This study is also limited by the paucity of comparable data across
and within states regarding health outcomes and health-system
indicators. It would be desirable, for example, to examine indicators
such as diabetics in control, or hypertensives in control. Or, rather than
looking at readmission rates of Medicare beneficiaries, it would be
preferable to analyze hospital readmission rates limited to persons
under age 75. Currently, however, state-based rates of such indicators
do not exist. Efforts to identify and develop additional health-outcome
indicators that are sensitive to variations in performance as well as
sentinel health care-related factors related to outcomes would enable
local, state, and national public and private initiatives to target further
efforts to improve. It will require national initiatives to assure that
additional indicators are measured uniformly across states and
available in sub-state regions and metropolitan areas. The above notwithstanding, it may be possible within some states to examine
variation by area within the state. For example, in a state with several
million people, it may be possible to obtain sufficient data for each of
several metropolitan statistical areas to enable some comparison
between them.