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2006 National Healthcare Quality Report

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
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 less than 140/80 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


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

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

Table

1.16. Percent of adults age 40 and over with diabetes who had all three examinations in the past year: a hemoglobin A1c test, a retinal eye examination, and a foot examination, United States, 2000 and 2003.

Data Source

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

Denominator

Adult U.S. population (40 years of age and older, civilian, noninstitutionalized) with diabetes who answered the Diabetes Care Survey (DCS) questions and had valid, non-missing responses to all 3 questions with regard to the components of the composite measure.

Numerator

Adult U.S. population (40 years of age and older, civilian, noninstitutionalized) with diabetes whose answers indicated they had at least 1 hemoglobin A1c measurement, a retinal eye examination, and a foot examination during the survey year.

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 Quality Report.

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

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

The component measures are also Healthy People 2010 measures (5-12, 5-13, and 5-14).

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Management of Diabetes

Measure Title

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

Measure Source

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

National Table

1.17a. Percent of adults age 40 and over with diabetes who reported having a hemoglobin A1c measurement at least once in the past year, United States, 2000 and 2003.

National Data Source

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

National Denominator

Adults, age 40 and over, with diabetes who answered the Diabetes Care Survey (DCS) question: During the survey year, "How many times did a doctor, nurse, or other health professional check for glycosylated hemoglobin or ‘hemoglobin A-one-C';? " Nonresponses and "Don't Know" responses were excluded.

National Numerator

Adults with diabetes who had a hemoglobin A1c test at least once in the survey year.

State Table

1.17b. Percent of adults age 40 and over with diabetes who had a hemoglobin A1c measurement at least once in the past year, by State, 2001 and 2004.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults, age 40 and over, with diabetes.

State Numerator

Adults with diabetes who had a hemoglobin A1c test at least once in the survey year.

Comments

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

The national table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources section of this appendix for more information on the DCS.

Percents are age adjusted to the 2000 standard population; age-specific estimates are not age adjusted.

This measure is also a Healthy People 2010 measure (5-12).

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Management of Diabetes

Measure Title

Percent of 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.

Table

1.18. Percent of adults age 40 and over with diabetes who reported receiving a lipid profile in the past 2 years, United States, 2000 and 2003.

Data Source

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

Denominator

Adults, age 40 and over, 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?" Nonresponses and "Don't Know" responses were excluded.

Numerator

Adults with diabetes who answered "Within the past year" or "Within the past 2 years" to the question.

Comments

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

This table reports data from the MEPS Preventive Care section. See the MEPS entry in the Data Sources section of this appendix for more information.

Percents are age adjusted to the 2000 standard population; age-specific estimates are not age adjusted.

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Management of Diabetes

Measure Title

Percent of adults with diabetes who had a retinal eye examination in the past year.

Measure Source

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

National Table

1.19a. Percent of adults age 40 and over with diabetes who reported having a retinal eye examination in the past year, United States, 2000 and 2003.

National Data Source

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

National Denominator

Adults, age 40 and over, with diabetes who answered a question about eye examinations in the survey years. Nonresponses and "Don't Know" responses were excluded.

National Numerator

Adults with diabetes who answered "During 2000" or "During 2001" for 2000 data, or answered "During 2001" or "During 2002" for 2002 data, or answered "During 2002" or "During 2003" for 2002 data, depending on the panel.

State Table

1.19b. Percent of adults age 40 and over with diabetes who had a retinal eye examination in the past year, by State, 2001 and 2004.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults, age 40 and over, with diabetes.

State Numerator

Adults with diabetes who had at least 1 retinal eye examination in the survey years.

Comments

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

The national table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources section of this appendix and http://www.meps.ahrq.gov/ for more information on the DCS and MEPS panels.

Percents are age adjusted to the 2000 standard population; age-specific estimates are not age adjusted.

There is a slight difference between the text of the question asked in 2003 and later and the question asked in 2002 and earlier. In the earlier years, respondents were asked "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." In 2002 and later, respondents were asked "Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light."

This measure is also a Healthy People 2010 measure (5-13).

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Management of Diabetes

Measure Title

Percent of adults with diabetes who had a foot examination in the past year.

Measure Source

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

National Table

1.20a. Percent of adults age 40 and over with diabetes who reported having a foot examination in past year, United States, 2000 and 2003.

National Data Source

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

National Denominator

Adults, age 40 and over, with diabetes who answered the question: During the survey year, "How many times did a health professional check your feet for any sores or irritations?" Nonresponses and "Don't Know" responses were excluded.

National Numerator

Adults with diabetes who had a foot examination 1 or more times in the survey year.

State Table

1.20b. Percent of adults age 40 and over with diabetes who had a foot examination in the past year, by State, 2001 and 2004.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults, age 40 and over, with diabetes.

State Numerator

Adults with diabetes who had a foot examination 1 or more times in the survey years.

Comments

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

The national table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources section of this appendix for more information on the DCS.

This measure is also a Healthy People 2010 measure (5-14).

Percents are age adjusted to the 2000 standard population; age-specific estimates are not age adjusted.

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Management of Diabetes

Measure Title

Percent of adults with diabetes who had an influenza immunization in the past year.

Measure Source

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

National Table

1.21a. Percent of adults age 40 and over with diabetes who reported receiving influenza immunization in the past year, United States, 2000 and 2003.

National Data Source

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

National Denominator

Adults, age 40 and over, with diabetes who answered the question "How long since you had a flu shot?" Nonresponses and "Don't Know" responses were excluded.

National Numerator

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

State Table

1.21b. Percent of noninstitutionalized high-risk adults age 18-64 with diabetes who had an influenza immunization in the past year, by State, 2001 and 2004.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

High-risk adults, age 18-64, with diabetes.

State Numerator

High-risk adults age 18-64 with diabetes who had an influenza immunization in the past years.

Comments

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

The national table reports data from the MEPS Preventive Care section. See the MEPS entry in the Data Sources section of this appendix for more information.

Percents are age adjusted to the 2000 standard population; age-specific estimates are not age adjusted.

High-risk conditions include diabetes, heart disease, lung disease, kidney disease, liver disease and cancer. Here high-risk is defined as adults having diabetes and therefore definition for the State table differs slightly from the Healthy People 2010 definition for 14-29c in that it focuses exclusively on non-institutionalized adults with diabetes.

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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.

Table

1.22. Percent of adults age 40 and over with diagnosed diabetes whose hemoglobin A1c level was less than 7.0% (optimal control), United States, 1988-1994 and 1999-2002.

Data Source

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

Denominator

Adults, age 40 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

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

Percents are age adjusted using 2000 standard population with 3 age groups (18-39, 40-59, 60 and over).

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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.

Table

1.23. Percent of adults age 40 and over with diagnosed diabetes whose total cholesterol was less than 200 mg/dL, United States, 1988-1994 and 1999-2002.

Data Source

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

Denominator

Adults, age 40 or older, with diabetes.

Numerator

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

Comments

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

Percents are age adjusted using 2000 standard population with 3 age groups (18-39, 40-59, 60 and over).

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Management of Diabetes

Measure Title

Percent of adults with diagnosed diabetes with most recent blood pressure less than140/80 mm Hg.

Measure Source

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

Table

1.24. Percent of adults age 40 and over with diagnosed diabetes with systolic blood pressure less than 140 mmHg and diastolic blood pressure less than 80 mm Hg based on average of 3 measurements, United States, 1988-1994 and 1999-2002.

Data Source

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

Denominator

Adults, age 40 and over, with diabetes.

Numerator

Adults with diabetes with blood pressure less than 140/80 mm Hg at exam.

Comments

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

Percents are age adjusted using 2000 standard population with 3 age groups (18-39, 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

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

Tables

1.25a. Admissions for uncontrolled diabetes without complications (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age 18 years and older, United States, 2001 and 2003.

1.25b. Admissions for uncontrolled diabetes without complications (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age 18 years and older, by State, 2002 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample and State Inpatient Databases.

Denominator

U.S. population age 18 and over.

Numerator

Discharges age 18 and over with principal diagnosis of uncontrolled diabetes (ICD-9-CM code 250.02, 250.03) without mention of a short-term (ketoacidosis, hyperosmolarity, coma) or long-term complication (renal, eye, neurological, circulatory, other unspecified). Obstetric and neonatal admissions and 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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 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.

Tables

1.26a. 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, 2001 and 2003.

1.26b. Admissions for diabetes with short-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 years and older, by State, 2002 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample and State Inpatient Databases.

Denominator

U.S. population age 18 and over.

Numerator

Adult discharges age 18 and over with a principal diagnosis of diabetes with short-term complications (ketoacidosis, hyperosmolar, coma) (ICD-9-CM code 250.10-250.13, 250.20-250.23, 250.30-250.33). Obstetric admissions and 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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

Tables were 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.

Tables

1.27a. 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, 2001 and 2003.

1.27b. Admissions for diabetes with long-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 years and older, by State, 2002 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample and State Inpatient Databases.

Denominator

U.S. population age 18 and over.

Numerator

Hospital inpatient discharges age 18 and over with a principal diagnosis code for long-term complications (renal, eye, neurological, circulatory, or complications not otherwise specified) (ICD-9-CM codes 250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93). Obstetric admissions and patients transferred from other institutions are excluded.

Comments

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

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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

Measure Source

Healthy People 2010, measure 5-10.

Table

1.28. Hospital admissions for lower extremity amputations in patients with diabetes per 1,000 population, United States, 1998-2000 and 2002-2004.

Data Source

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

Denominator

Number of U.S. civilian persons who report that they have ever been diagnosed with diabetes, excluding women age 18 and over who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes).

Numerator

Number of hospital discharges 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

Rate in the national table is age adjusted. The age groups used for age adjustment for estimates are different from those in some earlier versions of the NHQR. Race classification changed in 2000. Data for 2000 and later years may not be comparable to data from previous years.

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