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2006 National Healthcare Quality Report

Effectiveness of Care: Heart Disease

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Screening for High Blood Pressure
People age 18+ who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure is normal or high
Screening for High Cholesterol
Adults 18+ receiving cholesterol measurement within 5 years
Counseling on Risk Factors
Smokers receiving advice to quit smoking
Treatment of AMI
Composite measure: AMI patients administered aspirin and beta-blocker within 24 hours of admission, prescribed aspirin and beta-blocker at discharge, and given smoking cessation counseling while hospitalized
AMI patients administered aspirin within 24 hours of admission
AMI patients with aspirin prescribed at discharge
AMI patients administered beta-blocker within 24 hours of admission
AMI patients with beta-blocker prescribed at discharge
AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge
AMI patients given smoking cessation counseling while hospitalized
Median time in minutes to thrombolysis
Median time to PTCA
Treatment of Acute Heart Failure
Composite measure: Heart failure patients having evaluation of left ventricular ejection fraction and prescribed ACE inhibitor at discharge, if indicated, for left ventricular systolic dysfunction
Heart failure patients having evaluation of left ventricular ejection fraction
Heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge
Management of Hypertension
People with hypertension who have blood pressure under control
Management of Congestive Heart Failure
Hospital admissions for congestive heart failure (CHF)
Heart Disease Treatment
Pediatric heart surgery mortality rate
Abdominal aortic aneurysm (AAA) repair mortality rate
Coronary artery bypass graft (CABG) mortality rate
Percutaneous transluminal coronary angioplasty (PTCA) mortality rate
Acute myocardial infarction (AMI) mortality rate
Congestive heart failure (CHF) mortality rate
Preventive Care
Obese adults who were told by a doctor they were overweight
Obese adults who were given advice about exercise
Obese adults who were given advice about eating fewer high fat or high cholesterol foods


Screening for High Blood Pressure

Measure Title

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

Measure Source

Healthy People 2010, measure 12-12.

Table

1.35. Percent of adults age 18 and over who had their blood pressure measured within the preceding 2 years and could state whether their blood pressure was normal or high, United States, 1998 and 2003.

Data Source

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

Denominator

U.S. adult population, age 18 and over.

Numerator

Number of adults, age 18 and over, who had their blood pressure measured within the preceding 2 years and can state their blood-pressure level.

Comments

Percents are age adjusted.

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Screening for High Cholesterol

Measure Title

Percent of adults 18 and over receiving cholesterol measurement within 5 years.

Measure Source

Healthy People 2010, measure 12-15.

National Table

1.36a. Percent of adults age 18 and over who had their blood cholesterol checked within the preceding 5 years, United States, 1998 and 2003.

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. adult population, age 18 and over.

National Numerator

U.S. adult population, age 18 and over, who have had their cholesterol checked within 5 years.

State Table

1.36b. Percent of adults age 18 and over who had their blood cholesterol checked within the preceding 5 years, by State, 2001 and 2004.

State Data Source

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

State Denominator

U.S. adult population, age 18 and over.

State Numerator

Adults who have had their cholesterol checked within 5 years.

Comments

Percents 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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Counseling on Risk Factors

Measure Title

Percent of smokers receiving advice to quit smoking.

Measure Source

Healthy People 2010, measure 1-3c.

National Table

1.37a. Percent of current smokers age 18 and over with a checkup who reported receiving advice to quit smoking, 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 18 and over, who reported in the survey year, that they currently smoke and had a routine check up in the past 12 months, and answered the question: "In the past 12 months did a doctor advise you to stop smoking?" Nonresponses and "Don't Know" responses were excluded.

National Numerator

Subset of the denominator population who received advice to quit smoking.

State Table

1.37b. Percent of current smokers age 18 and over who reported receiving advice to quit smoking, 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

Adult current smokers, age 18 and over, with a physician visit in the past year.

State Numerator

Adult smokers who received advice to quit smoking.

Comments

The allowable responses to the MEPS survey question about smoking changed in 2003. Therefore, reported national rates may not be comparable to earlier years.

The national table reports data from the MEPS Self-Administered Questionnaire (SAQ). See the MEPS entry in the Data Sources section of this appendix for more information on the SAQ. Percents in the State table are age adjusted to the 2000 standard population.

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Treatment of AMI

Measure Title

Composite measure: Percent of AMI patients administered aspirin and beta-blocker within 24 hours of admission, prescribed aspirin and beta-blocker at discharge, and given smoking cessation counseling while hospitalized.

Measure Source

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

Tables

1.38a. Percent of recommended hospital care received by patients with acute myocardial infarction (AMI), Medicare beneficiaries, United States, 2002 and 2004.

1.38b. Percent of recommended hospital care received by patients with acute myocardial infarction (AMI), Medicare beneficiaries, by State, 2004.

1.38c. Percent of recommended hospital care received by patients with acute myocardial infarction (AMI), all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and a history of smoking cigarettes anytime during the year prior to hospital arrival.

Numerator

Subset of AMI denominator patients who received all recommended processes during the hospital stay: aspirin and beta-blocker administered within 24 hours of admission, aspirin and beta-blocker prescribed at discharge, and smoking cessation counseling given while hospitalized.

Comments

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18, patients transferred to another acute care or Federal hospital, patients transferred to hospice, patients who expired, and patients who left against medical advice. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.38c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Percent of AMI patients administered aspirin within 24 hours of admission.

Measure Source

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

Tables

1.39a. Percent of AMI patients administered aspirin within 24 hours of admission, Medicare beneficiaries, United States, 2002 and 2004.

1.39b. Percent of AMI patients administered aspirin within 24 hours of admission, Medicare beneficiaries, by State, 2002 and 2004.

1.39c. Percent of AMI patients administered aspirin within 24 hours of admission, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without aspirin contraindication.

Numerator

Subset of AMI denominator patients who received aspirin within 24 hours before or after hospital arrival.

Comments

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age 18, patients transferred to another acute care or Federal hospital on day of arrival, transfers from other acute care hospitals, patients discharged, patients who expired or left against medical advice on day of arrival, and patients with certain aspirin contraindications. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.39c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Percent of AMI patients with aspirin prescribed at discharge.

Measure Source

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

Tables

1.40a. Percent of AMI patients with aspirin prescribed at discharge, Medicare beneficiaries, United States, 2002 and 2004.

1.40b. Percent of AMI patients with aspirin prescribed at discharge, Medicare beneficiaries, by State, 2002 and 2004.

1.40c. Percent of AMI patients with aspirin prescribed at discharge, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without aspirin contraindication.

Numerator

Subset of AMI denominator patients who were prescribed aspirin at hospital discharge.

Comments

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age 18, patients transferred to another acute care or Federal hospital, patients who expired, patients who left against medical advice, patients discharged to hospice, and patients with certain aspirin contraindications. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.40c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Percent of AMI patients administered beta-blocker within 24 hours of admission.

Measure Source

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

Tables

1.41a. Percent of AMI patients administered a beta-blocker within 24 hours of admission, Medicare beneficiaries, United States, 2002 and 2004.

1.41b. Percent of AMI patients administered a beta-blocker within 24 hours of admission, Medicare beneficiaries, by State, 2002 and 2004.

1.41c. Percent of AMI patients administered a beta-blocker within 24 hours of admission, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without beta-blocker contraindication.

Numerator

Subset of AMI denominator patients who received a beta-blocker within 24 hours after hospital arrival.

Comments

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age18, patients transferred to another acute care or Federal hospital, patients who expired or were discharged to hospice, patients who left against medical advice, and patients with certain conditions or contraindications pertaining to beta-blockers. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.41c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Percent of AMI patients with beta-blocker prescribed at discharge.

Measure Source

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

Tables

1.42a. Percent of AMI patients with a beta-blocker prescribed at discharge, Medicare beneficiaries, United States, 2002 and 2004.

1.42b. Percent of AMI patients with a beta-blocker prescribed at discharge, Medicare beneficiaries, by States, 2002 and 2004.

1.42c. Percent of AMI patients with a beta-blocker prescribed at discharge, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) without beta-blocker contraindication.

Numerator

Subset of AMI denominator patients who were prescribed a beta-blocker at hospital discharge.

Comments

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. Measure criteria exclude patients under age18, patients transferred to acute care hospital or Federal hospital, patients who expired, patients who left against medical advice, patients discharged to hospice and patients with certain beta-blocker contraindications. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.42c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Measure Source

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

National Tables

1.43a. Percent of AMI patients with left ventricular systolic dysfunction prescribed an ACE inhibitor at discharge, Medicare beneficiaries, United States, 2002 and 2004.

1.43b. Percent of AMI patients with left ventricular systolic dysfunction prescribed an ACE inhibitor at discharge, Medicare beneficiaries, by State, 2002 and 2004.

National Data Source

CMS, Medicare Quality Improvement Organization Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI), and with a left ventricular ejection fraction, and without contraindication for angiotensin-converting enzyme (ACE) inhibitors.

National Numerator

Subset of the denominator prescribed an ACE inhibitor at hospital discharge.

State Table

1.43c. Percent of AMI patients with left ventricular systolic dysfunction prescribed an ACE inhibitor or an angiotensin receptor blocker at discharge, all payers, by State, 2004 and 2005.

State Data Source

CMS, Hospital Compare.

State Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI), and with a left ventricular ejection fraction, and without contraindication for angiotensin-converting enzyme (ACE) inhibitors or an angiotensin receptor blockers (ARB).

State Numerator

Subset of the denominator prescribed ACE inhibitor or ARB medication at hospital discharge

Comments

Effective November 2004, CMS revised this measure to incorporate newly recognized treatment. NHQR 2005 tables 1.43a and 1.43b refer to the prior version of the measure; table 1.43c refers to the revised version.

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure criteria exclude patients under age18, patients transferred to another acute care or Federal hospital, patients who expired, patients who left against medical advice, patients discharged to hospice, and patients with certain conditions or contraindications pertaining to the medications described in the measure. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.43c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Percent of AMI patients given smoking cessation counseling while hospitalized.

Measure Source

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

Tables

1.44a. Percent of AMI patients given smoking cessation counseling while hospitalized, Medicare beneficiaries, United States, 2002 and 2004.

1.44b. Percent of AMI patients given smoking cessation counseling while hospitalized, Medicare beneficiaries, by State, 2002 and 2004.

1.44c. Percent of AMI patients given smoking cessation counseling while hospitalized, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and a history of smoking cigarettes anytime during the year prior to hospital arrival.

Numerator

Subset of AMI denominator patients who received smoking cessation advice or counseling during the hospital stay.

Comments

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18, patients transferred to another acute care or Federal hospital, patients transferred to hospice, patients who expired, and patients who left against medical advice. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.44c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

Median time in minutes 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.

Measure Source

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

National Tables

1.45a. Median time for AMI patients to thrombolysis, Medicare beneficiaries, United States, 2002 and 2004.

1.45b. Median time for AMI patients to thrombolysis, Medicare beneficiaries, by State, 2002 and 2004.

National Data Source

CMS, Medicare Quality Improvement Organization Program.

National Population

Discharged hospital patients meeting all 3 of the following criteria:

  1. Principal diagnosis of acute myocardial infarction (AMI)
  2. ST segment elevation or LBBB on the ECG performed closest to the hospital arrival
  3. Thrombolytic therapy during the hospital stay

State Table

1.45c. Percent of AMI patients receiving thrombolytic medication within 30 minutes of arrival, all payers, by State, 2004 and 2005.

State Data Source

CMS, Hospital Compare.

State Numerator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and thrombolytic documented therapy during the hospital stay.

State Denominator

Subset of numerator with thrombolytic therapy within 30 minutes of arrival.

Comments

Effective October 2003, CMS revised this measure. NHQR 2005 tables 1.45a and 1.45b refer to the prior version of the measure; table 1.45c refers to the revised version.

Median time is in minutes 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.

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18 and patients transferred from another acute care hospital, including another emergency department. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.45c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of AMI

Measure Title

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.

Measure Source

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

National Tables

1.46a. Median time for AMI patients to PTCA, Medicare beneficiaries, United States, 2002 and 2004.

1.46b. Median time for AMI patients to PTCA, Medicare beneficiaries, by State, 2002 and 2004.

National Data Source

CMS, Medicare Quality Improvement Organization Program.

National Population

Discharged hospital patients meeting all 3 of the following criteria:

  1. Principal diagnosis of acute myocardial infarction (AMI)
  2. ST segment elevation or LBBB on the ECG performed closest to the hospital arrival
  3. Percutaneous transluminal angioplasty performed during the hospital stay

State Table

1.46c. Percent of AMI patients given percutaneous coronary intervention within 120 minutes of arrival, all payers, by State, 2005.

State Data Source

CMS, Hospital Compare.

State Numerator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented percutaneous transluminal angioplasty or stent placement during the hospital stay.

State Denominator

Subset of numerator with given percutaneous coronary intervention (angioplasty or stent placement) within 120 minutes of arrival.

Comments

Effective October 2003, CMS revised this measure. NHQR 2005 tables 1.46a and 1.46b refer to the prior version of the measure; table 1.46c refers to the revised version.

Median time is time in minutes 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.

ICD-9-CM codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of under age 18 and patients transferred from other acute care hospitals, including other emergency departments, and patients administered thrombolytic agents. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.46c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Heart Failure

Measure Title

Composite measure: percent of heart failure patients having evaluation of left ventricular ejection fraction and prescribed ACE inhibitor at discharge, if indicated, for left ventricular systolic dysfunction.

Measure Source

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

Tables

1.47a. Percent of heart failure patients who received recommended hospital care, Medicare beneficiaries, United States, 2002 and 2004.

1.47b. Percent of heart failure patients who received recommended hospital care, Medicare beneficiaries, by State, 2004.

1.47c. Percent of heart failure patients who received recommended hospital care, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure and without angiotensin converting enzyme (ACE) inhibitor contraindications.

Numerator

Subset of the denominator heart failure patients with documentation that left ventricular ejection fraction was assessed before arrival, during hospitalization, or was planned for after discharge and who are prescribed an ACE inhibitor at hospital discharge.

Comments

ICD-9-CM codes for heart failure include 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9.

Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.47c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Heart Failure

Measure Title

Percent of heart failure patients having evaluation of left ventricular ejection fraction.

Measure Source

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

Tables

1.48a. Percent of heart failure patients having evaluation of left ventricular ejection fraction, Medicare beneficiaries, United States, 2002 and 2004.

1.48b. Percent of heart failure patients having evaluation of left ventricular ejection fraction, Medicare beneficiaries, by State, 2002 and 2004.

1.48c. Percent of heart failure patients having evaluation of left ventricular ejection fraction, all payers, by State, 2004 and 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure.

Numerator

Subset of heart failure patients with documentation in the hospital record that left ventricular ejection fraction was assessed before arrival, during hospitalization, or was planned for after discharge.

Comments

ICD-9-CM codes for heart failure include 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9.

Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.48c were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Heart Failure

Measure Title

Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge.

Measure Source

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

National Tables

1.49a. Percent of heart failure patients with left ventricular systolic dysfunction prescribed an ACE inhibitor at discharge, Medicare beneficiaries, United States, 2002 and 2004.

1.49b. Percent of heart failure patients with left ventricular systolic dysfunction prescribed an ACE inhibitor at discharge, Medicare beneficiaries, by State, 2002 and 2004.

National Data Source

CMS, Medicare Quality Improvement Organization Program.

National Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure and with left ventricular systolic dysfunction and without contraindications to and without contraindication for angiotensin-converting enzyme (ACE) inhibitors.

National Numerator

Subset of the denominator heart failure patients who are prescribed an ACE inhibitor at hospital discharge.

State Table

1.49c Percent of heart failure patients with left ventricular systolic dysfunction prescribed an ACE inhibitor or angiotensin receptor blocker at discharge, all payers, by State, 2004 and 2005.

State Data Source

CMS, Hospital Compare.

State Denominator

Hospital patients discharged alive with a principal diagnosis of heart failure and with left ventricular systolic dysfunction and without contraindications for angiotensin-converting enzyme (ACE) inhibitors or an angiotensin receptor blockers (ARB).

State Numerator

Subset of the denominator prescribed an ACE inhibitor or ARB medication at hospital discharge

Comments

Effective November 2004, CMS revised this measure to incorporate newly recognized treatment. NHQR 2005 tables 1.49a and 1.49b refer to the prior version of the measure. Table 1.49c refers to the revised measure.

ICD-9-CM codes for heart failure include 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9.

Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The State average percents on table 1.49c were pre-calculated and supplied as part of the Hospital Compare database.

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Management of Hypertension

Measure Title

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

Measure Source

Healthy People 2010, measure 12-10.

Table

1.50. Percent of adults age 18 and over with hypertension whose blood pressure is under 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

U.S. civilian noninstitutionalized adults, age 18 and over, either having elevated blood pressure (average systolic pressure of at least 140 mm Hg or average diastolic pressure of at least 90 mm Hg) or taking antihypertension medication.

Numerator

Subset denominator to those with average systolic blood pressure is less than 140 mmHg and average diastolic blood pressure less than 90 mmHg based on average of 3 measurements and taking antihypertension medication.

Comments

Percents are age adjusted to the 2000 standard population using 3 age groups: 18-39, 40-59, 60 and over

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Management of Congestive Heart Failure

Measure Title

Hospital admissions for congestive heart failure (CHF).

Measure Source

Healthy People 2010, measure 12-6 (modified age group).

National Table

1.51a. Hospitalizations for congestive heart failure per 1,000 population, United States, 2002 and 2003.

National Data Source

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

National Denominator

U.S. civilian population.

National Numerator

Number of discharges with a principal diagnosis of congestive heart failure (ICD-9-CM code 428.0).

State Table

1.51b. Admissions for congestive heart failure (excluding patients with cardiac procedures, obstetric and neonatal conditions, and transfers from other institutions) per 100,000 population, age 18 years and older, by State, 2002 and 2003.

State Data Source and Comparative National Source

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

State Denominator and Comparative National Denominator

U.S. population age 18 and over.

State Numerator and Comparative National Numerator

Number of hospital discharges with a principal diagnosis of congestive heart failure, excluding patients with cardiac procedures, obstetric and neonatal conditions, and transfers from other institutions.

Comments

The rate in the national table is age adjusted. Race classification changed in 2000. Data for 2000 and later years may not be comparable to data from previous years.

Rates in the State table are adjusted by age and gender, using the total U.S. population for 2000 as the standard population. 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. The State table with its comparative national estimate was created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 8 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Heart Disease Treatment

Measure Title

Pediatric heart surgery mortality rate (number of deaths per 1,000 heart surgeries in patients under age 18).

Measure Source

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

Table

1.52. Deaths per 1,000 pediatric heart surgery admissions, patients age less than 18 years (excluding obstetric admissions; patients with transcatheter interventions as single cardiac procedures, performed without bypass but with catheterization; patients with septal defects as single cardiac procedures without bypass; heart transplant; premature infants with patent ductus arteriosus (PDA) closure as only cardiac procedure; and infants less than 30 days of age with PDA closure as only cardiac procedure; and transfers to another hospital), United States, 2001 and 2003.

Data Source

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

Denominator

Hospital inpatient discharges with either a procedure for (1) specified heart surgery in any field or (2) any heart surgery and diagnosis of hypoplastic left heart syndrome in any field, under age 18.

Excludes patients transferring to another short-term hospital; obstetric admission; patients who underwent PDA ligation as a single cardiac procedure; patients with prosthetic closures of atrial septal defects or ventricular septal defects or atrial septal enlargement without concomitant use of cardiopulmonary bypass; patients with PDA closure as a single cardiac procedure with concomitant cardiac catheterization; patients with occlusion of thoracic vessel without congenital heart defect.

Numerator

Number of deaths with a code of pediatric heart surgery in any procedure field.

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.

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.

This table was created using version 2.1, revision 3, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 10 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Heart Disease Treatment

Measure Title

Abdominal aortic aneurysm (AAA) repair mortality rate (number of deaths per 1,000 AAA repairs).

Measure Source

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

Table

1.53. Deaths per 1,000 admissions with abdominal aortic aneurysm (AAA) repair (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2001 and 2003.

Data Source

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

Denominator

Hospital inpatient discharges with an AAA repair procedure (ICD-9-CM codes of 38.34, 38.44, and 38.64) in any procedure field and a diagnosis code of AAA (ICD-9-CM 44.13, 44.14) in any field, excluding patients transferring to another short-term hospital and obstetric and neonatal admissions.

Numerator

Number of deaths with an AAA repair surgery in any procedure field.

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.

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.

This table was created using version 2.1, revision 3, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 11 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Heart Disease Treatment

Measure Title

Coronary artery bypass graft (CABG) mortality rate (number of deaths per 1,000 CABG procedures).

Measure Source

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

Table

1.54. Deaths per 1,000 admissions with coronary artery bypass graft (CABG), age 40 and older (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2001 and 2003.

Data Source

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

Denominator

Hospital inpatient discharges, age 40 and older, with a coronary artery bypass graft (ICD-9-CM codes of 36.10 through 36.19) in any procedure field.

Excludes patients transferring to another short-term hospital and obstetric and neonatal admissions.

Numerator

Number of deaths with a code of CABG in any procedure field.

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.

This table was created using version 2.1, revision 3, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 12 in the software documentation.

Although not all States participate in the HCUP database, it 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.

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Heart Disease Treatment

Measure Title

Percutaneous transluminal coronary angioplasty (PTCA) mortality rate (number of deaths per 1,000 PTCAs).

Measure Source

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

Table

1.55. Deaths per 1,000 adult admissions age 40 and older with percutaneous transluminal coronary angioplasties (PTCA) (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2001 and 2003.

Data Source

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

Denominator

Hospital inpatient discharges with percutaneous transluminal coronary angioplasties (ICD-9-CM codes 36.01, 36.02, 36.05, or 36.06) in any procedure field, excluding obstetric and neonatal admissions and transfers to another hospital.

Numerator

Number of deaths with a code of PTCA in any procedure field.

Comments

Rates table 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.

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.

This table was created using version 2.1, revision 3, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 30 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Heart Disease Treatment

Measure Title

Acute myocardial infarction (AMI) mortality rate (number of deaths per 1,000 discharges for AMI).

Measure Source

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

Table

1.56. Deaths per 1,000 admissions with acute myocardial infarction (AMI) as principal diagnosis, age 18 and older (excluding transfers to another hospital), United States, 2001 and 2003.

Data Source

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

Denominator

All hospital inpatient discharges age 18 and older with a principal diagnosis code of AMI (ICD-9-CM 41001, 41051, 41011, 41061, 41021, 41071, 41031, 41081, 41041, 41091).

Excludes patients transferring to another short-term hospital and obstetric and neonatal admissions.

Numerator

Number of deaths with a principal diagnosis code of AMI.

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.

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.

This table was created using version 2.1, revision 3, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 15 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Heart Disease Treatment

Measure Title

Congestive heart failure (CHF) mortality rate (number of deaths per 1,000 discharges for CHF).

Measure Source

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

Table

1.57. Deaths per 1,000 admissions with congestive heart failure (CHF) as principal diagnosis, age 18 and older (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2001 and 2003.

Data Source

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

Denominator

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

Numerator

Number of deaths with a principal diagnosis code of CHF.

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.

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.

This table was created using version 2.1, revision 3, of the AHRQ Inpatient Quality Indicators software. This measure is referred to as indicator 16 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Preventive Care

Measure Title

Noninstitutionalized adults who were obese who were told by a doctor they were overweight.

Measure Source

Healthy People 2010, measure 19-2.

Table

1.58. Percent of obese adults age 20 and over who had been told by a doctor or health professional that they were overweight, United States, 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

Persons age 20 and over with a body mass index (BMI) of 30 or greater.

Numerator

Subset of denominator who reported they were told by a doctor or health professional that they were overweight.

Comments

Estimates are age adjusted to the 2000 standard population using 3 age groups: 20-44, 44-64, 65+ for total, ethnicity, gender, family income, and 25-44, 45-64, 65+ for education.

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Preventive Care

Measure Title

Noninstitutionalized adults who were obese who were given advice about exercise.

Measure Source

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

Table

1.59. Percent of adults age 18 and over who were obese who were given advice about exercise, United States, 2003.

Data Source

AHRQ, MEPS.

Denominator

Persons age 18 and over with a body mass index (BMI) of 30 or greater.

Numerator

Subset of denominator who reported they were given advice about exercise by a doctor or health professional.

Comments

Body mass index is based on reported height and weight.

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Preventive Care

Measure Title

Noninstitutionalized adults who were obese who were given advice about eating fewer high fat or high cholesterol foods.

Measure Source

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

Table

1.60. Percent of adults age 18 and over who were obese who were given advice about eating fewer high fat or high cholesterol foods, United States, 2003.

Data Source

AHRQ, MEPS.

Denominator

Persons age 18 and over with a body mass index (BMI) of 30 or greater.

Numerator

Subset of denominator who reported they were advised by a doctor or health professional about restricting foods high in fat and cholesterol.

Comments

Body mass index is based on reported height and weight.

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