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National Healthcare Disparities Report, 2006

Effectiveness of Care: Diabetes

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Management of Diabetes
Composite measure: Adults with diabetes who had at least 1 hemoglobin A1c measurement, a retinal eye examination, and a foot examination in the past year
Adults with diabetes who had a hemoglobin A1c measurement at least once in the past year
Adults with diabetes who had a lipid profile in the past 2 years
Adults with diabetes who had a retinal eye examination in the past year
Adults with diabetes who had a foot examination in the past year
Adults with diabetes who had an influenza immunization in the past year
Hospital admissions for uncontrolled diabetes per 100,000 population
Hospital admissions for short-term complications of diabetes per 100,000 population
Hospital admissions for long-term complications of diabetes per 100,000 population
Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 population
Adults with diagnosed diabetes with HbA1c level greater than 9.0% and less than 7.0%
Adults with diagnosed diabetes with total cholesterol less than 200 mg/dL
Adults with diagnosed diabetes with most recent blood pressure <140/80 mm Hg


Management of Diabetes

Measure Title

Composite measure: Adults with diabetes who had at least 1 hemoglobin A1c measurement, a retinal eye examination, and a foot examination in the past year.

Measure Source

Healthy People 2010, measures 5-12, 5-13, 5-14.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

14. Adults age 40 and over with diabetes who had a hemoglobin A1c test, a retinal eye examination, and a foot examination in the past year, United States, 2003, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question and had valid, non-missing responses to all 3 questions.

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes whose answers indicated they had at least 1 hemoglobin A1c test, a retinal eye examination, and a foot examination in 2003.

Comments

The criteria for selecting the diabetes population from the MEPS survey and the methodology for calculating the diabetes composite measure have changed have changed; reported rates may not be comparable to those found prior years' editions of the National Healthcare Disparities Report.

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

Estimates are age adjusted to the 2000 standard population with two age-groups: 40-59, 60 and over.

See entries for each of the 3 components of the composite measure for further details about the individual survey questions.

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Management of Diabetes

Measure Title

Adults with diabetes who had a hemoglobin A1c measurement at least once in the past year.

Measure Source

Healthy People 2010, measure 5-12.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

15. Adults age 40 and over with diabetes who had a hemoglobin A1c measurement in past year, United States, 2003, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question: "During 2003, how many times did a doctor, nurse, or other health professional check for glycosylated hemoglobin or "hemoglobin A-one-C"?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had a hemoglobin A1c test at least once in 2003.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable to those found prior years' editions of the National Healthcare Disparities Report.

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

Estimates are age adjusted to the 2000 standard population with two age-groups: 40—59, 60 and over.

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Management of Diabetes

Measure Title

Adults with diabetes who had a lipid profile in the past 2 years.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

16. Adults age 40 and over with diabetes who had a lipid profile in the past 2 years, United States, 2003, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the question: "About how long has it been since you had your blood cholesterol checked by a doctor or other health professional?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered "Within the past year" or "Within the past two years" to the question.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable to those found prior years' editions of the National Healthcare Disparities Report.

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

Estimates are age adjusted to the 2000 standard population with two age-groups: 40-59, 60 and over.

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Management of Diabetes

Measure Title

Adults with diabetes who had a retinal eye examination in the past year.

Measure Source

Healthy People 2010, measure 5-13.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

17. Adults age 40 and over with diabetes who had a retinal eye examination in the past year, United States, 2003, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question: "When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to light.

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had at least 1 retinal eye examination in 2003 or early 2004 (depending on panel).

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable to those found prior years' editions of the National Healthcare Disparities Report.

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

Estimates are age adjusted to the 2000 standard population with two age-groups: 40-59, 60 and over.

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Management of Diabetes

Measure Title

Adults with diabetes who had a foot examination in the past year.

Measure Source

Healthy People 2010, measure 5-14.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

18. Adults age 40 and over with diabetes who had a foot examination in the past year, United States, 2003, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question: "During 2003, how many times did a health professional check your feet for any sores or irritations?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had a foot examination 1 or more times in 2003.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable to those found prior years' editions of the National Healthcare Disparities Report.

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

Estimates are age adjusted to the 2000 standard population with two age-groups: 40-59, 60 and over.

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Management of Diabetes

Measure Title

Adults with diabetes who had an influenza immunization in the past year.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

19. Adults age 40 and over with diabetes who had an influenza immunization in the past year, United States, 2003, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the question: "How long since last flu shot?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had an influenza immunization within 2003.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable to those found prior years' editions of the National Healthcare Disparities Report.

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

Estimates are age adjusted to the 2000 standard population with two age-groups: 40-59, 60 and over.

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Management of Diabetes

Measure Title

Hospital admissions for uncontrolled diabetes per 100,000 population.

Measure Source

Healthy People 2010, measure 1-9c

Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators.

Table

20. Admissions for uncontrolled diabetes without complication (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age 18 years and older, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Adult U.S. population age 18 and older by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Adult non-maternal discharges age 18 and over with principal diagnosis of uncontrolled diabetes, without mention of a short-term (ketoacidosis, hyperosmolarity, coma) or long-term complication (renal, eye, neurological, circulatory, other unspecified). Transfers from other institutions are excluded.

Comments

This measure is also a Healthy People 2010 measure.

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

Tables were created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 14 in the AHRQ Prevention Quality Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Management of Diabetes

Measure Title

Hospital admissions for short-term complications of diabetes per 100,000 population.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators.

Table

21. Admissions for diabetes with short-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 years and older, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Adult U.S. population age 18 and older by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Adult discharges age 18 and over with a principal diagnosis of diabetes with short-term complications (ketoacidosis, hyperosmolarity, coma), ICD-9-CM code 250.10-250.13, 250.20-250.23, 250.30-250.33). Excluded obstetric admissions and transfers from other institutions.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 1 in the AHRQ Prevention Quality Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Management of Diabetes

Measure Title

Hospital admissions for long-term complications of diabetes per 100,000 population.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators.

Table

22. Admissions for diabetes with long-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 years and older, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Adult U.S. population age 18 and older by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Adult non-maternal discharges age 18 and over with a diagnosis of diabetes and any diagnosis indicating long-term complications including: retinopathy; microvascular disease (including coronary heart disease, cerebrovascular disease, and peripheral vascular disease, leading to amputation); sensory neuropathy; and impaired renal function. Transfers from other institutions are excluded.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 3 in the AHRQ Prevention Quality Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Management of Diabetes

Measure Title

Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 population.

Measure Source

Healthy People 2010, measure 5-10.

Table

23. Hospital admissions for lower extremity amputations in patients with diabetes per 1,000 population, United States, 2002-2004, by

  • Race

Data Source

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

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

Denominator

Number of persons in the NHIS population who report that they have ever been diagnosed with diabetes.

Numerator

Number of hospital discharges among U.S. civilian persons with diabetes (ICD-9-CM code 250) as any listed diagnosis and amputation of the lower limb (ICD-9-CM procedure code 84.1) as any listed procedure.

Comments

The numerator and denominator of this measure refer to slightly different populations. The numerator includes the U.S. civilian population; the denominator includes only the U.S. civilian noninstitutionalized population.

Amputations due to causes other than diabetes are not included.

Adults are considered to have diabetes if they respond "yes" to either of the two questions listed in the denominator section of the survey. Those who respond "borderline" and women who report only gestational diabetes are excluded. Children are considered to have diabetes if the adult proxy respondent reports that they have ever been told by a doctor that the child has diabetes.

Data are age adjusted to the 2000 standard population using the age groups under 65 years, 65-74, and 75 years and over. Age-adjusted rates are weighted sums of age-specific rates.

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Management of Diabetes

Measure Title

Percent of adults with diagnosed diabetes with HbA1c level greater than 9.0% (poor control) and less than 7.0% (optimal).

Measure Source

This measure is a combined measure developed expressly for the purpose of reporting both minimal and optimal levels of quality.

Tables

Data source does not support detailed tables.

Data Source

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

Denominator

Adults, age 18 or older, with diagnosed diabetes.

Numerator

Adults with diabetes who had hemoglobin A1c level greater than 9.0% or less than 7.0%, respectively, at examination.

Comments

Rates are age adjusted using 2000 standard population.

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Management of Diabetes

Measure Title

Percent of adults with diagnosed diabetes whose total cholesterol is less than 200 mg/dL.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

Data source does not support detailed tables.

Data Source

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

Denominator

Adults, age 18 or older, with diabetes.

Numerator

Subset of the denominator with most recent low-density lipoprotein-cholesterol level less than 130mg/dL or less than 100mg/dL, respectively, at examination.

Comments

Rates are age adjusted using 2000 standard population.

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Management of Diabetes

Measure Title

Percent of adults with diagnosed diabetes with most recent blood pressure <140/80 mm Hg.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

Data source does not support detailed tables.

Data Source

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

Denominator

Adults, age 18 or older, with diabetes.

Numerator

Subset of the denominator most recent blood pressure measurement <140/80 mm Hg.

Comments

Rates are age adjusted using 2000 standard population.

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