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National Healthcare Disparities Report, 2007

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Effectiveness of Care: Respiratory Diseases


Influenza Immunization
High-risk adults ages 18-64 who received influenza vaccine in the past year
Noninstitutionalized adults age 65 and over who received influenza vaccine in the past year
Hospital admissions for influenza per 100,000 population age 65 and over
Pneumonia Immunization
High-risk adults ages 18-64 who ever received pneumococcal vaccination
Noninstitutionalized adults age 65 and over who ever received pneumococcal vaccination
Treatment of Pneumonia
Deaths per 1,000 adult admissions with pneumonia
Composite measure: Pneumonia patients who received recommended hospital care for pneumonia (blood cultures collected before antibiotics are administered, received the initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and received screening for influenza and pneumococcal disease vaccination status and vaccination, if indicated)
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 Upper Respiratory Infection (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 age 18
Hospital admissions for asthma per 100,000 population age 18 and over
People currently with asthma who ever had emergency room/urgent care clinic visits for asthma within the past year
Treatment of Tuberculosis
Tuberculosis patients who complete a curative course of treatment within 12 months of initiation of treatment

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Influenza Immunization

Measure Title

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

Measure Source

Healthy People 2010.

Tables

104 High-risk adults ages 18-64 who received influenza vaccine in the past year, United States, 2005, by

  • Race.
  • Ethnicity.
  • Family income.

Data Source

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

Denominator

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

Numerator

Number of high-risk adults ages 18-64 who reported 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 rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

This measure is referred to as measure 14-29c in Healthy People 2010 documentation.

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Influenza Immunization

Measure Title

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

Measure Source

Healthy People 2010.

National Tables

105a Noninstitutionalized adults age 65 and over who received influenza vaccine in the past year, United States, 2005, by

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized population age 65 and over.

National Numerator

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

State Tables

105b Adults age 65 and over who received influenza vaccine within the past year, California, 2005, by

  • Race.
  • Ethnicity.
  • Family income.
  • Asian ethnicity.

State Data Source

University of California, Los Angeles (UCLA), California Health Interview Survey (CHIS).

State Denominator

California civilian population age 65 and over, excluding people residing in group quarters.

State 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 Indicators, 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 reported in national tables 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.

This measure and its tables are also presented in other relevant sections of the report.

This measure is referred to as measure 14-29a in Healthy People 2010 documentation.

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Influenza Immunization

Measure Title

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

Measure Source

Healthy People 2010.

Table

106 Immunization-preventable influenza admissions (excluding transfers from other institutions) per 100,000 population, age 65 and over, United States, 2004, by

  • Race/ethnicity.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

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, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This measure and its tables are also presented in other relevant sections of the report.

This measure is referred to as measure 1-9c in Healthy People 2010 documentation.

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Pneumonia Immunization

Measure Title

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

Measure Source

Healthy People 2010.

Tables

107 High-risk adults ages 18-64 who ever received a pneumococcal vaccination, United States, 2005, by

  • Race.
  • Ethnicity.
  • Family income.

Data Source

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

Denominator

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

Numerator

Number of high-risk persons ages 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 rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 14-29d in Healthy People 2010 documentation.

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Pneumonia Immunization

Measure Title

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

Measure Source

Healthy People 2010.

Tables

108 Noninstitutionalized adults age 65 and over who ever received a pneumococcal vaccination, United States, 2005, by

  • Race.
  • Ethnicity.
  • Family income.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), 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 Indicators, 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 rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure and its tables are also presented in other relevant sections of the report.

This measure is referred to as measure 14-29b in Healthy People 2010 documentation.

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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 (IQI).

Table

109 Deaths per 1,000 admissions with pneumonia as principal diagnosis (excluding obstetric and neonatal admissions and transfers to another hospital), age 18 and over, United States, 2004, by

  • Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

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, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, 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: Pneumonia patients who received recommended hospital care for pneumonia (blood cultures collected before antibiotics are administered, received the initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and received screening for influenza and pneumococcal disease vaccination status and vaccination, if indicated).

Measure Source

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

Table

110 Percent of pneumonia patients who received recommended hospital care, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

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

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

Table

111 Percent of pneumonia patients who have blood cultures collected before antibiotics are administered, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

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

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

Table

112 Percent of pneumonia patients who received the first dose of antibiotic within 4 hours of arrival at the hospital, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

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

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

Table

113 Percent of immunocompetent pneumonia patients (either ICU or non-ICU) who received the recommended empirical antibiotic regimen during the first 24 hours that is consistent with current guidelines, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

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

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

Table

114 Percent of pneumonia patients age 50 and older discharged during October-February who were screened for influenza vaccine status and were vaccinated prior to discharge, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

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

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

Table

115 Percent of pneumonia patients age 65 and older who were screened for pneumococcal vaccine status and vaccinated prior to discharge, if indicated, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

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 Upper Respiratory Infection (URI)

Measure Title

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

Measure Source

Healthy People 2010.

Table

116 Emergency and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, United States, 2004-2005, by

  • Race.

Data Source

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

Denominator

Number of 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 estimates as of July 1 of the period of study and are based on 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 of the period of study.

This measure is referred to as measure 14-19 in Healthy People 2010 documentation.

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Management of Asthma

Measure Title

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

Measure Source

Healthy People 2010.

Table

117 Pediatric asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system and transfers from other institutions) per 100,000 population, ages 2-17, United States, 2004, by

  • Race/ethnicity.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

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, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, 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.

This measure and its tables are also presented in other relevant sections of the report.

This measure is referred to as measures 24-2 and 1-9a in Healthy People 2010. documentation

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Management of Asthma

Measure Title

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

Measure Source

Healthy People 2010.

University of California, Los Angeles (UCLA), Center for Health Policy Research (CHPR), California Health Interview Survey (CHIS).

National Tables

118a Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2004, by

  • Race/ethnicity.

118b Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 65 and over, United States, 2004, by

  • Race/ethnicity.

National Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

National Denominator

U.S. civilian population: adults age 18 and over.

National Numerator

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

State Tables

118c Asthma patients age 18 and over who ever had hospital admissions for asthma within the past year, California, 2001, by

  • Race.
  • Ethnicity.
  • Family income.
  • Asian ethnicity.

State Data Source

UCLA, CHIS.

State Denominator

California civilian population age 18 and over, excluding people residing in group quarters.

State 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.

National 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, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, 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.

This measure is referred to as measure 24-2 in Healthy People 2010 documentation.

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Management of Asthma

Measure Title

People currently with asthma who ever had emergency room/urgent care clinic visits for asthma within the past year.

Measure Source

University of California, Los Angeles (UCLA), Center for Health Policy Research (CHPR), California Health Interview Survey (CHIS).

Tables

119 People currently with asthma who ever had emergency room/urgent care clinic visits for asthma within the past year, California, 2005, by

  • Race.
  • Ethnicity.
  • Family income.
  • Asian ethnicity.

Data Source

UCLA, CHIS.

Denominator

California Health Interview Survey respondents who indicated they had asthma.

Numerator

Subset of denominator who answered "yes" to the question: "During the past 12 months, have you had to visit a hospital emergency room or urgent care clinic because of your asthma?"

Comments

This measure and its tables are also presented in other relevant sections of the report.

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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.

Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination.

Tables

120 Tuberculosis patients who completed a curative course of treatment within 12 months of initiation of treatment, United States, 2003, by

  • Race.
  • Ethnicity.
  • Race (foreign born only).
  • Ethnicity (foreign born only).

Data Source

CDC, National Tuberculosis Surveillance System (NTBSS).

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.

For a discussion of completion of TB therapy, see Appendix A of the CDC publication Reported Tuberculosis in the United States, 2003, available at http://www.cdc.gov/tb/surv/.

This measure and its tables are also presented in other relevant sections of the report.

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