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National Healthcare Disparities Report, 2003

Safety

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Complications of Care
Birth trauma.
Death in low mortality DRGs
Transfusion reactions.
Foreign body left in body during procedure.
Complications of anesthesia.
Decubitus ulcers.
Iatrogenic pneumothorax.
Infection due to intravenous lines or catheters.
Postoperative hip fractures.
Postoperative hemorrhage or hematoma.
Postoperative physiologic and metabolic derangements.
Postoperative respiratory failure
Postoperative pulmonary embolism or deep venous thrombosis.
Postoperative septicemia.
Technical difficulty with procedure.
Postoperative wound dehiscence.
Obstetric trauma - vaginal with instrument.
Obstetric trauma - vaginal without instrument.
Obstetric trauma - Cesarean delivery
Prescribing Medications
Percent of community dwelling elderly who had at least one prescription (from a list of 11 medications and from a list of 33 medications) that is potentially inappropriate for the elderly.
Percent of persons with provider who usually asks about medications and treatments other doctors may give.


Complications of Care

Measure Title

Birth trauma.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Birth trauma injury per 1,000 live births (excluding preterm and osteogenesis imperfecta births), 2000, by

  • Race

Data Source

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

Denominator

Live birth discharges in the 16 States, excluding preterm and osteogenesis imperfecta births.

Numerator

Subset of denominator with any diagnosis of birth trauma.

Comments

Rates are adjusted by gender.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 17 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Death in low mortality DRGs.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Deaths per 1,000 admissions in low mortality DRGs (DRGs with a NIS 1997 benchmark of less than 0.5% mortality, excluding trauma, immunocompromised, and cancer patients), 2000, by

  • Race

Data Source

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

Denominator

Hospital admissions in low mortality DRGs, excluding trauma, immunocompromised, and cancer patients.

Numerator

Subset of denominator with discharge disposition of "death".

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 2 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Transfusion reactions.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Transfusion reactions per 1,000 discharges (excluding neonates; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

All non-neonatal medical and surgical inpatient hospital discharges.

Numerator

Non-neonatal medical and surgical discharges with any secondary diagnosis indicating transfusion reaction.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

These tables were created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. These measures are referred to as indicator 16 (discharge-based) and 26 (area-based) in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Foreign body left in body during procedure.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Foreign body left in during procedure per 1,000 medical and surgical discharges (excluding neonates; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

All non-neonatal medical and surgical inpatient hospital discharges.

Numerator

Non-neonatal medical and surgical discharges with any secondary diagnosis indicating foreign body left in during procedure.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

These tables were created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. These measures are referred to as indicator 5 (discharge-based) and 21 (area-based) in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Complications of anesthesia.

Measure Source

AHRQ Patient Safety Indicators.

Tables

2.8 Complications of anesthesia per 1,000 surgical discharges (excluding patients with such complications who also have substance use disorders), 2000, by

  • Race

Data Source

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

Denominator

All surgical hospital discharges, excluding patients with active drug dependence, active nondependent abuse of drugs, and self-inflicted injury.

Numerator

Subset of denominator with any secondary diagnosis indicating anesthesia complications.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 1 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Decubitus ulcers.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Decubitus ulcers per 1,000 discharges of length 4 or more days (excluding paralysis patients and patients admitted from long-term-care facilities and neonates), 2000, by

  • Race

Data Source

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

Denominator

All non-neonatal medical and surgical hospital discharges with length of stay of 4 or more days, excluding paralysis patients and patients admitted from long-term-care facilities.

Numerator

Subset of denominator with any secondary diagnosis of decubitus ulcer (ICD-9-CM diagnosis code 707.0).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 3 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Iatrogenic pneumothorax.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Iatrogenic pneumothorax per 1,000 discharges (excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery and neonates; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

All non-neonatal medical and surgical hospital discharges, excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Numerator

Non-neonatal medical and surgical discharges with any secondary diagnosis of iatrogenic pneumothorax (ICD-9-CM diagnosis code 512.1,) excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. These measures are referred to as indicator 6 (discharge-based) and 22 (area-based) in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Infection due to intravenous lines or catheters.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Infection due to intravenous lines or catheters per 1,000 discharges (excluding immunocompromised or cancer patients and neonates; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

All non-neonatal medical and surgical hospital discharges, excluding immunocompromised or cancer patients.

Numerator

All non-neonatal medical and surgical hospital discharges with any secondary diagnosis of infection (ICD-9-CM diagnosis code 999.3 or 996.62,) excluding immunocompromised or cancer patients.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

These tables were created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. These measures are referred to as indicator 7 (discharge-based) and 23 (area-based) in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative hip fractures.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative hip fracture for adults per 1,000 surgical patients age 18 years and older who were not susceptible to falling, 2000, by

  • Race

Data Source

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

Denominator

Inpatient hospital surgical discharges age 18 and over who were not susceptible to falling. (i.e., excluding patients with musculoskeletal disease; those admitted for seizures, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium, psychoses, anoxic brain injury; patients with metastatic cancer, lymphoid malignancy, bone malignancy, and self-inflicted injury).

Numerator

Subset of denominator with any secondary diagnosis indicating hip fracture.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 8 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative hemorrhage or hematoma.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges (excluding obstetrical and neonatal admissions; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

Inpatient hospital surgical discharges, excluding obstetrical and neonatal admissions.

Numerator

Subset of denominator meeting the following criteria:

  • Secondary diagnosis indicating postoperative hemorrhage or postoperative hematoma.
  • Secondary procedure indicating postoperative control of hemorrhage or drainage of hematoma.

Comments

Procedure code for postoperative control of hemorrhage or hematoma not verified as following surgery.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 9 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative physiologic and metabolic derangements.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative physiologic and metabolic derangements per 1,000 elective-surgery patients (excluding some serious disease and obstetric and neonatal admissions), 2000, by

  • Race

Data Source

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

Denominator

All elective hospital surgical discharges, excluding some serious disease (i.e., patients with diabetic coma; patients with renal failure who were admitted for AMI, cardiac arrhythmia, cardiac arrest, shock, hemorrhage, or gastrointestinal hemorrhage ) and obstetric and neonatal admissions.

Numerator

Subset of denominator with any secondary diagnosis indicating physiologic and metabolic derangements.

Comments

Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure for dialysis.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 10 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative respiratory failure.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative respiratory failure per 1,000 elective-surgery discharges (excluding patients with respiratory disease, circulatory disease, and obstetric or neonatal conditions), 2000, by

  • Race

Data Source

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

Denominator

All elective hospital surgical discharges, excluding patients with respiratory disease, circulatory disease, and obstetric or neonatal conditions.

Numerator

Subset of denominator with any secondary diagnosis of acute respiratory failure (ICD-9-CM diagnosis codes 518.81 and 518.84).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 11 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative pulmonary embolism or deep venous thrombosis.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative pulmonary embolus or deep vein thrombosis (DVT) per 1,000 surgical discharges (excluding patients admitted for DVT, obstetrics, neonatal, and plication of vena cava before or after surgery; based on secondary diagnoses of DVT only), 2000, by

  • Race

Data Source

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

Denominator

Hospital surgical patients, excluding patients admitted for deep vein thrombosis, obstetrics, neonatal, and plication of vena cava before or after surgery.

Numerator

Subset of denominator with any secondary diagnosis of deep vein thrombosis or pulmonary embolism.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 12 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative septicemia.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative septicemia per 1,000 elective-surgery discharges of longer than 3 days (excluding patients admitted for infection; patients with cancer or immunocompromised states, and obstetric and neonatal conditions), 2000, by

  • Race

Data Source

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

Denominator

All elective hospital surgical discharges with length of stay longer than 3 days, excluding patients admitted for infection, patients with cancer or immunocompromised states, and obstetric and neonatal conditions.

Numerator

Subset of denominator with any secondary diagnosis of sepsis.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 13 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Technical difficulty with procedure.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Accidental puncture or laceration during procedures per 1,000 discharges (excluding obstetric and neonatal admissions; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

Hospital medical and surgical discharges, excluding obstetric and neonatal admissions.

Numerator

Non-maternal/non-neonatal medical and surgical discharges with any secondary diagnosis denoting technical difficulty (e.g., accidental cut, puncture, perforation or laceration during a procedure).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

These tables were created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. These measures are referred to as indicator 15 (discharge-based) and 25 (area-based) in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Postoperative wound dehiscence.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges (excluding obstetric and neonatal conditions; based on secondary diagnoses only), 2000, by

  • Race

Data Source

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

Denominator

Inpatient hospital abdominopelvic-surgery discharges, excluding obstetric and neonatal conditions.

Numerator

Non-maternal/non-neonatal abdominopelvic-surgery discharges with secondary procedure for reclosure of postoperative disruption of abdominal wall (ICD-9-CM procedure code 54.61).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. DRGs are Diagnosis Related Groups which identify patients with similar illnesses.

These tables were created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. These measures are referred to as indicator 14 (discharge-based) and 24 (area-based) in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Obstetric trauma - vaginal with instrument.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Obstetric trauma per 1,000 instrument-assisted vaginal deliveries, 2000, by

  • Race

Data Source

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

Denominator

All vaginal delivery hospital discharges with any procedure indicating instrument assisted delivery.

Numerator

Subset of denominator with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 18 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Obstetric trauma - vaginal without instrument.

Measure Source

AHRQ Patient Safety Indicators.

Tables

Obstetric trauma per 1,000 vaginal deliveries without instrument assistance, 2000, by

  • Race

Data Source

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

Denominator

All vaginal delivery hospital discharges without indication of instrument assistance.

Numerator

Subset of denominator with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 19 in the AHRQ Patient Safety Indicators software documentation.

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Complications of Care

Measure Title

Obstetric trauma - Cesarean delivery

Measure Source

AHRQ Patient Safety Indicators.

Tables

2.22 Obstetric trauma per 1,000 Cesarean deliveries, United States, by

  • Race

Data Source

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

Denominator

All Cesarean section delivery hospital discharges.

Numerator

Cesarean section delivery discharges with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age.

This table was created using a beta-test version of the AHRQ Patient Safety Indicators software dated July 2002 that differs from the AHRQ Patient Safety Indicators software currently available on the AHRQ Web site. This measure is referred to as indicator 20 in the AHRQ Patient Safety Indicators software documentation.

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Prescribing Medications

Measure Title

Percent of community dwelling elderly who had at least one prescription (from a list of 11 medications and from a list of 33 medications) that is potentially inappropriate for the elderly.

Measure Source

Agency for Healthcare Research and Quality, Center for Quality Improvement and Patient Safety.

Data Source

Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey.

Denominator

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

Numerator

Persons age 65 and over who had one or more of the 11 of 33 potentially inappropriate medications

Comments

For details about the inappropriate medications, refer to: Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickzier SW, Meyer GS. Potentially Inappropriate Medication Use in the Community-Dwelling Elderly: Findings from 1996 Medical Expenditure Panel Survey. Journal of the American Medical Association, 286(22), 2823-2829, 2001.

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Prescribing Medications

Measure Title

Percent of persons with provider who usually asks about medications and treatments other doctors may give.

Measure Source

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

Tables

Percent of persons with provider who usually asks about medications and treatments other doctors may give, United States, 1999, 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

U.S. population (civilian, noninstitutionalized) who reported to have a usual source of care.

Numerator

U.S. population (civilian, noninstitutionalized) who reported to have a usual source of care who subsequently reported that their provider usually asks about prescription medications and treatments other doctors may give them.

Comments

Usual source of care is defined as a particular doctor's office, clinic, health center, or other health care facility to which an individual usually would go to obtain health care services.


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2003 National Healthcare Disparities Report

 

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