Methodology
Zip Health Rankings
Several notable changes to the ZHR claims-based measures were implemented as part of the 2025 release to provide users with the most up-to-date definitions aligned with externally credible organizations. These included:
- Health Factor Domain, Clinical Care Sub-Domain: Replacing the outdated NYU Emergency Room algorithm for defining potentially avoidable ED utilization with five Agency for Healthcare Research and Quality Prevention Quality Indicators in Emergency Department Settings (PQEs). Details about the definitions of these measures can be found here: https://qualityindicators.ahrq.gov/measures/pqe_resources
- Health Outcome Domain, Quality of Life Sub-Domain: Adding seven new measures for conditions in the top 20 most prevalent conditions in Missouri defined using the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Warehouse (CCW), as well as two standalone cancers not previously included. New measures include anemia; anxiety disorders; atrial fibrillation; depression, bipolar, or other depressive mood disorders; endometrial cancer, fibromyalgia and chronic pain and fatigue; hyperlipidemia; hypothyroidism; and prostate cancer. Details about the definitions of these measures can be found here: https://www2.ccwdata.org/web/guest/condition-categories
- Health Outcome Domain, Quality of Life Sub-Domain: Adding a new mental health composite measure representing the sum of visits with diagnoses of anxiety disorders; depression, bipolar, or other depressive mood disorders; and inpatient diagnoses of mental disease and disorders (Major Diagnostic Category=19)
- Multiple Domains and Sub-Domains: Updating measures previously defined using HIDI legacy definitions to definitions curated by the following organizations: CMS CCW and AHRQ Clinical Classifications Software-Refined (CCSR). When definitions from these sources were not available, HIDI used definitions from its Enhanced Indicator Bundle set or ICD-10 diagnosis code ranges.
The anticipated impact on users is expected to be minimal; however, users may notice slightly higher or lower prevalence of conditions, depending on the measure, compared with prior years. Please contact exploreMOhealth@mhanet.com for additional details and questions.
County Health Rankings & Roadmaps (CHR&R)
CHR&R switched from a county rankings approach—where every county is ranked from most to least healthy in its state—to a grouping approach in 2024, the vintage of this year’s CHR&R data on exploreMOhealth. As a result, CHR&R no longer provides domain rankings or sub-domain Z-scores or rankings for each county. Instead, counties are assigned to one of ten groups for the health outcome and health factors domains. Details about the new methodology can be found in the CHR&R 2024 Technical Documentation. The exploreMOhealth site has been updated to align with the data available using this new methodology. Please contact exploreMOhealth@mhanet.com for additional details and questions.
exploreMOhealth offers several options for comparative analysis. First, state-level results are displayed alongside ZIP- and county-level data. Second, ZIP codes are ranked for each domain and subdomain using a unique methodology that was developed with funding from the Robert Wood Johnson Foundation and County Health Rankings & Roadmaps.
The exploreMOhealth platform is based on the population health model used by County Health Rankings & Roadmaps. The model is comprised of two overarching domains: Health Factors and Health Outcomes. Health Factors are influenced by local policies and programs, and subdomains include Health Behaviors, Clinical Care, Social and Economic Factors, and the Physical Environment. Health Outcomes are influenced by Health Factors, and subdomains include Length of Life and Quality of Life.
The platform features demographic data from the U.S. Census and hospital discharge data that are specific to Missouri. The county-level health indicators are provided by County Health Rankings & Roadmaps. The ZIP-code level data are provided by the Hospital Industry Data Institute and Washington University School of Medicine through the Missouri ZIP Health Rankings Project. More information on the data is available here.
The ZIP code-level data included in the most recent version of the site are based on hospital discharges occurring between fiscal years 2022 and 2024 (October 1, 2021 through September 30, 2024), and the 2023 American Community Survey of the U.S. Census. The previous versions of the ZIP Health Rankings data are also available in the Map Room, or for download.
The data are available on exploreMOhealth at the county- and ZIP-code levels, however you can identify counties and ZIP codes included within larger geographic areas such as state Senate Districts to compare variation within these areas.
Yes, the reports generated by exploreMOhealth feature detailed descriptions of the data they contain. Information on the limitations of the ZIP-code data may be found on pages 7-8 of Nagasako, et al. (2018). Additional information on the reliability and statistical uncertainty of the County Health Rankings & Roadmaps data is available on the CHR&R Data Quality page.
A Z-score is a standardized measure of the number of standard deviations each rate lies from the mean. Positive values indicate a higher than average rate for the ZIP code, while negative values indicate a lower than average rate.
The ZIP codes used on exploreMOhealth are based on ZIP Code Tabulation Areas, the U.S. Census Bureau’s geographic approximations of U.S. Postal Service ZIP codes.
The name used by the U.S. postal service for each ZIP code is provided for spatial context. In many cases, a ZIP code may encompass additional unnamed communities, however the name of the ZIP code is typically attributed to the largest, and/or most centrally located community within the ZIP code.
ZIP code boundaries overlap county boundaries. By selecting a county or counties, this report includes any ZIP code with at least 10 percent of its population residing within one of the selected counties.
Access/Cost
Yes, the platform was developed with funding from the Hospital Industry Data Institute and MHA Health Institute to assist communities, hospitals, public health officials, and other community health stakeholders in identifying health needs and developing actionable community health needs assessments using ZIP code and county-level data.
The platform is designed to be a public resource and is available to anyone with an interest in community health. Setting up an optional account allows users to customize their experience by saving geographic areas, health indicators, customized reports, and other features of exploreMOhealth in which they are most interested.
Yes, the platform is designed to be a public resource, and available to anyone with an interest in community health. Setting up an optional account allows users to customize their experience by saving geographic areas, health indicators, customized reports, and other features that they are most interested in.
We support the latest two stable versions of Firefox, Chrome, and Microsoft Edge. The content, formatting and functionality of the site has been optimized for desktop, tablet and mobile devices.
Download / Customization
Yes, exploreMOhealth has options to export reports directly to Excel for use in GIS applications, you can also download the entire public-use data file on the About page.
Yes, setting up an exploreMOhealth account allows users to customize their experiences by saving geographic areas, health indicators, customized reports and other features of exploreMOhealth of which they have the most interest.
Contact Information
Questions on the platform can be submitted at any time to exploreMOhealth@mhanet.com.