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2007 National Healthcare Quality Report

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End Stage Renal Disease

Importance and Measures

Type of statistic Number
Mortality
Total ESRD deaths (2004) 84,25210
Prevalence
Total cases (2004). 472,09910
Incidence
Number of new cases (2004) 104,36410
Cost
Total ESRD Medicare program expenditures (2004) $18.4 billion10

Note: Statistics may vary from previous years due to revised and updated source statistics or addition of new data sources.

Measures

The NHQR includes six measures of ESRD management to assess the quality of care provided to renal dialysis patients. The two core report measures highlighted here are:

  • Adequacy of hemodialysis.
  • Registration for transplantation.

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Findings

Management: Patients With Adequate Hemodialysis

Dialysis removes harmful waste and excess fluid buildup in the blood that occurs when kidneys fail to function. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. The adequacy of dialysis is measured by the percentage of hemodialysis patients with a urea reduction ratio equal to or greater than 65%; this measure indicates how well urea, a waste product, is eliminated by the dialysis machine.

Figure 2.12. Medicare hemodialysis patients age 18 and over with adequate dialysis (urea reduction ratio 65% or higher), 2001-2005

Line graph shows percentage of Medicare hemodialysis patients age 18 and over with adequate dialysis: 2001, 84; 2002, 86; 2003, 87; 2004, 87; 2005, 88.

Source: Centers for Medicare & Medicaid Services, ESRD Clinical Performance Measures Project, 2001-2005.

Reference population: ESRD hemodialysis patients age 18 and over.

  • Between 2001 and 2005, the percentage of all hemodialysis patients with adequate dialysis improved from 84% to 88% (Figure 2.12). The rates for each age group also improved over this period (data not shown).

Figure 2.13. State variation: Medicare hemodialysis patients with adequate dialysis (urea reduction ratio 65% or higher), 2005

Map of United States shows State variation for Medicare hemodialysis patients with adequate dialysis. States above average: Washington, Oregon, Montana, Wyoming, Minnesota, Maine, Vermont, Massachusetts, Connecticut, Indiana, Pennsylvania, New Jersey, Colorado, New Mexico, North Carolina, South Carolina, Texas, Hawaii. States below average: Idaho, Wisconsin, California, Nevada, Utah, Nebraska, Missouri, Ohio, West Virginia, Arkansas, Tennessee, Georgia, Louisiana, Puerto Rico. average states: North Dakota, South Dakota, Michigan, Iowa, New York, New Hampshire, Rhode Island, Illinois, Kansas, Delaware, Maryland, Virginia, D.C., Arizona, Oklahoma, Mississippi, Alabama, Alaska, Florida.

Source: Centers for Medicare & Medicaid Services, ESRD Clinical Performance Measures Project, 2005.

Key: Above average = rate is significantly above the reporting States average in 2005. Below average = rate is significantly below the reporting States average in 2005.

Reference population: ESRD hemodialysis patients and peritoneal dialysis patients.

Note: The "reporting States average" is the average of all reporting States (52 in this case, including the District of Columbia and Puerto Rico), which is a separate figure from the national average.

  • In 2005, the reporting States average was 92.6%, ranging from 87.6% (Utah) to 96.9% (Hawaii).
  • Eighteen Statesxi were significantly above the reporting States average in 2005 (Figure 2.13), with a combined average rate of 94.8%.
  • Fifteen Statesxii were significantly below the reporting States average in 2005, with a combined average rate of 89.8%.
  • Six States showed improvement on this measure from 2004 to 2005, while five States declined (data not shown).

xi The States are Colorado, Connecticut, Hawaii, Indiana, Maine, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, South Carolina, Texas, Vermont, Washington, and Wyoming.
xii The States are Arkansas, California, Georgia, Idaho, Kentucky, Louisiana, Missouri, Nebraska, Nevada, Ohio, Puerto Rico, Tennessee, Utah, West Virginia, and Wisconsin.


Management: Registration for Transplantation

Kidney transplantation is a procedure that replaces a failing kidney with a healthy kidney. If a patient is deemed a good candidate for transplant, he or she is placed on the transplant program's waiting list. Dialysis patients wait for transplant centers to match them with the most suitable donor. Registration for transplantation is an initial step towards patients receiving the option of kidney transplantation. Early transplantation that decreases or eliminates the need for dialysis can also lessen the occurrence of acute rejection and patient mortality. In 2004, there were 60,393 patients on the Organ Procurement and Transplantation Network deceased donor kidney transplant waiting list in the United States, and only 10,228 deceased donor kidney transplants were performed.10

Figure 2.14. Medicare dialysis patients registered on waiting list for transplantation, by age group, 1999-2003

Line graph shows shows percentage of Medicare dialysis patients registered on waiting list for transplantation, by age group. Total: 1999, 14.9; 2000, 14.5; 2001, 14.2; 2002, 14.5; 2003; 15. 0-19: 1999, 46.3; 2000, 39.4; 2001, 40.5; 2002, 40.7; 2003, 44. 20-39: 1999, 28.6; 2000, 27.3; 2001, 26.4; 2002, 27.3; 2003, 26.5. 40-59: 1999, 16.7; 2000, 16.3; 2001, 16; 2002, 15.7; 2003, 16.4. 60-69: 1999, 6.3; 2000, 6.7; 2001, 6.6; 2002, 7.3; 2003, 8.1.

Source: Centers for Medicare & Medicaid Services, ESRD Clinical Performance Measures Project, 1999-2003.

Reference population: ESRD hemodialysis patients and peritoneal dialysis patients under age 70.

Note: The 2003 estimates in this chart differ from those reported in the 2006 NHQR. The 2006 NHQR estimates for 2003 were preliminary data and have been updated.

  • In 2003, 15% of dialysis patients were registered on a waiting list for transplantation. This rate did not improve from 1999 for the total population or for any age group (Figure 2.14).
  • In all five data years, the likelihood of being on a transplantation waiting list decreased significantly with age.

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Heart Disease

Importance and Measures

Type of statistic Number
Mortality
Number of deaths (2004) 654,0922
Cause of death rank (2004) 1st2
Prevalence
Number of cases of coronary heart disease (2005) 14,088,00011
Number of cases of heart failure (2004) 5,200,00011
Number of cases of high blood pressure (2005) 48,759,00011
Number of heart attacks (2004) 7,900,00011
Incidence
Number of new cases of congestive heart failure (2004) 550,00011
Cost
Total cost of cardiovascular disease (2006 est.) $403.0 billion4
Total cost of congestive heart failure (2006 est.) $29.6 billion11
Direct medical costs of cardiovascular disease (2006 est.) $257.6 billion4
Cost effectiveness of hypertension screening $14,000-$35,000/QALY5

Note: Statistics may vary from previous years due to revised and updated source statistics or addition of new data sources.

Measures

The NHQR tracks several quality measures for preventing and treating heart disease, including the following six core report measures:

  • Counseling smokers to quit smoking.
  • Counseling obese adults about being overweight.
  • Counseling obese adults about exercise.
  • Receipt of recommended care for heart attack (acute myocardial infarction).
  • Inpatient mortality following heart attack.
  • Receipt of recommended care for acute heart failure.

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Findings

Prevention: Counseling Smokers To Quit Smoking

Smoking may be the single most important modifiable risk factor for heart disease, and providers can encourage patients to quit smoking.

Figure 2.15. Current smokers age 18 and over with a routine office visit who reported receiving advice to quit smoking, 2000-2004

Line graph shows current smokers age 18 and over with a routine office visit who reported receiving advice to quit smoking by age. Total: 2000, 61.9; 2001, 60.9; 2002, 63.5; 2003, 66.1; 2004, 63.7. 18-44: 2000, 56.5; 2001, 56.4; 2002, 57.1; 2003, 59.7; 2004, 58.5. 45-64: 2000, 68.9; 2001, 65.4; 2002, 69.2; 2003, 71.9; 2004, 68.5. 65 and over: 2000, 65.4; 2001, 65.7; 2002, 71.2; 2003, 71.5; 2004, 67.9.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000-2004.

Reference population: Civilian noninstitutionalized population age 18 and over.

  • In 2004, 63.7% of smokers with routine office visits during the preceding year reported that their providers had advised them to quit, an increase from 61.9% in 2000. This rate remained statistically unchanged for every age group during this time period (Figure 2.15).
  • In all five data years, smokers ages 18-44 were less likely than the other age groups to receive advice to quit smoking.

Prevention: Counseling Obese Adults About Overweight

More than 32% of adults age 20 and over in the United States are obese (defined as having a body mass index of 30 or higher),12 putting them at increased risk for many chronic, often deadly conditions, such as hypertension, cancer, diabetes, and coronary heart disease.13 Although physician guidelines recommend that health care providers screen all adult patients for obesity,14 obesity remains underdiagnosed among U. S. adults.15

Figure 2.16. Obese adults age 20 and over who were told by a doctor or health professional that they were overweight, 1999-2004

Bar chart shows percentage of obese adults age 20 and over who were told by a doctor or health professional that they were overweight by age. Total, 66.2; 20-44, 59.5; 45-64, 73; 65 and over, 73.6.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 1999-2004.

Reference population: Civilian noninstitutionalized adults age 20 and over.

  • In 1999-2004, 66.2% of obese adults were told they were overweight by a doctor or health professional (Figure 2.16).
  • During the time period 1999-2004, obese adults ages 45-64 (73%) and age 65 and over (73.6%) were more likely than those ages 20-44 (59.5%) to be told by a doctor or health professional that they were overweight.

Prevention: Counseling Obese Adults About Exercise

Physician-based exercise counseling is an important component of effective weight loss interventions,14 and it has been shown to produce increased levels of physical activity among sedentary patients.16 Regular exercise aids in weight loss and blood pressure control efforts, reducing the risk of heart disease, stroke, diabetes, and other comorbidities of obesity.

Figure 2.17. Obese adults age 18 and over who were given advice about exercise, 2002-2004

Bar chart shows percentage of obese adults age 18 and over who were given advice about exercise. 2002--Total, 56.8; 18-44, 46.5; 45-64, 66.9; 65 and over, 64.3. 2003--Total, 58.2; 18-44, 48.9; 45-64, 67.1; 65 and over, 64.7. 2004--Total, 58.8; 18-44, 47.4; 45-64, 68.6; 65 and over, 67.7.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2004.

Reference population: Civilian noninstitutionalized adults age 18 and over.

  • In 2004, 58.8% of obese adults were given advice about exercising. This figure did not improve from 2002, nor did it improve for any population subgroup (Figure 2.17).
  • In all three years, obese adults ages 45-64 and 65 and over were more likely to receive advice about exercise than those ages 18-44.

Treatment: Receipt of Recommended Care for Heart Attack

There is consensus that recommended care for patients with a heart attack includes administration of aspirin within 24 hours of heart attack and at discharge, administration of beta blocker within 24 hours of attack and at discharge, angiotensin-II converting enzyme (ACE) inhibitor or angiotensin receptor blocker treatment among patients with left ventricular systolic dysfunction, and counseling to quit smoking among smokers. The NHQR reports on these measures, as well as a composite of these measures that addresses the proportion of all opportunities in which heart attack patients receive recommended care.

Figure 2.18. Receipt of recommended care for heart attack among patients age 18 and over: Overall composite and six components, 2000-2001, 2002, 2003, 2004, and 2005

Trend line chart shows receipt of recommended care for heart attack among patients age 18 and over. Composite: 2000-2001, 77.2; 2002, 80; 2003, 82.1; 2004, 85.6; 2005, 93.5. Aspirin 24 hours: 2000-2001, 85.1; 2002, 85.3; 2003, 86.4; 2004, 88.5; 2005, 95.3. Aspirin at discharge: 2000-2001, 85.9; 2002, 87.4; 2003, 88.8; 2004, 91; 2005, 95.6. ACE inhibitor: 2000-2001, 73.9; 2002, 66.8; 2003, 68.2; 2004, 68.5; 2005, 83.7. Smoking cessation: 2000-2001, 42.7; 2002, 49.5; 2003, 54.2; 2004, 68.1; 2005, 90.9. Beta blocker at discharge: 2000-2001, 78.5; 2002, 81.5; 2003, 85; 2004, 89;  2005, 94.5. Beta blocker 24 hours: 2000-2001, 69.3; 2002, 76.3; 2003, 78.3; 2004, 82.5; 2005, 91.5.

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2000-2001, 2002, 2003, 2004, and 2005.

Key: ACE=angiotensin converting enzyme; ARB=angiotensin receptor blocker.

Denominator: Patients hospitalized with a principal diagnosis of acute myocardial infarction.

Note: Beginning in 2005, the data collection method changed from the abstraction of randomly selected medical records for Medicare beneficiaries to the receipt of hospital self-reported data for all payer types. The ACE inhibitor measure was changed in 2005 to also include angiotensin receptor blockers as an acceptable alternative to ACE inhibitors.

  • The overall heart attack composite shows improvement in the provision of recommended care for Medicare patients with heart attacks from 77.2% of the opportunities to provide recommended care in 2000-2001 to 93.5% in 2005 (Figure 2.18).
  • All six of the component measures showed improvement, including aspirin within 24 hours of admission (from 85.1% to 95.3%), aspirin at discharge (from 85.9% to 95.6%), counseling for smoking cessation (from 42.7% to 90.9%), beta blocker within 24 hours of admission (from 69.3% to 91.5%), and beta blocker at discharge (from 78.5% to 94.5%).
  • Overall, from 2000-2001 to 2005, ACE inhibitor use improved from 73.9% to 83.7%. An apparent decline occurred between 2000-2001 and 2002. It should be noted that, in 2005, this measure was refined to also include angiotensin receptor blockers as an acceptable alternative to ACE inhibitors.
  • It should also be noted that the data collection method changed between 2004 and 2005 from the abstraction of randomly selected medical records for Medicare beneficiaries to the receipt of hospital self-reported data for all payer types. This change could contribute to the change in the estimates for these measures over the period 2004 to 2005.

Treatment: Inpatient Mortality Following Heart Attack

Survival following admission for a heart attack reflects multiple patient factors, such as a patient's comorbidities, as well as health care system factors, such as the possible need to transfer hospitals in order to receive services. Also, it may partly reflect receipt of appropriate health services.

Figure 2.19. Deaths per 1,000 admissions with a heart attack as principal discharge diagnosis among persons age 18 and over, 1994, 1997, and 2000-2004

Line graph shows deaths per 1,000 admissions with a heart attack as principal discharge diagnosis among persons age 18 and over. 1994, 124.9; 1997, 112.2; 2000, 103.8; 2001, 100.1; 2002, 99.8; 2003, 86.4; 2004, 81.7.

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 1994, 1997, 2000-2004.

Denominator: Any person age 18 and over, U.S. citizen or foreign, using non-Federal, community hospitals in the United States, with a heart attack as principal discharge diagnosis.

Note: Rates are adjusted by age, gender, age-gender interactions, and all-payer refined diagnosis-related groups scoring of risk of mortality. Data were analyzed for two selected historical years (1994 and 1997) and annually with each NHQR (2000-2004).

  • Between 1994 and 2004, the overall inpatient mortality rate declined from 124.9 to 81.7 deaths per 1,000 admissions with heart attack (Figure 2.19).

Treatment: Receipt of Recommended Care for Acute Heart Failure

The NHQR tracks the national rates of the receipt of a recommended test for heart functioning (heart failure patients having evaluation of left ventricular ejection fraction [LVEF]), for recommended medication treatment (patients with left ventricular dysfunction prescribed ACE inhibitor or angiotensin receptor blocker at discharge), and an overall composite measure that describes the proportion of all episodes in which heart failure patients receive recommended care.

Figure 2.20. Receipt of recommended care for acute heart failure among patients: Overall composite and two components, 2000-2001, 2002, 2003, 2004, and 2005

Trend line chart shows receipt of recommended care for acute heart failure among patients. Overall composite: 2000/2001, 68.5; 2002, 73.4; 2003, 74.6; 2004, 77.7; 2005, 86.9. LVEF: 2000/2001, 69.1; 2002, 76; 2003, 78; 2004, 81.6; 2005, 88.4. ACE inhibitor: 2000/2001, 66.1; 2002, 64.9; 2003, 63.6; 2004, 64.8; 2005, 82.9.

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2000-2001, 2002, 2003, 2004, and 2005.

Key: LVEF=left ventricular ejection fraction; ACE=angiotensin-II converting enzyme; ARB=angiotensin receptor blocker.

Denominator: Patients hospitalized with a principal diagnosis of acute heart failure.

Note: Beginning in 2005, the data collection method changed from the abstraction of randomly selected medical records for Medicare beneficiaries to the receipt of hospital self-reported data for all payer types. The ACE inhibitor measure was changed in 2005 to also include ARBs as an acceptable alternative to ACE inhibitors.

  • The overall heart failure composite showed improvement in the provision of recommended care for Medicare patients with heart failure from 68.5% of the opportunities to provide recommended care in 2000-2001 to 86.9% in 2005 (Figure 2.20).
  • The LVEF measure showed improvement from 69.1% in 2000-2001 to 88.4% in 2005.
  • The use of ACE inhibitors for treatment of acute heart failure for patients with left ventricular dysfunction remained stable between 2000-2001 and 2004; however, the value for this measure increased between 2004 and 2005 when the measure was changed to also include angiotensin receptor blockers as an acceptable alternative to ACE inhibitors.
  • It should be noted that the data collection method changed between 2004 and 2005 from the abstraction of randomly selected medical records for Medicare beneficiaries to the receipt of hospital self-reported data for all payer types. This change could contribute to the change in the estimates for these measures over the period 2004 to 2005.

Figure 2.21. State variation: Receipt of recommended hospital care for acute heart failure, 2005

Map of United States shows State variation in receipt of recommended hospital care for acute heart failure. States above average: Washington, Wisconsin, Maine, Michigan, New Hampshire, Massachusetts, New York, Rhode Island, Connecticut, New Jersey, Pennsylvania, Ohio, Illiinois, Iowa, Nebraska, California, Nevada, Utah, Colorado, Maryland, Missouri, Virginia, Arizona, North Carolina, South Carolina, Florida, Alaska. States below average: Montana, Wyoming, Indiana, Kansas, Kentucky, D.C., Tennessee, New Mexico, Oklahoma, Arkansas, Georgia, Mississippi, Texas, Louisiana, Puerto Rico, Hawaii. Average states: Alabama, West Virginia, Delaware, Vermont, Minnesota, South Dakota, North Dakota, Idaho, Oregon.

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005.

Key: Above average = rate is significantly above the reporting States average in 2005. Below average = rate is significantly below the reporting States average in 2005.

Denominator: Patients hospitalized with a principal diagnosis of acute heart failure.

Note: The "reporting States average" is the average of all reporting States (52 in this case, including the District of Columbia and Puerto Rico), which is a separate figure from the national average.

  • In 2005, the reporting States average was 86.9%, with States ranging from a low of 68.8% to a high of 92.9%.
  • Twenty- seven Statesxiii were significantly above the reporting States average in 2005 (Figure 2.21), with a combined average rate of 89.5%.
  • Sixteen Statesxiv were significantly below the reporting States average in 2005, with a combined average rate of 82.4%.

xiii The States are Alaska, Arizona, California, Colorado, Connecticut, Florida, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, Virginia, Washington, and Wisconsin.
xiv The States are Arkansas, District of Columbia, Georgia, Hawaii, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Montana, New Mexico, Oklahoma, Tennessee, Texas, Wyoming, and Puerto Rico.


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HIV and AIDS

Importance and Measures

Type of statistic Number
Mortality
Number of deaths among persons with AIDS (2005) 17,01117
Prevalence
Number of persons in the United States living with HIV (2005) 215,34617
Number of persons in the United States living with AIDS (2005) 421,87317
Incidence
New AIDS cases (2005) 40,60817
Cost
Federal spending on HIV/AIDS care (2006) $17.9 billion18

Note: Statistics may vary from previous years due to revised and updated source statistics or addition of new data sources.

Measures

This section highlights one core report measure focusing on quality of preventive care for HIV-infected individuals:

  • New AIDS cases.

In addition, four supplemental measures related to prevention are also presented: one measure on prevention of opportunistic infections in HIV patients from the HIV Research Network and three measures focusing on testing for HIV from the National Survey of Family Growth:

  • Testing for HIV infection.xv
  • Eligible AIDS patients receiving prophylaxis for Pneumocystis pneumonia (PCP) and Mycobacterium avium complex (MAC).

xv Includes the following three measures: (1) testing for HIV outside of blood donation; (2) women completing a pregnancy with an HIV test as part of prenatal care; and (3) people with any HIV risk behavior in the last 12 months who had an HIV test outside of blood donation.


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Findings

Prevention: New AIDS Cases

Changes in HIV infection rates reflect changes in behavior by at-risk individuals that may only partly be influenced by the health care system. However, individual and community programs have shown progress in influencing behavior change. Changes in the incidence of new AIDS cases are affected by changes in HIV infection rates and by the availability of appropriate treatments for HIV-infected individuals. Improved treatments that extend life for those with the disease are reflected in the fact that the number of deaths due to AIDS fell from about 18,000 to 16,000 between 2003 and 2005, after showing no change for the previous three years.17

Figure 2.22. New AIDS cases per 100,000 population age 13 and over, 1998-2005

Trend line chart shows new AIDS cases per 100,000 population age 13 and over.  Healthy People 2010 Target: 1. National total: 1998, 18; 1999, 17.9; 2000, 17.3; 2001, 17; 2002, 17.2; 2003, 17.6; 2004, 17.1; 2005, 18.1. 13-17: 1998, 0.7; 1999, 0.7; 2000, 0.8; 2001, 0.9; 2002, 0.9; 2003, 0.7; 2004, 0.8; 2005, 1.2. 18-44: 1998, 26.6; 1999, 26.6; 2000, 25.2; 2001, 24.6; 2002, 24.7; 2003, 25.2; 2004, 24.2; 2005, 25.1. 45-64: 1998, 16.4; 1999, 16.8; 2000, 17; 2001, 17.2; 2002, 17.8; 2003, 18.3; 2004, 18.2; 2005, 20. 65 and over: 1998, 2; 1999, 1.5; 2000, 2.1; 2001, 2.1; 2002, 2.1; 2003, 2.4; 2004, 2.4; 2005, 2.4.

Source: Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, HIV/AIDS Reporting System, 1998-2005.

Reference population: U.S. population age 13 and over.

  • The overall rate of new AIDS cases per 100,000 did not improve between 1998 and 2005. However, during that same time span, the rate of new AIDS cases decreased for adults ages 18-44 while increasing for children ages 13-17, adults ages 45-64, and adults age 65 and over (Figure 2.22).
  • The 2005 national rate of 18.1 new AIDS cases per 100,000 persons is well above the Healthy People 2010 target of 1.0 new case per 100,000 persons. If current trends continue, the target will not be met.

Prevention: HIV Testing

Routine voluntary HIV testing is recommended by the Centers for Disease Control and Prevention as part of normal medical practice in all health care settings.19 HIV infection is a serious health disorder that can be diagnosed before symptoms develop. HIV can be detected by reliable, inexpensive, and noninvasive screening tests. Although blood donations are routinely tested for HIV, it is important to track HIV testing in a health care setting to determine the impact of preventive care for the population. HIV-infected patients have years of life to gain if treatment is initiated early, before symptoms develop.

To normalize HIV testing as a routine part of medical care, in September 2006, the Centers for Disease Control and Prevention published revised recommendations that all patients ages 13-64 be tested on a voluntary basis. The revised recommendations also expanded the existing recommendations for screening pregnant women.

Figure 2.23. Women ages 15-44 who completed a pregnancy in the last 12 months and had an HIV test as part of prenatal care, by age group, 2002

Bar chart shows women ages 15-44 who completed a pregnancy in the last 12 months and had an HIV test as part of prenatal care, by age group: Total, 66.7; 15-19, 70.1; 20-24, 68.8; 25-29, 74.1; 30-34, 58.1; 35-44, 62.4.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Family Growth, 2002.

  • In 2002, the proportion of pregnant women ages 15-44 who had an HIV test as part of prenatal care was 66.7% (Figure 2.23).
  • Among pregnant women ages 15-44, the rate of HIV testing as part of prenatal care was highest for women ages 25-29 (74.1%) and lowest for women ages 30-34 (58.1%).

Figure 2.24. Persons ages 15-44 who ever had an HIV test outside of blood donation, by age group, 2002

Bar chart shows persons ages 15-44 who ever had an HIV test outside of blood donation, by age group.  Total, 50.8; 15-19, 18.8; 20-24, 44.3; 25-29, 60.6; 30-34, 64.4; 35-39, 61.9; 40-44, 53.8.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Family Growth, 2002.

  • In 2002, just over half of people ages 15-44 ever had an HIV test outside of blood donation (Figure 2.24).
  • People ages 30-34 had the highest rate of HIV testing (64.4%) and those ages 15-19 had the lowest rate (18.8%).

Figure 2.25. Persons ages 15-44 with any HIV risk behaviors in the last 12 months who had an HIV test outside of blood donation in the last 12 months, 2002

Bar chart shows persons ages 15-44 with any HIV risk behaviors in the last 12 months who had an HIV test outside of blood donation in the last 12 months. Total, 27.4; 15-19, 30; 20-24, 35.3; 25-29, 29.5; 30-34, 21.8; 35-39, 23.3; 40-44, 21.4.

Note: This table is based on a composite measure of HIV risk as defined by the Centers for Disease Control and Prevention in Advance Data20, 21 The statistics in this table represent 6.55 million women and 7.81 million men ages 15-44 who fulfilled the definition. A survey respondent (R) was included if she/he reported any of the following in the 12 months before interview: crack cocaine or illicit intravenous drug use, five or more opposite-sex sexual partners, any same-sex partners (if R is male), a partner with intravenous drug use, a male partner who has had sex with males (if R is female), an HIV-positive partner, sex exchanged for money or drugs, or treatment for sexually transmitted disease.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Family Growth, 2002.

  • In 2002, 27.4% of people ages 15-44 with any HIV risk behaviors in the last 12 months had an HIV test outside of blood donation (Figure 2.25).
  • Among people ages 15-44 with any HIV risk behaviors in the last 12 months, those ages 20-24 had the highest rate of HIV testing (35.3%). Those ages 40-44 had the lowest rate (21.4%).

Prevention: PCP and MAC Prophylaxis

Management of chronic HIV disease includes outpatient and inpatient services. Without adequate treatment, as HIV disease progresses, CD4 cell counts fall and patients become increasingly susceptible to opportunistic infections. When CD4 cell counts fall below 200, medicine to prevent development of PCP is routinely recommended; when CD4 cell counts fall below 50, medicine to prevent development of disseminated MAC infection is routinely recommended.22 Because national data on HIV care are not routinely collected, HIV measures tracked in the NHQR come from the HIV Research Network, which consists of 18 medical practices across the United States that treat large numbers of HIV patients.xvi

Figure 2.26. Eligible AIDS patients age 18 and over receiving PCP and MAC prophylaxis, 2003 and 2004

Bar chart shows eligible AIDS patients age 18 and over receiving PCP and MAC prophylaxis, 2003 and 2004. Healthy People 2010 Target: 95. PCP prophylaxis: 2003, 83.9; 2004, 86.6. MAC prophylaxis: 2003, 84.3; 2004, 81.8.

Source: HIV Research Network, 2003 and 2004.

Key: PCP = Pneumocystis pneumonia; MAC = Mycobacterium avium complex.

Reference population: Adult patients with AIDS with CD4 cell counts below 200 (PCP) or CD4 cell counts below 50 (MAC).

Note: Data from the HIV Research Network are not nationally representative of the level of care received by all Americans living with HIV. Participation in this network is voluntary, and network data represent only patients who are actually receiving care. Furthermore, data shown above are not representative of the HIV Research Network as a whole because they represent only a subset of network sites that have the best quality data. (For more information on the HIV Research Network, go to: www.ahrq.gov/data/hivnet.htm.)

  • Of eligible patients (3,157 AIDS patients with at least two CD4 cell counts below 200), 86.6% received PCP prophylaxis in 2004 (Figure 2.26), which is a significant increase compared with 2003 but still below the Healthy People 2010 target of 95%.
  • Of eligible patients (966 AIDS patients with at least two CD4 cell counts below 50), 81.8% received MAC prophylaxis in 2004, which is not significantly different from 2003 and is below the Healthy People 2010 target of 95%.

xvi Although program data are collected from all Ryan White HIV/AIDS Program grantees, the aggregate nature of the data makes it difficult to assess the quality of care provided by Ryan White HIV/AIDS Program providers.


Chapter 2 (continued): Maternal and Child Health Chapter 2. Effectiveness

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