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2003 National Healthcare Quality Report

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Measures Specifications Appendix

Contents

Effectiveness of Care
Cancer
End Stage Renal Disease
Diabetes
Heart Disease
HIV/AIDS
Maternal and Child Health
Mental Health
Respiratory Diseases
Nursing Home and Home Health Care

Safety
Complications of Care
Prescribing Medications

Timeliness
Basic Access
Getting Appointments for Care
Waiting Time

Patient Centeredness
Patient Experience of Care

Resource Consumption
Resource Consumption

Overall Measures
Overall Measures

Effectiveness of Care

Cancer

Screening for Breast Cancer
Percent of women (age 40 and over) who report they had a mammogram within the past 2 years.
Rate of breast cancers diagnosed at advanced stage.

Screening for Cervical Cancer
Percent of women (age 18 and over) who report that they had a Pap smear within the past 3 years.
Rate of cervical cancers diagnosed as invasive (includes local, regional, and distant disease except in situ disease).

Screening for Colorectal Cancer
Percent of men and women (age 50 and over) who report they ever had a flexible sigmoidoscopy/colonoscopy.
Percent of men and women (age 50 and over) who reported they had a fecal occult blood test (FOBT) within the past 2 years.
Rate of colorectal cancers diagnosed as regional or distant staged cancers.

Cancer Treatment
Cancer deaths per 100,000 persons per year for all cancers.
Cancer deaths per 100,000 persons per year for most common cancers, prostate cancer.
Cancer deaths per 100,000 persons per year for most common cancers, breast cancer.
Cancer deaths per 100,000 persons per year for most common cancers, lung cancer.
Cancer deaths per 100,000 persons per year for most common cancers, colorectal cancer.

Palliative Care
Cancer deaths in hospice per 100 cancer deaths.
Median length of stay for cancer patients who received hospice care.

End Stage Renal Disease

Management of End Stage Renal Disease
Percent of dialysis patients registered on waiting list for transplantation.
Percent of patients with treated chronic kidney failure who receive a transplant within three years of renal failure.
Percent of hemodialysis patients with URR 65 or greater.
Percent of patients with hematocrit 33 or greater.
Patient survival rate.

Diabetes

Management of Diabetes
Percent of adults with diabetes who had a hemoglobin A1c measurement at least once in the past year.
Percent of adults with diabetes who had a lipid profile in past two years.
Percent of adults with diabetes who had a retinal eye examination in past year.
Percent of adults with diabetes who had a foot examination in past year.
Percent of adults with diabetes who had an influenza immunization in past year.
Percent of adults with diagnosed diabetes with HbA1c level >9.5% (poor control); < 9.0 (minimally acceptable); < 7.0 (optimal).
Percent of adults with diagnosed diabetes with most recent LDL-C level < 130 mg/dL (minimally acceptable); <100 (optimal).
Percent of adults with diagnosed diabetes with most recent blood pressure <140/90 mm/Hg.
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 1,000 population.

Heart Disease

Screening for High Blood Pressure
Percent of people age 18 and over who have had blood pressure measured within preceding 2 years and can state whether their blood pressure is normal or high.

Screening for High Cholesterol
Percent of adults 18 and over receiving cholesterol measurement within 5 years.

Counseling on Risk Factors
Percent of smokers receiving advice to quit smoking.

Treatment of AMI
Percent of AMI patients administered aspirin within 24 hours of admission.
Percent of AMI patients with aspirin prescribed at discharge.
Percent of AMI patients administered beta blocker within 24 hours of admission.
Percent of AMI patients with beta blocker prescribed at discharge.
Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.
Percent of AMI patients given smoking cessation counseling while hospitalized.
Median time to thrombolysis. Time from arrival to initiation of a thrombolytic agent in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time.
Median time to PTCA. Median time from arrival to percutaneous transluminal angioplasty (PTCA) in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time.

Treatment of Acute Heart Failure
Percent of heart failure patients having evaluation of left ventricular ejection fraction.
Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Management of Hypertension
Percent of people with hypertension who have blood pressure under control.

Management of CHF
Hospital admissions for congestive heart failure (CHF) per 1,000 population.

HIV/AIDS

AIDS Prevention
New AIDS cases per 100,000 population (age 13 or over).

Management of HIV/AIDS
HIV-infection deaths per 100,000 population.

Maternal and Child Health

Maternity Care
Percent of pregnant women receiving prenatal care in first trimester.
Percent of liveborn infants with low and very low birthweight (less than 2,500 grams, less than 1,500 grams).
Infant mortality per 1,000 live births.
Maternal deaths per 100,000 live births.

Immunization, Childhood
Percent of children 19-35 months who received all recommended vaccines.
Percent of children 19-35 months who received 4 doses of DPaT vaccine.
Percent of children 19-35 months who received 3 doses of polio vaccine.
Percent of children 19-35 months who received 1 dose of MMR vaccine.
Percent of children 19-35 months who received 3 doses of Hib vaccine.
Percent of children 19-35 months who received 3 doses of hepatitis B vaccine.
Percent of children 19-35 months who received 1 dose of varicella vaccine.

Immunization, Adolescent
Percent of adolescents (age 13-15) reported to have received 3 or more doses of hepatitis B vaccine.
Percent of adolescents (age 13-15) reported to have received 2 or more doses of MMR vaccine.
Percent of adolescents (age 13-15) reported to have received 1 or more doses of tetanus-diphtheria booster.
Percent of adolescents (age 13-15) reported to have received one or more doses of varicella vaccine.

Childhood Dental Care
Percent of children age 2-17 who report dental visit in last year.

Treatment of Pediatric Gastroenteritis
Hospital admissions for pediatric gastroenteritis per 100,000 population less than 18 years of age.

Mental Health

Treatment of Depression
Percent of adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase.
Percent of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase.
Percent of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment.
Deaths due to suicide per 100,000 population.

Respiratory Diseases

Immunization, Influenza
Percent of high risk persons (e.g. COPD) age 18-64 who received an influenza vaccination in the past 12 months.
Percent of persons age 65 and over who received an influenza vaccination in the past 12 months.
Percent of institutionalized adults (persons in long-term care or nursing homes) who received influenza vaccination in past 12 months.
Hospital admissions for immunization-preventable influenza per 100,000 population.

Immunization, Pneumonia
Percent of high risk persons (e.g. COPD) age 18-64 who ever received a pneumococcal vaccination.
Percent of persons, age 65 and over who ever received a pneumococcal vaccination.
Percent of institutionalized adults (persons in long-term care or nursing homes) who ever received pneumococcal vaccination.

Treatment of Pneumonia
Percent of patients with pneumonia who have blood cultures collected before antibiotics are administered.
Percent of patients with pneumonia who receive the initial antibiotic dose within 8 hours of hospital arrival.
Percent of patients with pneumonia who receive the initial antibiotic consistent with current recommendations.
Percent of patients with pneumonia who receive influenza screening or vaccination.
Percent of patients with pneumonia who receive pneumococcal screening or vaccination.

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

Management of Asthma
Percent of people with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma (inhaled corticosteroids).
Hospital admissions for pediatric asthma per 10,000 population under age 18.
Hospital admissions for asthma per 10,000 population.
Hospital admissions for asthma per 100,000 population age 65 and over.

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

Nursing Home and Home Health Care

Nursing Facility Care
Chronic care: Percent of residents with pain.
Chronic care: Late-loss ADL worsening.
Chronic care: Infections prevalence.
Chronic care: Stage 1-4 pressure ulcer prevalence.
Chronic care: Restraint use prevalence.
Post acute care: Failure to improve/manage delirium symptoms.
Post acute care: Percent of residents with pain.
Post acute care: Improvement in walking.

Home Health Care
Improvement in upper body dressing.
Improvement in management of oral medications.
Improvement in bathing.
Stabilization in bathing.
Improvement in transferring.
Improvement in ambulation/locomotion.
Improvement in toileting.
Improvement in pain interfering with activity.
Improvement in dyspnea.
Improvement in urinary incontinence.
Improvement in confusion frequency.
Acute care hospitalization.

Safety

Complications of Care

Birth trauma.
Death in low mortality DRGs.
Failure to rescue.
Transfusion reactions and Transfusion reactions (area).
Foreign body left in body during procedure and foreign body left in body during procedure (area).
Central line-associated bloodstream infection in ICU patients.
Central line-associated bloodstream infection in infants weighing 1,000 grams or less at birth in intensive care.
Complications of anesthesia.
Decubitus ulcers.
Iatrogenic pneumothorax and iatrogenic pneumothorax (area).
Infection due to intravenous lines or catheters and infection due to intravenous lines or catheters (area).
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 and technical difficulty with procedure (area).
Postoperative wound dehiscence and postoperative wound dehiscence (area).
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.
Percentage of adults who report that usual source of care asks about prescription medications and treatments from other providers.

Timeliness

Basic Access

Percent of persons who report that they have a usual source of medical care, by place of care.
Percent of families who experienced difficulty in obtaining care, by reason.

Getting Appointments for Care

Percent of persons who report that they can get an appointment for routine care as soon as they wanted (always, usually, sometimes/never).
Percent of persons who report that they can get care for illness or injury as soon as they wanted (always, usually, sometimes/never).

Waiting Time

ED visits: Percent of patients with waiting time to be seen by physician greater than or equal to one hour (presented separately for emergent, urgent, semi-urgent, and non-urgent visits).
ED visits: Percent of patients who left without being seen.

Patient Centeredness

Patient Experience of Care

Percent of patients who report that doctor listens carefully (always, usually, sometimes/never), adults and parents of children.
Percent of patients who report that doctor explains things clearly (always, usually, sometimes/never), adults and parents of children.
Percent of patients who report that doctor showed respect for what they had to say (always, usually, sometimes/never), adults and parents.
Percent of patients who report that doctor spent enough time with them (always, usually, sometimes/never), adults and parents of children.

Resource Consumption

Resource Consumption

National health expenditures by source of funds: selected calendar years.
Total per capita health expenditures in dollars: selected countries and years.
Total personal health care as a percent of gross state product by state.

Overall Measures

Overall Measures

Overall rating of health care received.
Life expectancy (at birth, at age 65).
Days of activity limitation due to health.

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