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National Healthcare Disparities Report, 2005

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How This Chapter Is Organized

This chapter presents new information about disparities in quality of health care in America. The measures used here are the same as those used in the National Healthcare Quality Report, and this chapter is constructed to mirror sections in the NHQR—effectiveness, patient safety, timeliness, and patient centeredness. Effectiveness of care is presented under eight clinical condition or care setting areas: cancer, diabetes, end stage renal disease (ESRD), heart disease, HIV and AIDS, mental health and substance abuse, respiratory diseases, and nursing home and home health care. Maternal and child health is discussed in Chapter 4, Priority Populations.

As in previous NHDRs, this chapter's discussion on quality of care focuses on disparities in quality related to race, ethnicity, and socioeconomic status in the general U.S. population. Disparities in quality of care within specific priority populations are presented in Chapter 4. This chapter also presents analyses of changes over time, as well as some stratified analyses.

Additionally, this year the NHDR focuses on a narrower set of measures than the full set of measures tracked in previous reports. With guidance from the Interagency Work Groups advising the NHDR and NHQR, this narrower set of core report measures was established. The core report measures aim to be representative of the overall NHDR measure set; but, because they are fewer in number, they are more manageable for policymakers and others to understand and apply when utilizing the NHDR. For details on the process used to establish core report measures, see Chapter 1, Introduction and Methods.

It is primarily core report measures that are presented in the 2005 NHDR and that will be tracked in future iterations of the NHDR. However, the entire NHDR measure set will continue to appear in the appendixes; and from year to year, supplemental measures (those from the overall NHDR measure set that are not core report measures) will be presented in the text of the NHDR as well. This year's report includes a small amount of supplemental measures.

Finally, new composite measures are introduced in this year's NHDR, including composites for appropriate hospital care for heart attack and pneumonia. They are presented in this chapter in the sections on heart disease and respiratory diseases, respectively. For composite details, see Chapter 1, Introduction and Methods.

Categorization of Effectiveness Measures by Health Care Need

To facilitate identifying the measures discussed in this section as related to the patient's need for preventive care, treatment of acute illness, and chronic disease management, the effectiveness section of this chapter categorizes measures as follows:


The majority of health care resources are invested in caring for the unhealthy. However, caring for healthy people is another important component of health care. Educating people about healthy behaviors can help to postpone and avoid illness and disease. Additionally, detecting health problems at an early stage increases the chances of effectively treating them, often reducing suffering and expenditures.


Even when preventive care is ideally implemented, it cannot entirely avert the need for acute care. Delivering optimal treatments for acute illness can help reduce the consequences of illness and promote the best recovery possible.


Some diseases, such as diabetes and end stage renal disease, are chronic, which means they cannot simply be treated once; they must be managed across a lifetime. Management of chronic disease often involves lifestyle changes and regular contact with a provider to monitor the status of the disease. For patients, effective management of chronic disease can mean the difference between normal, healthy living and frequent medical problems.

Note that findings for women and children, which parallel those presented in the NHQR for maternal and child health, are presented in the sections on women and children in Chapter 4, Priority Populations, but applicable measures are included in the list below.

Measures presented in effectiveness fall within the three components of health care need as listed below. (For findings related to all core report measures of effectiveness, go to Tables 2.1a and 2.1b.)

Section Measure
Cancer (breast) Mammography
Cancer (breast) Advanced stage breast cancer
Heart disease Cholesterol screening*
Respiratory diseases Pneumococcal vaccination
Maternal and child health (women) Osteoporosis screening*
Maternal and child health (women) Prenatal care
Maternal and child health (women) Dental care
Maternal and child health (children) Dental carei*
Maternal and child health (children) Counseling about physical activity
Heart disease Recommended hospital care for heart attack
Respiratory diseases Recommended hospital care for pneumonia
Nursing home and home health care Improved walking or moving
Nursing home and home health care Hospital admission for home care patients
Maternal and child health (women) Recommended hospital care for heart attack
Maternal and child health (children) Hospital admissions for gastroenteritis
Mental health and substance abuse Reported help from mental disorder treatment
Mental health and substance abuse Completion of substance abuse treatment
Mental health and substance abuse Receipt of needed substance abuse treatment
Diabetes Hemoglobin, cholesterol, blood pressure
Diabetes Receipt of recommended services for diabetes
End stage renal disease (ESRD) Adequacy of hemodialysis
End stage renal disease (ESRD) Registration for transplantation
Heart disease Blood pressure under control*
HIV and AIDS HIV patients with PCP and MAC prophylaxis*
HIV and AIDS New AIDS cases
Nursing home and home health care Use of physical restraints
Nursing home and home health care Prevalence of pressure sores
Maternal and child health (women) Receipt of recommended services for diabetes
Maternal and child health (children) Pediatric asthma admissions

* Supplemental measure.

i Includes 1 core measure—dental visits—and 1 supplemental measure—untreated dental carries.



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