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National Healthcare Disparities Report, 2003

Effectiveness of Care: Respiratory Diseases

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Immunization, Influenza
High risk persons (e.g. COPD) age 18-64 who received an influenza vaccination in the past 12 months
Persons age 65 and over who received an influenza vaccination in the past 12 months.
Institutionalized adults (persons in long-term care or nursing homes) age 18 and over who received influenza vaccination in past 12 months.
Hospital admissions for immunization-preventable influenza per 100,000 population
Immunization, Pneumonia
High risk persons (e.g. COPD) age 18-64 who ever received a pneumococcal vaccination
Persons, age 65 and over who ever received a pneumococcal vaccination.
Institutionalized adults (persons in long-term care or nursing homes) who ever received pneumococcal vaccination
Treatment of Pneumonia
Patients with pneumonia who have blood cultures collected before antibiotics are administered.
Patients with pneumonia who receive the initial antibiotic dose within 8 hours of hospital arrival
Patients with pneumonia who receive the initial antibiotic consistent with current recommendations
Patients with pneumonia who receive influenza screening or vaccination
Patients with pneumonia who receive pneumococcal screening or vaccination
Treatment of URI
Percent of visits where antibiotic was prescribed for the diagnosis of a common cold, adults and children.
Management of Asthma
Hospital admissions for pediatric asthma per 10,000 population under 18
Hospital admissions for asthma per 10,000 population
Treatment of Tuberculosis
Tuberculosis patients who complete a curative course of treatment within 12 months of initiation of treatment


Immunization, Influenza

Measure Title

Percent of high risk persons (e.g. COPD) age 18-64 who received an influenza vaccination in the past 12 months.

Measure Source

Healthy People 2010, measure 14-29c.

Tables

Percent of high risk persons age 18-64 who received an influenza vaccination, United States, 2000, by

  • Race
  • Ethnicity
  • Family Income

Data Source

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

Denominator

U.S. population (civilian, non-institutionalized): high-risk adults, age 18 to 64.

Numerator

Number of high-risk adults, age 18 to 64, who report receiving an influenza vaccination in the past 12 months.

Comments

High risk conditions include diabetes, heart disease, lung disease, kidney disease, liver disease and cancer. Not all high-risk conditions for complications of influenza and pneumococcal disease can be ascertained by NHIS (for example, immunocompromised), and the sample size may be too small for some groups.

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, go to Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Influenza

Measure Title

Percent of persons age 65 and over who received an influenza vaccination in the past 12 months.

Measure Source

Healthy People 2010, measure 14-29a.

Tables

Percent of persons age 65 and over who received an influenza vaccination, United States, 2000, by

  • Race
  • Ethnicity
  • Family Income

Data Source

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

Denominator

U.S. population (civilian, non-institutionalized), age 65 and over.

Numerator

Number of adults age 65 and over who report receiving an influenza vaccination in the past 12 months.

Comments

This measure is one of the components of the Immunization Leading Health Indicator, which further defines the measure as pertaining to high-risk adults. Refer to Appendix H of Tracking Healthy People 2010 for a complete listing of Leading Health Indicators.

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, go to Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Influenza

Measure Title

Percent of institutionalized adults (persons in long-term care or nursing homes) age 18 and over who received influenza vaccination in past 12 months.

Measure Source

Healthy People 2010, measure 14-29e.

Tables

Percent of institutionalized adults age 18 and over who received an influenza vaccination in the past 12 months, United States, 1999, by

  • Race

Data Source

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

Denominator

U.S. population: adults in long-term care facilities or nursing homes.

Numerator

Adults in long-term care facilities or nursing homes reported to have received an influenza vaccination in the past 12 months.

Comments

Data are from the population residing in long-term care facilities or nursing homes and exclude residents in facilities providing only room and board or serving special health problems such as mental retardation or alcoholism.

Vaccination status is ascertained by the staff member completing the survey based on available records; sampled residents are not queried. In the 1995 NNHS, the percentage of sampled residents for whom vaccination status could not be ascertained was 21 percent for influenza vaccination and 43 percent for pneumococcal vaccination.

The percent vaccinated calculation will include persons with unknown vaccination status in the denominator. Improvements to administration of the survey will be made in 1999 to minimize the reporting of unknown vaccination status.

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, go to Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Influenza

Measure Title

Hospital admissions for immunization-preventable influenza per 100,000 population.

Measure Source

Healthy People 2010, measure 1-9c.

Tables

Immunization-preventable influenza admissions for elderly (excluding transfers from other institutions) per 100,000 patients age 65 years and older, 2000, by

  • Race

Data Source

Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases, 16-State database.

Denominator

Population in the 16 States age 65 and over.

Numerator

Non-maternal discharges age 65 and over with any diagnosis of immunization-preventable influenza (ICD-9-CM codes 4870, 4871, and 4878).

Comments

Rates are adjusted by age and sex, using the year 2000 population age 18 and over in the 16 States as the standard population.

The 16 States are Arizona, California, Connecticut, Florida, Georgia, Kansas, Massachusetts, Maryland, Missouri, New Jersey, New York, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

This measure is not included in the AHRQ Prevention Quality Indicators software available on the AHRQ Web site.

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Immunization, Pneumonia

Measure Title

Percent of high risk persons (e.g. COPD) age 18-64 who ever received a pneumococcal vaccination.

Measure Source

Healthy People 2010, measure 14-29d.

Tables

Percent of high risk persons age 18-64 who ever received a pneumococcal vaccination, United States, 2000, by

  • Race
  • Ethnicity
  • Family Income

Data Source

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

Denominator

U.S. population (civilian, non-institutionalized): high-risk persons, age 18 to 64.

Numerator

Number of high-risk persons, age 18 to 64 who answered "Yes" to the question "Have you ever had a pneumonia vaccination, sometimes called a pneumonia shot? This shot is usually given only once in a person's lifetime and is different from the flu shot."

Comments

High risk conditions include diabetes, heart disease, lung disease, kidney disease, liver disease and cancer. Not all high-risk conditions for complications of influenza and pneumococcal disease can be ascertained by NHIS (for example, immunocompromised), and the sample size may be too small for some groups.

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, go to Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Pneumonia

Measure Title

Percent of persons, age 65 and over who ever received a pneumococcal vaccination.

Measure Source

Healthy People 2010, measure 14-29b.

Tables

Percent of persons age 65 and over who ever received a pneumococcal vaccination, United States, 2000, by

  • Race
  • Ethnicity
  • Family Income

Data Source

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

Denominator

U.S. population (civilian, non-institutionalized): age 65 and over.

Numerator

Number of adults, age 65 and over, who had a pneumonia vaccination.

Comments

This measure is one of the components of the Immunization Leading Health Indicator, which further defines the measure as pertaining to high-risk adults. Go to Appendix H of Tracking Healthy People 2010 for a complete listing of Leading Health Indicators.

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, go to Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Pneumonia

Measure Title

Percent of institutionalized adults (persons in long-term care or nursing homes) who ever received pneumococcal vaccination.

Measure Source

Healthy People 2010, measure 14-29f.

Tables

Percent of institutionalized adults who ever received pneumococcal vaccination, United States, 1999, by

  • Race

Data Source

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

Denominator

U.S. population: adults in long-term facilities or nursing homes.

Numerator

Number of adults in long-term care facilities or nursing homes reported to have ever received a pneumococcal vaccination.

Comments

Data are from the population residing in long-term care facilities or nursing homes and exclude residents in facilities providing only room and board or serving special health problems such as mental retardation or alcoholism.

Vaccination status is ascertained by the staff member completing the survey based on available records; sampled residents are not queried. In the 1995 NNHS, the percentage of sampled residents for whom vaccination status could not be ascertained was 21 percent for influenza vaccination and 43 percent for pneumococcal vaccination.

The percent vaccinated calculation will include persons with unknown vaccination status in the denominator. Improvements to administration of the survey will be made in 1999 to minimize the reporting of unknown vaccination status.

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, go to Part A, Section 5 of Tracking Healthy People 2010.

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Treatment of Pneumonia

Measure Title

Percent of patients with pneumonia who have blood cultures collected before antibiotics are administered.

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 meeting either of the following criteria:

  • Principal diagnosis of pneumonia.
  • Secondary diagnosis of pneumonia with a principal diagnosis of either septicemia or respiratory failure (acute or chronic).

Numerator

Subset of the denominator population who had blood cultures performed prior to antibiotic administration.

Comments

Excludes patients who were transferred from another acute care or critical access hospital, patients who had no working diagnosis of pneumonia at the time of admission, patients who received comfort measures only, patients who had insufficient data to determine both blood culture and arrival timing data in their medical record.

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Treatment of Pneumonia

Measure Title

Percent of patients with pneumonia who receive the initial antibiotic dose within 8 hours of hospital arrival.

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 meeting either of the following criteria:

  • Principal diagnosis of pneumonia.
  • Secondary diagnosis of pneumonia with a principal diagnosis of either septicemia or respiratory failure (acute or chronic).

Numerator

Pneumonia patients who received their first dose of antibiotics within 8 hours after arrival at the hospital.

Comments

Excludes patients who were transferred from another acute care or critical access hospital, patients who had no working diagnosis of pneumonia at the time of admission, patients who received comfort measures only, patients who did not receive antibiotics during the hospitalization or within 36 hours of admission to the hospital, patients who had insufficient arrival or antibiotic timing data (i.e., missing date and/or time) in their medical record.

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Treatment of Pneumonia

Measure Title

Percent of patients with pneumonia who receive the initial antibiotic consistent with current recommendations.

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 meeting either of the following criteria:

  • Principal diagnosis of pneumonia.
  • Secondary diagnosis of pneumonia with a principal diagnosis of either septicemia or respiratory failure (acute or chronic).

Numerator

Pneumonia patients who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization.

Comments

Excludes patients who were transferred from another acute care or critical access hospital, patients who had no working diagnosis of pneumonia at the time of admission, patients who received comfort measures only, patients who did not receive antibiotics during the hospitalization or within 36 hours after arrival at the hospital, patients who were immunocompromised (based on comorbidities), patients who potentially had nosocomial pneumonia (index admission within 14 days of a previous admission), patients who had insufficient arrival or antibiotic timing data in their medical record.

Go to Medicare Priorities (HCFA Publication 10156) for a discussion of accepted antibiotic regimens for pneumonia.

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Treatment of Pneumonia

Measure Title

Percent of patients with pneumonia who receive influenza screening or vaccination.

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 65 and over meeting either of the following criteria:

  • Principal diagnosis of pneumonia.
  • Secondary diagnosis of pneumonia with a principal diagnosis of either septicemia or respiratory failure (acute or chronic).

Numerator

Medicare patients with pneumonia, age 65 or older, who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated.

Comments

Excludes patients who were transferred from another acute care or critical access hospital, patients who had no working diagnosis of pneumonia at the time of admission, patients who received comfort measures only, patients who expired in the hospital, patients who left the hospital against medical advice, patients who were discharged to hospice care.

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Treatment of Pneumonia

Measure Title

Percent of patients with pneumonia who receive pneumococcal screening or vaccination.

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 65 and over meeting either of the following criteria:

  • principal diagnosis of pneumonia.
  • secondary diagnosis of pneumonia with a principal diagnosis of either septicemia or respiratory failure (acute or chronic).

Numerator

Medicare patients with pneumonia, age 65 or older, who were screened for pneumococcal vaccine status and were vaccinated prior to discharge, if indicated.

Comments

Excludes patients who were transferred from another acute care or critical access hospital, patients who had no working diagnosis of pneumonia at the time of admission, patients who received comfort measures only, patients who expired in the hospital, patients who left the hospital against medical advice, patients who were discharged to hospice care, patients with a principal or secondary diagnosis of 487.0 (influenza with pneumonia), patients who were transferred to another short term general hospital for inpatient care.

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Treatment of URI

Measure Title

Percent of visits where antibiotic was prescribed for the diagnosis of a common cold, adults and children.

Measure Source

Healthy People 2010, measure 14-19.

Tables

Percent of visits where antibiotic was prescribed for diagnosis of common cold by selected characteristics, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

Denominator

Number outpatient and emergency room visits.

Numerator

Number of antibiotic courses ordered, supplied, administered, or continued at a specific visit for persons diagnosed with the common cold (ICD-9-CM codes 460.0, 465, or 472.0).

Comments

With one exception (Expected Source of Payment), rates are calculated using US Census Bureau monthly postcensal estimates of the civilian noninstitutional population as of July 1, 1999 and July 1, 2000 and are available at the Census Bureau Internet site: http://www.census.gov/popest/archives/1990s/nat_monthly_noninstitutional.html. Figures have been adjusted for net underenumeration using the 1990 National Population Adjustment Matrix.

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Management of Asthma

Measure Title

Hospital admissions for pediatric asthma per 10,000 population under age 18.

Measure Source

Healthy People 2010, measure 24-2, 1-9a.

Tables

Hospitalizations for pediatric asthma per 10,000 population (persons under age 18), 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: children under age 18.

Numerator

Number of discharges with principal diagnosis of asthma (ICD-9-CM code 493) among children under age 18.

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Management of Asthma

Measure Title

Hospital admissions for asthma per 10,000 population.

Measure Source

Healthy People 2010, measure 24-2.

Tables

Hospitalizations for adult asthma per 10,000 population (persons age 18 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: adults age 18 and over.

Numerator

Number of discharges with first listed diagnosis of asthma (ICD-9-CM code 493) among adults age 18 and over.

Comments

Excludes obstetric admissions and transfers from other institutions.

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Treatment of Tuberculosis (TB)

Percent of TB patients who complete a curative course of TB treatment within 12 months of initiation of treatment.

Measure Source

American Thoracic Society/CDC treatment guidelines.

Tables

Percent of TB patients who complete a curative course of TB treatment within 12 months of initiation of treatment, United States, 1999, by

  • Race
  • Ethnicity
  • Race, foreign born
  • Ethnicity, foreign born

Data Source

Centers for Disease Control and Prevention, National TB Surveillance System.

Denominator

U.S. resident population with verified tuberculosis.

Numerator

TB cases completing therapy within one year.

Comments

Go to American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America: Treatment of Tuberculosis, Am J Respir Crit Care Med, 2003, vol. 167 pp. 603-662 for further information regarding current tuberculosis treatment guidelines.

Go to Appendix A of CDC publication Reported Tuberculosis in the United States, 2000 for a discussion of completion of TB therapy.


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2003 National Healthcare Disparities Report

 

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