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National Healthcare Quality Report, 2007

Effectiveness of Care: Heart Disease

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Counseling on Risk Factors
Smokers receiving advice to quit smoking
Treatment of Acute Myocardial Infarction
Composite measure: Patients with acute myocardial infarction (AMI) who received all recommended hospital care for AMI (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 angiotensin-converting enzyme (ACE) inhibitor at discharge
AMI patients given smoking cessation counseling while hospitalized
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
Median time in minutes to PTCA: Median time from arrival to percutaneous transluminal angioplasty (PTCA) in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time
Treatment of Acute Heart Failure
Composite measure: Heart failure patients who received all recommended hospital care for heart failure (having evaluation of left ventricular ejection fraction and prescribed angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB] 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 angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) 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 (number of deaths per 1,000 heart surgeries in patients under age 18)
Abdominal aortic aneurysm (AAA) repair mortality rate (number of deaths per 1,000 AAA repairs)
Coronary artery bypass graft (CABG) mortality rate (number of deaths per 1,000 CABG procedures)
Percutaneous transluminal coronary angioplasty (PTCA) mortality rate (number of deaths per 1,000 PTCAs)
Acute myocardial infarction (AMI) mortality rate (number of deaths per 1,000 discharges for AMI)
Congestive heart failure (CHF) mortality rate (number of deaths per 1,000 discharges for CHF)
Noninstitutionalized adults who were obese who were told by a doctor they were overweight
Noninstitutionalized adults who were obese who were given advice about exercise
Noninstitutionalized adults who were obese who were given advice about eating fewer high fat or high cholesterol foods

Counseling on Risk Factors

Measure Title

Smokers receiving advice to quit smoking.

Measure Source

Healthy People 2010.

National Tables

1.41a Percent of current smokers age 18 and over with a checkup who reported receiving advice to quit smoking in the past 12 months, 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

Adults age 18 and over who reported in the survey year that they currently smoke, had a routine checkup 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 Tables

1.41b Percent of current smokers age 18 and over who reported receiving advice to quit smoking, 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

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 with earlier years.

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

This measure is referred to as measure 1-3c in Healthy People 2010 documentation.

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Treatment of Acute Myocardial Infarction

Measure Title

Composite measure: Patients with acute myocardial infarction (AMI) who received all recommended hospital care for AMI (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 & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

1.42a Percent of AMI patients who received recommended hospital care, all payers, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI).

National Numerator

Subset of instances in which AMI denominator patients received 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.

State Tables

1.42b Percent of AMI patients who received recommended hospital care, all payers, by State, 2005.

1.42c Percent of AMI patients who received recommended hospital care, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

AMI patients administered aspirin within 24 hours of admission.

Measure Source

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

National Tables

1.43a Percent of AMI patients administered aspirin within 24 hours of admission, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

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

State Tables

1.43b Percent of AMI patients administered aspirin within 24 hours of admission, by State, 2005.

1.43c Percent of AMI patients administered aspirin within 24 hours of admission, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

AMI patients with aspirin prescribed at discharge.

Measure Source

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

National Tables

1.44a Percent of AMI patients with aspirin prescribed at discharge, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

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

State Tables

1.44b Percent of AMI patients with aspirin prescribed at discharge, by State, 2005.

1.44c Percent of AMI patients with aspirin prescribed at discharge, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

AMI patients administered beta blocker within 24 hours of admission.

Measure Source

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

National Tables

1.45a Percent of AMI patients administered beta blocker within 24 hours of admission, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

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

State Tables

1.45b Percent of AMI patients administered beta blocker within 24 hours of admission, by State, 2005.

1.45c Percent of AMI patients administered a beta blocker within 24 hours of admission, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

AMI patients with beta blocker prescribed at discharge.

Measure Source

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

National Tables

1.46a Percent of AMI patients with beta blocker prescribed at discharge, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

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

State Tables

1.46b Percent of AMI patients with beta blocker prescribed at discharge, by State, 2005.

1.46c Percent of AMI patients with a beta blocker prescribed at discharge, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 age 18, 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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

AMI patients with left ventricular systolic dysfunction prescribed angiotensin-converting enzyme (ACE) inhibitor at discharge.

Measure Source

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

National Tables

1.47a Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor or angiotensin receptor blocker (ARB) at discharge, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

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

State Tables

1.47b Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor or angiotensin receptor blocker at discharge, by State, 2005.

1.47c 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 2006.

State Data Source

CMS, Hospital Compare (HC).

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 angiotensin receptor blockers (ARBs).

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.

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 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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

AMI patients given smoking cessation counseling while hospitalized.

Measure Source

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

National Tables

1.48a Percent of AMI patients given smoking cessation counseling while hospitalized, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National 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.

National Numerator

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

State Tables

1.48b Percent of AMI patients given smoking cessation counseling while hospitalized, by State, 2005.

1.48c Percent of AMI patients given smoking cessation counseling while hospitalized, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

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 & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

1.49a Median time for AMI patients to thrombolysis, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

State Tables

1.49b Median time for AMI patients to thrombolysis, by State, 2005.

1.49c Percent of AMI patients receiving thrombolytic medication within 30 minutes of arrival, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

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

State Numerator

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

Comments

Effective October 2003, CMS revised this measure. Rates may not be comparable with earlier versions of the report.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Myocardial Infarction

Measure Title

Median time in minutes 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 & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

1.50a Median time for AMI patients to PTCA, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

State Tables

1.50b Median time for AMI patients to PTCA, by State, 2005.

1.50c Percent of AMI patients given percutaneous coronary intervention within 120 minutes of arrival, all payers, by State, 2005 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

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

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.

Comments

Effective October 2003, CMS revised this measure. Rates may not be comparable with earlier versions of the report.

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 patients under age 18, 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 average percents in the State table 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: Heart failure patients who received all recommended hospital care for heart failure (having evaluation of left ventricular ejection fraction and prescribed angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB] at discharge, if indicated, for left ventricular systolic dysfunction).

Measure Source

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

National Tables

1.51a Percent of heart failure patients who received recommended hospital care, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

Subset of instances in which denominator heart failure patients received recommended processes during the hospital stay: evaluation of left ventricular ejection fraction and prescribed an ACE inhibitor or ARB at hospital discharge.

State Tables

1.51b Percent of heart failure patients who received recommended hospital care, by State, 2005.

1.51c Percent of heart failure patients who received recommended hospital care, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Heart Failure

Measure Title

Heart failure patients having evaluation of left ventricular ejection fraction.

Measure Source

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

National Tables

1.52a Percent of heart failure patients having evaluation of left ventricular ejection fraction, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National 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.

State Tables

1.52b Percent of heart failure patients having evaluation of left ventricular ejection fraction, by State, 2005.

1.52c Percent of heart failure patients having evaluation of left ventricular ejection fraction, all payers, by State, 2004 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Treatment of Acute Heart Failure

Measure Title

Heart failure patients with left ventricular systolic dysfunction prescribed angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) at discharge.

Measure Source

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

National Tables

1.53a Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor or angiotensin receptor blocker (ARB) at discharge, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

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

National Numerator

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

State Tables

1.53b Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor or angiotensin receptor blocker at discharge, by State, 2005.

1.53c 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 2006.

State Data Source

CMS, Hospital Compare (HC).

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 angiotensin receptor blockers (ARBs).

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.

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 average percents in the State table were pre-calculated and supplied as part of the Hospital Compare database.

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Management of Hypertension

Measure Title

People with hypertension who have blood pressure under control.

Measure Source

Healthy People 2010.

Tables

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

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 of denominator with average systolic blood pressure less than 140 mm Hg and average diastolic blood pressure less than 90 mm Hg based on average of three measurements and taking antihypertension medication.

Comments

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

This measure is referred to as measure 12-10 in Healthy People 2010 documentation.

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Management of Congestive Heart Failure

Measure Title

Hospital admissions for congestive heart failure (CHF).

Measure Source

Healthy People 2010.

National Tables

1.55a Hospitalizations for congestive heart failure per 1,000 population, United States, 2002 and 2005.

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 Tables

1.55b Admissions for congestive heart failure (excluding patients with cardiac procedures, obstetric conditions, and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2003 and 2004.

State Data Source

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

State Denominator

U.S. population age 18 and over.

State 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 with 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 PQI software. This measure is referred to as indicator 8 in the AHRQ PQI software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure is referred to as measure 12-6 in Healthy People 2010 documentation. The age range has been modified from the original specification.

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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 (IQI).

Tables

1.56 Deaths per 1,000 pediatric heart surgery admissions, patients under age 18 (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 age less than 30 days with PDA closure as only cardiac procedure; transfers to another hospital; patients with unknown disposition; and neonates with a birth weight less than 500 grams), United States, 2003 and 2004.

Data Source

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

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 admissions; 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 IQI 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 (IQI).

Tables

1.57 Deaths per 1,000 admissions with abdominal aortic aneurysm (AAA) repair (excluding obstetric and neonatal admissions and transfers to another hospital), age 18 and over, United States, 2003 and 2004.

Data Source

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

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 IQI 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 (IQI).

Tables

1.58 Deaths per 1,000 admissions with coronary artery bypass graft (excluding obstetric and neonatal admissions and transfers to another hospital), age 40 and over, United States, 2003 and 2004.

Data Source

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

Denominator

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

Tables

1.59 Deaths per 1,000 adult admissions age 40 and over with percutaneous transluminal coronary angioplasty (PTCA) (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2003 and 2004.

Data Source

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

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 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 IQI 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 (IQI).

Tables

1.60 Deaths per 1,000 admissions with acute myocardial infarction (AMI) as principal diagnosis (excluding transfers to another hospital), age 18 and over, United States, 2003 and 2004.

Data Source

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

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 IQI 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 (IQI).

Tables

1.61 Deaths per 1,000 admissions with congestive heart failure (CHF) as principal diagnosis (excluding obstetric and neonatal admissions and transfers to another hospital), age 18 and over, United States, 2003 and 2004.

Data Source

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

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 IQI 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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Heart Disease Treatment

Measure Title

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

Measure Source

Healthy People 2010.

Tables

1.62 Percent of obese adults age 20 and over who had been told by a doctor or health professional that they were overweight, United States, 1999-2004.

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, and 65 and over for total, ethnicity, gender, family income, and 25-44, 45-64, 65 and over for education.

This measure is referred to as measure 19-2 in Healthy People 2010 documentation.

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Heart Disease Treatment

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).

Tables

1.63 Percent of obese adults age 18 and over who were ever given advice about exercise, United States, 2002 and 2004.

Data Source

AHRQ, CFACT, Medical Expenditure Panel Survey (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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Heart Disease Treatment

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).

Tables

1.64 Percent of obese adults age 18 and over who were ever given advice about eating fewer high fat or high cholesterol foods, United States, 2002 and 2004.

Data Source

AHRQ, CFACT, Medical Expenditure Panel Survey (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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