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National Healthcare Disparities Report, 2006

Effectiveness of Care: Respiratory Diseases

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Immunization, Influenza
High-risk adults age 18-64 who received influenza vaccine in the past year
Noninstitutionalized adults age 65+ who received influenza vaccine in the past year
Hospital admissions for influenza per 100,000 population age 65+
Immunization, Pneumonia
High-risk adults age 18-64 who ever received pneumococcal vaccination
Noninstitutionalized adults age 65+ who ever received pneumococcal vaccination
Treatment of Pneumonia
Deaths per 1,000 adult admissions with pneumonia
Composite measure: Patients with pneumonia who have blood cultures collected before antibiotics are administered, receive the initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and receive influenza and pneumococcal screening or vaccination
Patients with pneumonia who have blood cultures collected before antibiotics are administered.
Patients with pneumonia who receive the initial antibiotic dose within 4 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
Antibiotics prescribed at visits with a diagnosis of common cold per 10,000 population
Management of Asthma
Hospital admissions for asthma per 100,000 population under 18
Hospital admissions for asthma per 100,000 population age 18+
Treatment of Tuberculosis
Tuberculosis patients who complete a curative course of treatment within 12 months of initiation of treatment


Immunization, Influenza

Measure Title

High-risk adults age 18—64 who received influenza vaccine in the past year.

Measure Source

Healthy People 2010, measure 14-29c.

Tables

97. High-risk adults age 18—64 who received influenza vaccine in the past year, United States, 2004, by

  • Race
  • Ethnicity
  • Family income

Data Source

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

Denominator

U.S. civilian noninstitutionalized population: high-risk adults age 18—64.

Numerator

Number of high-risk adults age 18—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 of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Influenza

Measure Title

Noninstitutionalized adults age 65 and over who received influenza vaccine in the past year.

Measure Source

Healthy People 2010, measure 14-29a.

Tables

98. Noninstitutionalized adults age 65 and over who received influenza vaccine in the past year, United States, 2004, by

  • Race
  • Ethnicity
  • Family income

Data Source

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

Denominator

U.S. civilian noninstitutionalized population 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. See 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 of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Influenza

Measure Title

Hospital admissions for influenza per 100,000 population 65 and over.

Measure Source

Healthy People 2010, measure 1-9c.

Table

99. Immunization-preventable influenza admissions (excluding transfers from other institutions) per 100,000 population, age 65 years and older, United States, 2003, by

  • Race/ethnicity

Data Source

Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Elderly U.S. population (age 65 and older) by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Non-maternal hospital discharges age 65 and over with any diagnosis of immunization-preventable influenza (ICD-9-CM codes 487.0, 487.1, and 487.8), excluding 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.

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Immunization, Pneumonia

Measure Title

High-risk adults age 18—64 who ever received pneumococcal vaccination.

Measure Source

Healthy People 2010, measure 14-29d.

Tables

100. High-risk adults age 18—64 who ever received a pneumococcal vaccination, United States, 2004, by

  • Race
  • Ethnicity
  • Family income

Data Source

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

Denominator

U.S. civilian noninstitutionalized population: high-risk persons age 18—64.

Numerator

Number of high-risk persons age 18—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 of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

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Immunization, Pneumonia

Measure Title

Noninstitutionalized adults age 65 and over who ever received pneumococcal vaccination.

Measure Source

Healthy People 2010, measure 14-29b.

Tables

101. Noninstitutionalized adults age 65 and over who ever received a pneumococcal vaccination, United States, 2004, by

  • Race
  • Ethnicity
  • Family income

Data Source

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

Denominator

U.S. civilian noninstitutionalized population: 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. See 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 of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

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Treatment of Pneumonia

Measure Title

Deaths per 1,000 adult admissions with pneumonia.

Measure Source

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

Table

102. Deaths per 1,000 admissions with pneumonia as principal diagnosis, age 18 and older (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2003, by

  • Race/ethnicity

Data Source

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

Denominator

All discharges age 18 and older with principal diagnosis code of pneumonia. Excludes patients transferring to another short-term hospital, and obstetric and neonatal admissions.

Numerator

Number of deaths with a principal diagnosis code of pneumonia.

Comments

Rates are adjusted by age, gender, age-gender interactions, and APR-DRG risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

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 2, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 20 in the AHRQ Inpatient Quality Indicators software documentation. See http://www.qualityindicators.ahrq.gov for further information.

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Treatment of Pneumonia

Measure Title

Composite measure: Percent of patients with pneumonia who have blood cultures collected before antibiotics are administered, receive the initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and receive influenza and pneumococcal screening or vaccination.

Measure Source

Centers for Medicare and Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare hospital discharges age 65 and over meeting either of the following criteria:

  1. Principal diagnosis of pneumonia (ICD-9-CM codes: 480—483.8, 485—486, 487.0)
  2. Secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM code of 038.0—038.9) or respiratory failure (acute or chronic, ICD-9-CM code 518.81)

Numerator

Subset of the denominator population who received all recommended care, if indicated and appropriate: blood cultures collected before antibiotics are administered, initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and influenza and pneumococcal screening or vaccination.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

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Treatment of Pneumonia

Measure Title

Patients with pneumonia who have blood cultures collected before antibiotics are administered.

Measure Source

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

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges meeting either of the following criteria:

  1. Principal diagnosis of pneumonia
  2. 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

The measure specifications exclude 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, and 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

Patients with pneumonia who receive the initial antibiotic dose within 4 hours of hospital arrival.

Measure Source

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

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges meeting either of the following criteria:

  1. Principal diagnosis of pneumonia
  2. 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 4 hours after arrival at the hospital.

Comments

The measure specifications exclude 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, and 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

Patients with pneumonia who receive the initial antibiotic consistent with current recommendations.

Measure Source

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

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges meeting either of the following criteria:

  1. Principal diagnosis of pneumonia
  2. 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

The measure specifications exclude 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), and patients who had insufficient arrival or antibiotic timing data in their medical record.

See http://www.medqic.org for a discussion of accepted antibiotic regimens for pneumonia and information on other hospital-based measures for pneumonia.

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Treatment of Pneumonia

Measure Title

Patients with pneumonia who receive influenza screening or vaccination.

Measure Source

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

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges age 65 and over meeting either of the following criteria:

  1. Principal diagnosis of pneumonia
  2. 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

The measure specifications exclude 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, and patients who were discharged to hospice care.

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Treatment of Pneumonia

Measure Title

Patients with pneumonia who receive pneumococcal screening or vaccination.

Measure Source

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

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare discharges age 65 and over meeting either of the following criteria:

  1. principal diagnosis of pneumonia
  2. 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

The measure specifications exclude 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), and patients who were transferred to another short-term general hospital for inpatient care.

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Treatment of URI

Measure Title

Antibiotics prescribed at visits with a diagnosis of common cold per 10,000 population.

Measure Source

Healthy People 2010, measure 14-19.

Table

109. Emergency and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, United States, 2003—2004, by

  • Race

Data Source

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

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

Estimates of the civilian noninstitutionalized population are from special tabulations developed by the Population Division, U.S. Census Bureau, using the July 1, 2001 and July 1, 2002 set of State population estimates, and reflect Census 2000 data

Estimates of metropolitan and nonmetropolitan statistical areas used in calculating visit rates are preliminary figures based on Census 2000 data and were obtained through the Office of Research and Methodology and Division of Health Interview Statistics, NCHS. They are based on U.S. Census Bureau estimates of the civilian noninstitutionalized population of the United States as of July 1, 2003 and July 1, 2004.

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Management of Asthma

Measure Title

Hospital admissions for asthma per 100,000 population under 18.

Measure Source

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

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

Table

110. Pediatric asthma admissions (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age less than 18 years, United States, 2003, by

  • Race/ethnicity

Data Source

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

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.

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.

Tables were created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 4 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 Asthma

Measure Title

Hospital admissions for asthma per 100,000 population 18 and over.

Measure Source

Healthy People 2010, measure 24-2.

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

Table

111. Adult asthma admissions (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

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.

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 15 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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Treatment of Tuberculosis

Measure Title

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

Measure Source

American Thoracic Society/CDC treatment guidelines.

Tables

112. Tuberculosis patients who completed a curative course of treatment within 12 months of initiation of treatment, United States, 2002, 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

Tuberculosis cases completing therapy within 1 year.

Comments

See 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.

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

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