is interesting is we also collaborate with mammograms to get the word out, but they're still low."

People know what flu is, and they do not want to get it, Nelson said, but women think they will never be the one out of eight who gets breast cancer.

"We are working with providers to improve care in Hawaii, and we will continue working until we get 100 percent on everything," she added.