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National Healthcare Disparities Report, 2003

Effectiveness of Care: Heart Disease

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Screening for High Blood Pressure
Percent of people age 18 and over who have had blood pressure measured within preceding 2 years and can state whether their blood pressure is normal or high
Screening for High Cholesterol
Percent of adults 18 and over receiving cholesterol measurement within 5 years.
Counseling on Risk Factors
Percent of smokers receiving advice to quit smoking
Treatment of AMI
Percent of AMI patients administered aspirin within 24 hours of admission.
Percent of AMI patients with aspirin prescribed at discharge
Percent of AMI patients administered beta blocker within 24 hours of admission.
Percent of AMI patients with beta blocker prescribed at discharge
Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.
Percent of AMI patients given smoking cessation counseling while hospitalized
Treatment of Acute Heart Failure
Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge
Management of Hypertension
Percent of people with hypertension who have blood pressure under control
Management of CHF
Hospital admissions for congestive heart failure (CHF) per 1,000 population.

Screening for High Blood Pressure

Measure Title

Percent of people age 18 and over who have had blood pressure measured within preceding 2 years and can state whether their blood pressure is normal or high.

Measure Source

Healthy People 2010, measure 12-12.

Tables

Proportion of persons age 18 and over who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high, United States, 1998, by

Race
Ethnicity
Income

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Denominator

U.S. resident population, age 18 and over.

Numerator

Number of adults, age 18 and over, who had their blood pressure measured within the preceding 2 years and can state blood-pressure level.

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Screening for High Cholesterol

Measure Title

Percent of adults 18 and over receiving cholesterol measurement within 5 years.

Measure Source

Healthy People 2010, measure 12-15.

Tables

Blood cholesterol screening within past 5 years, persons age 18 and over, United States, 1998, by

Race
Ethnicity
Income

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Denominator

U.S. resident population, age 18 and over.

Numerator

U.S. adult population, age 18 and over, who have had their cholesterol checked within 5 years

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion on age adjustment, refer to Part A, Section 5 of Tracking Healthy People 2010.

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Counseling on Risk Factors

Measure Title

Percent of smokers receiving advice to quit smoking.

Measure Source

Healthy People 2010, measure 1-3c.

Tables

Percent of smokers receiving advice to quit smoking, United States, 2000, by

Race
Ethnicity
Family income
Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

Adult U.S. population (18 years of age and older, civilian, noninstitutionalized) who reported in 2000 that they currently smoke and had a routine check-up and answered the question: "In the past 12 months did a doctor advise you to stop smoking?"

Numerator

Adult U.S. population (18 years of age and older, civilian, noninstitutionalized) who indicated they had received advice to quit smoking.

Comments

Nonresponses and "Don't know" responses to the DCS question were excluded from the analysis.

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Treatment of Acute Myocardial Infarction (AMI)

Measure Title

Percent of AMI patients administered aspirin within 24 hours of admission.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges age 18 and over with a principal diagnosis of AMI (ICD-9 codes 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, 410.91).

Excludes patients transferred to another acute care hospital on day of arrival, patients received in transfer from another hospital, including another emergency department, patients discharged on day of arrival, patients who expired on day of arrival.

Excludes patients with one or more of the following aspirin contraindications documented in the medical record: bleeding on admission, aspirin allergy, history of internal bleeding or bleeding/coagulation disorder, chronic liver disease, platelet count < 100 x 109/L on admission, anemia, treatment with warfarin prior to admission, history of peptic ulcer disease, admission serum creatinine > 3 mg/dL.

Numerator

Subset of AMI denominator patients who received aspirin within 24 hours before or after hospital arrival.

Comments

This measure is also a JCAHO core measure.

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Treatment of AMI

Measure Title

Percent of AMI patients with aspirin prescribed at discharge.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Excludes patients transferred to another acute care hospital, patients who expired, patients discharged to hospice and patients who had unknown discharge status.

Excludes patients with one or more of the following aspirin contraindications documented in the medical record: aspirin allergy, bleeding on admission, reaction to aspirin during admission, history of internal bleeding or bleeding/coagulation disorder, hemorrhage/bleed during hospital stay, chronic liver disease, admission platelet count < 100 x 109/L, anemia, admission or highest serum creatinine level > 3 mg/dL, history of peptic ulcer disease, acute upper GI disorder during hospital stay, treatment with warfarin at discharge.

Numerator

Subset AMI denominator patients prescribed aspirin at hospital discharge.

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Treatment of AMI

Measure Title

Percent of AMI patients administered beta blocker within 24 hours of admission.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Excludes patients with one or more of the following beta blocker contraindications documented in the medical record: beta blocker allergy; bradycardia (heart rate less than 60 bpm) on admission while not on a beta blocker; systolic blood pressure < 100 mm Hg on admission; heart failure or shock on admission; PR interval > .24 seconds, second or third degree heart block or bifascicular block on admission ECG; history of COPD, heart failure, asthma, or peripheral vascular disease; previous LVEF < 50 or described as depressed to any degree.

Numerator

Subset of AMI denominator patients who received a beta blocker within 24 hours after hospital arrival.

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Treatment of AMI

Measure Title

Percent of AMI patients with beta blocker prescribed at discharge.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Numerator

AMI patients prescribed a beta blocker at hospital discharge.

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Treatment of AMI

Measure Title

Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges age 18 and over with a principal diagnosis of AMI (ICD-9 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, 410.91) and chart documentation of a LVEF less than 40% or a narrative description of LVF consistent with moderate or severe systolic dysfunction.

Excludes patients transferred to another acute care hospital, patients who expired, patients with unknown discharge disposition.

Excludes patients with one or more of the following ACEI contraindications documented in the medical record: ACEI allergy or reaction to ACE inhibitors during hospitalization; aortic stenosis; admission or highest serum creatinine > 2 mg/dL; last systolic BP < 100 mm Hg and not discharged on an ACE inhibitor.

Numerator

Subset of denominator population prescribed an ACEI at hospital discharge.

Comments

LVSD is defined in this measure as chart documentation of a left ventricular ejection fraction less than 40% or a narrative description of left ventricular function consistent with moderate or severe systolic dysfunction.

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Treatment of AMI

Measure Title

Percent of AMI patients given smoking cessation counseling while hospitalized.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Excludes patients transferred to another acute care hospital, patients who expired and patients with unknown discharge disposition.

Numerator

Subset of AMI denominator patients who receive smoking cessation advice or counseling during the hospital stay.

Comments

A smoker is defined in this measure as someone who has smoked cigarettes anytime during the year prior to hospital arrival.

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Treatment of Acute Heart Failure

Measure Title

Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Measure Source

CMS Health Care Quality Improvement Program (HCQIP) Quality Indicator.

Data Source

Centers for Medicare and Medicaid Services, Medicare Quality Improvement Organization Program.

Denominator

Medicare live discharges age 18 and over meeting both of the following criteria:

Principal diagnosis of heart failure (ICD-9 codes 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, 428.x)
Documented left ventricular function evaluation not consistent with left ventricular systolic dysfunction (ejection fraction less than 40% or equivalent narrative description)

Numerator

Subset of denominator who meet at least one of the following three conditions:

On ACEI at discharge.
Chart documentation of one or more of the following contraindications to ACEI use: moderate or severe aortic stenosis; or bilateral renal artery stenosis; or history of angioedema, hives or severe rash with ACEI use.
Physician documentation of any specific reason why ACEI is not used.

Comments

Excludes patients transferred to another acute care hospital, patients who expired, patients who left against medical advice, patients on dialysis, patients on ARB but not ACEI at discharge, patients participating in a clinical trial testing alternatives to ACEIs as first-line heart failure therapy.

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Management of Hypertension

Measure Title

Percent of people with hypertension who have blood pressure under control.

Measure Source

Healthy People 2010, measure 12-10.

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.

Denominator

U.S. civilian, noninstitutionalized adults, age 18 and over, with high blood pressure.

Numerator

Number of adults, age 18 and over, who have been told by a doctor or other health professional to take prescribed blood pressure medicine and are now taking it and whose systolic blood pressure is less than 140 mmHg and diastolic blood pressure is less than 90 mmHg.

Comments

Hypertension is defined as either having elevated blood pressure (systolic pressure of at least 140 mmHg or diastolic pressure of at least 90 mmHg) or taking antihypertension medication.

Estimates are age adjusted to the 2000 standard population using 3 age groups: 18-39, 40-59, 60+.

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Management of CHF

Measure Title

Hospital admissions for congestive heart failure (CHF) per 1,000 population.

Measure Source

Healthy People 2010, measure 12-6.

Tables

Hospitalizations for congestive heart failure per 1,000 population (age 45 and over), United States, 2000. by

Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey.

Denominator

U.S. civilian population, age 45 and over.

Numerator

Number of discharges with a principal diagnosis of congestive heart failure (ICD-9-CM code 428.0).

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2003 National Healthcare Disparities Report

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