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National Healthcare Quality Report, 2007

Effectiveness of Care: Diabetes

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Management of Diabetes
Composite measure: Adults age 40 and over with diabetes who had all three recommended services for diabetes in the past year (at least one hemoglobin A1c measurement, a retinal eye examination, and a foot examination)
Adults age 40 and over with diabetes who had a hemoglobin A1c measurement at least once in past year
Adults age 40 and over with diabetes who had a lipid profile in past 2 years
Adults age 40 and over with diabetes who had a retinal eye examination in past year
Adults age 40 and over with diabetes who had a foot examination in past year
Adults age 40 and over with diabetes who had an influenza immunization in past year
Adults age 40 and over with diabetes whose condition is diagnosed
Adults age 40 and over with diagnosed diabetes with HbA1c level < 7.0% (optimal)
Adults age 40 and over with diagnosed diabetes whose total cholesterol is < 200 mg/dl
Adults age 40 and over with diagnosed diabetes with most recent blood pressure <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 age 40 and over with diabetes who had all three recommended services for diabetes in the past year (at least one hemoglobin A1c measurement, a retinal eye examination, and a foot examination).

Measure Source

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

Tables

1.19 Percent of adults age 40 and over with diabetes who had all three exams in the past year: hemoglobin A1c test, eye examination, and foot examination, United States, 2002 and 2004.

Data Source

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

Denominator

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

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes whose answers indicated they had at least one 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; reported rates may not be comparable with those found in 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 three 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

Adults age 40 and over with diabetes who had a hemoglobin A1c measurement at least once in past year.

Measure Source

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

National Tables

1.20a 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, 2002 and 2004.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized adults age 40 and older 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

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who had a hemoglobin A1c test at least once in the survey year.

State Tables

1.20b 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 2005.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), 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 with those found in prior years' editions of the National Healthcare Quality Report.

The national table reports data from the MEPS Diabetes Care Survey (DCS). Go to the MEPS entry in the Data Sources 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

Adults age 40 and over with diabetes who had a lipid profile in past 2 years.

Measure Source

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

Tables

1.21 Percent of adults age 40 and over with diabetes who reported receiving a lipid profile in the past 2 years, United States, 2002 and 2004.

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older 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

U.S. civilian noninstitutionalized adults age 40 and older 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 with those found in prior years' editions of the National Healthcare Quality Report.

This table reports data from the MEPS Preventive Care section. Go to the MEPS entry in the Data Sources 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

Adults age 40 and over with diabetes who had a retinal eye examination in past year.

Measure Source

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

National Tables

1.22a Percent of adults age 40 and over with diabetes who reported having an eye examination in the past year, United States, 2002 and 2004.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered a question about eye examinations in the survey years. (See Comments section for details.) Nonresponses and "Don't know" responses were excluded.

National Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had at least one retinal eye examination in target period (depending on panel).

State Tables

1.22b Percent of adults age 40 and over with diabetes who had a retinal eye examination in the past year, by State, 2001 and 2005.

State Data Source

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

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Adults with diabetes who had at least one 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 with those found in prior years' editions of the National Healthcare Quality Report.

The national table reports data from the MEPS Diabetes Care Survey (DCS). Go to the MEPS entry in the Data Sources 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

Adults age 40 and over with diabetes who had a foot examination in past year.

Measure Source

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

National Tables

1.23a Percent of adults age 40 and over with diabetes who reported having a foot examination in the past year, United States, 2002 and 2004.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized adults age 40 and older 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

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who had a foot examination one or more times in the survey year.

State Tables

1.23b Percent of adults age 40 and over with diabetes who had a foot examination in the past year, by State, 2001 and 2005.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), 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 one 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 with those found in prior years' editions of the National Healthcare Quality Report.

The national table reports data from the MEPS Diabetes Care Survey (DCS). Go to the MEPS entry in the Data Sources 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

Adults age 40 and over with diabetes who had an influenza immunization in past year.

Measure Source

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

National Tables

1.24a Percent of adults age 40 and over with diabetes who reported receiving influenza immunization in the past year, United States, 2002 and 2004.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the question: "How long since you had a flu shot?" Nonresponses and "Don't know" responses were excluded.

National Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who had an influenza immunization in the past year.

State Tables

1.24b Percent of noninstitutionalized high-risk adults ages 18-64 with diabetes who had an influenza immunization in the past year, by State, 2001 and 2005.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), 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 year.

Comments

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

The national table reports data from the MEPS Preventive Care section. Go to the MEPS entry in the Data Sources 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; therefore, the definition for the State table differs slightly from the Healthy People 2010 definition for objective 14-29c in that this measure focuses exclusively on noninstitutionalized adults with diabetes.

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Management of Diabetes

Measure Title

Adults age 40 and over with diabetes whose condition is diagnosed.

Measure Source

Healthy People 2010.

Tables

1.25 Percent of adults age 40 and over with diabetes whose condition is diagnosed, United States, 1999-2004.

Data Source

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

Denominator

Number of adults aged 40 years and older who have a fasting blood glucose level of 126 mg/dl.

Numerator

Subset of denominator who report that they have ever been diagnosed with diabetes.

Comments

This measure is referred to as measure 5-4 in Healthy People 2010 documentation. The age range has been modified from the original specification.

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes with HbA1c level < 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.

Tables

1.26 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 1999-2004.

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 older with 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 with those found in prior years' editions of the National Healthcare Quality Report.

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

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes whose total cholesterol is < 200 mg/dl.

Measure Source

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

Tables

1.27 Percent of adults age 40 and over with diagnosed diabetes whose total cholesterol was less than 200 mg/dL, United States, 1988-1994 and 1999-2004.

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 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 with those found in prior years' editions of the National Healthcare Quality Report.

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

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes with most recent blood pressure <140/80 mm Hg.

Measure Source

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

Tables

1.28 Percent of adults age 40 and over with diagnosed diabetes with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 80 mm Hg based on average of three measurements, United States, 1988-1994 and 1999-2004.

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 with those found in prior years' editions of the National Healthcare Quality Report.

Percents are age adjusted using 2000 standard population with three 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 (PQI).

National Tables

1.29a Admissions for uncontrolled diabetes without complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2003 and 2004.

National Data Source

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

National Denominator

U.S. population age 18 and over.

National 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.

State Tables

1.29b Admissions for uncontrolled diabetes without complications (excluding obstetric and neonatal admissions and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2003 and 2004.

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Population age 18 and over by State.

State Numerator

Same as national.

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 PQI software. This measure is referred to as indicator 14 in the AHRQ PQI 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 (PQI).

National Tables

1.30a Admissions for diabetes with short-term complications (excluding transfers from other institutions) per 100,000 population, ages 6-17, United States, 2003 and 2004.

1.30b Admissions for diabetes with short-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2003 and 2004.

National Data Source

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

National Denominator

U.S. population age 18 and over.

National Numerator

Adult discharges age 18 and over with a principal diagnosis of diabetes with short-term complications (ketoacidosis, hyperosmolarity, 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.

State Tables

1.30c Admissions for diabetes with short-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2003 and 2004.

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Population age 18 and over by State.

State Numerator

Same as national.

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 PQI software. This measure is referred to as indicator 1 in the AHRQ PQI 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 (PQI).

National Tables

1.31a Admissions for diabetes with long-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2003 and 2004.

National Data Source

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

National Denominator

U.S. population age 18 and over.

National 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.

State Tables

1.31b Admissions for diabetes with long-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2003 and 2004.

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Population age 18 and over by State.

State Numerator

Same as national.

Comments

Rates are adjusted by age and sex using the total U.S. population 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 PQI software. This measure is referred to as indicator 3 in the AHRQ PQI 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.

Tables

1.32 Hospital admissions for lower extremity amputations in patients with diabetes per 1,000 population, United States, 1998-2000 and 2003-2005.

Data Source

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

Rates in the national table are 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 with data from previous years.

This measure is referred to as measure 5-10 in Healthy People 2010 documentation.

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