Methodology
1. County Health Rankings & Roadmaps (CHR&R) Data Model
CHR&R implemented two major changes to its methodology since 2023, the vintage used on exploreTNhealth previously:
- In 2024, 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. 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.
- In 2025, CHR&R introduced a revised Model of Health. To minimize impacts on exploreTNhealth users, this year’s update continues to use the original CHR&R model and measures while incorporating the new 2025 CHR&R data. In the updated CHR&R framework, counties are assigned to “Population Health Well-Being” and “Community Conditions” Health Groups, which exploreTNhealth presents as “Health Outcomes” and “Health Factors” Groups, respectively, to align with the prior model labeling. Impacts of the CHR&R model changes on the counties’ assigned Health Groups were minimal. For additional details or questions, please contact exploreTNhealth@tha.com.
2. Changes to Underlying Claims Data
Specific types of outpatient services not required for reporting (e.g., labs) are now excluded from the claims-based measures. This resulted in a drop in the ZIP code rates of some ZIP Health Rankings (ZHR) measures. Impact: Mean ZIP code rates for total hospital utilization, cancer, and mammography screening decreased by over 30%, likely reflecting both data source changes and true clinical shifts. For additional details or questions, please contact exploreTNhealth@tha.com.
3. ZIP Measures
Several notable changes to the ZHR claims-based measures were implemented to provide users with the most up-to-date definitions aligned with externally credible organizations. 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. The changes included the following:
- Health Factor Domain, Clinical Care Sub-Domain: Replaced the outdated NYU Emergency Room algorithm for defining potentially avoidable ED utilization with five Agency for Healthcare Research and Quality Prevention Quality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: Added seven new measures for conditions in the top 20 most prevalent conditions in Tennessee 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: Added 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. Impact: Average ZIP code rates of smoking, STI, rheumatoid arthritis/osteoarthritis, male reproductive system cancers, urologic cancer, and opioid use dropped by over 30% across ZIP codes, attributed to a combination of definitional changes and actual clinical/ behavioral reductions. For additional details or questions, please contact exploreTNhealth@tha.com.
4. Look-and-Feel
The website’s user interface has been refreshed to enhance navigation and the overall user experience.
exploreTNhealth offers several options for comparative analysis. First, state-level results are displayed alongside ZIP- and county-level data. Second, counties and ZIP codes are ranked for each domain and subdomain. The ZIP Health Rankings were created using a unique methodology that was developed with funding from the Robert Wood Johnson Foundation and County Health Rankings & Roadmaps. Additional information on the development of the County Health Rankings is available on the CHR&R methods page.
The exploreTNhealth 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 two health-related data sources that are specific to Tennessee. The county-level health factors and outcomes data are provided from numerous sources by the County Health Rankings & Roadmaps program at the University of Wisconsin Institute for Public Health. The ZIP-level data are provided by the Tennessee Hospital Association and its data partner, the Hospital Industry Data Institute, through the Tennessee 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 calendar years 2022 and 2024 (January 1, 2022 through December 31, 2024), and the 2023 American Community Survey of the U.S. Census. The county-level data are drawn from the 2025 Tennessee County Health Rankings. Additional information on the date ranges for each measure is available on the CHR&R Tennessee Overview page.
The data contained on exploreTNhealth are available 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. Certain Demographic and Other Social and Economic Factors are available for alternate geographic levels in the Tennessee Health Atlas Report.
Yes, the reports generated by exploreTNhealth 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. (2017). Additional information on the reliability and statistical uncertainty of the county-level data is available on the CHR&R Data Quality page.
The ZIP code-level rates are based on the number of hospital inpatient and emergency department diagnoses per 1,000 residents between calendar years 2022 and 2024. The rates are a measure of utilization burden rather than population disease burden. County-level rates or prevalence are defined here.
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 county or ZIP code, while negative values indicate a lower than average rate.
The ZIP codes used on exploreTNhealth 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 Tennessee Hospital Association 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 exploreTNhealth in which they are most interested. Visit the Registration page to create an account.
Access and use of the content provided on exploreTNhealth is intended for public non-commercial or personal use only. Commercial use is prohibited without prior written approval from the Tennessee Hospital Association. All other use, copying or reproduction of this website or any part of it is prohibited (except to the extent permitted by law). None of the content or any part of it may be reproduced on any other Internet website without our express permission.
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.
Access and use of the content provided on exploreTNhealth is intended for public non-commercial or personal use only. Commercial use is prohibited without prior written approval from the Tennessee Hospital Association. All other use, copying or reproduction of this website or any part of it is prohibited (except to the extent permitted by law). None of the content or any part of it may be reproduced on any other Internet website without our express permission.
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.
Customization
Yes, setting up an exploreTNhealth account allows users to customize their experiences by saving geographic areas, health indicators, customized reports and other features of exploreTNhealth of which they have the most interest. Visit the Registration page to create an account.
Contact Information
Questions on the platform can be submitted at any time to exploreTNhealth@tha.com.