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National Healthcare Quality & National Healthcare Disparities Reports: Measure Specification Appendix, 2013

Effectiveness of Care: Respiratory Diseases

Measures

High-risk adults who received an influenza vaccination in the last 12 months
Adults age 65 and over who received an influenza vaccination in the last 12 months
High-risk adults ages 18-64 who ever received a pneumococcal vaccination
Adults age 65 and over who ever received pneumococcal vaccination
People with asthma who receive written asthma management plans from their health care provider
Hospital admissions for immunization-preventable influenza per 100,000 population, age 65 and over
Deaths per 1,000 adult hospital admissions with pneumonia
Hospital admissions for asthma per 100,000 population by age group
Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment
People with asthma who are taking daily or almost daily preventive medicine
Hospital patients with pneumonia who received recommended hospital care
Hospital patients with pneumonia who had blood cultures performed in the Emergency Department prior to initial antibiotic received in the hospital
Hospital patients with pneumonia who received the initial antibiotic dose within 6 hours of arrival
Hospital patients with pneumonia who received the initial antibiotic consistent with current recommendations
Hospital patients with pneumonia who received influenza screening or vaccination
Hospital patients with pneumonia who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated
Hospital admissions for immunization-preventable influenza per 100,000 population age 65 and over
Ability to control/manage asthma
 


 

Measure Title

High-risk adults who received an influenza vaccination in the last 12 months

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, States

Years Available

State: 2000-2011

National: 2001-2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race, ethnicity, location of residence, sex

Data Sources

National

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

State

CDC, Behavioral Risk Factor Surveillance System (BRFSS)

Denominator

U.S. civilian noninstitutionalized population ages 18-64 who have a high-risk condition

Numerator

Subset of the denominator who report receiving an influenza vaccination in the past 12 months

Comments

This measure is referred to as measure IID-12.6 in Healthy People 2020 documentation.

High-risk conditions include diabetes, heart disease, lung disease, kidney disease, liver disease, and cancer. Not all high-risk conditions for complications of influenza can be ascertained by the NHIS (e.g., immunocompromised states), and sample sizes may be too small to estimate.

Data are age adjusted to the 2000 U.S. standard population.

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Measure Title

Adults age 65 and over who received an influenza vaccination in the last 12 months

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, States

Years Available

State: 2000-2011

National: 2001-2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race, ethnicity, location of residence, sex

Data Sources

National

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

State

CDC, Behavioral Risk Factor Surveillance System (BRFSS)

Denominator

U.S. civilian noninstitutionalized population of adults age 65 and over

Numerator

Number of adults age 65 and over who report receiving an influenza vaccination in the past 12 months

Comments

This measure is referred to as measure IID-12.7 in Healthy People 2020 documentation.

Data are age adjusted to the 2000 U.S. standard population.

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Measure Title

High-risk adults ages 18-64 at who ever received a pneumococcal vaccination

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, States

Years Available

State: 2000-2011

National: 2001-2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race, ethnicity, location of residence, sex

Data Sources

National

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

State

CDC, Behavioral Risk Factor Surveillance System (BRFSS)

Denominator

U.S. civilian noninstitutionalized population of adults ages 18-64 with a high-risk condition

Numerator

Subset of the denominator who report ever receiving a pneumococcal vaccination

Comments

This measure is referred to as measure IID-13.2 in Healthy People 2020 documentation.

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Measure Title

Adults age 65 and over who ever received a pneumococcal vaccination

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, States

Years Available

State: 2000-2011

National: 2001-2010

Population Subgroups

Activity limitation, age, education, health insurance, income, race, ethnicity, location of residence, sex

Data Sources

National

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

State

CDC, Behavioral Risk Factor Surveillance System (BRFSS)

Denominator

U.S. civilian noninstitutionalized population of adults age 65 and over

Numerator

Subset of the denominator who report ever receiving a pneumococcal vaccination

Comments

This measure is referred to as measure IID-13.1 in Healthy People 2020 documentation.

Data are age adjusted to the 2000 U.S. standard population.

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Measure Title

People with asthma who received written asthma management plans from their health care provider

Measure Source

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

Table Description

Geographic Representation

National

Years Available

2009

Population Subgroups

Activity limitation, age, education, health insurance, income, race, ethnicity, location of residence, sex

Data Sources

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

Denominator

U.S. civilian noninstitutionalized population with asthma

Numerator

Subset of the denominator who report receiving written asthma management plans from their health provider

Comments

Estimates are age adjusted to the 2000 U.S. standard population. Age data and health insurance data for those aged 65 and over are unadjusted.

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Measure Title

Hospital admissions for immunization-preventable influenza per 100,000 population, age 65 and over

Measure Source

Healthy People 2010

Table Description

Geographic Representation

National, State

Years Available

National: 2000-2001; 2004-2010

State: 2000, 2004, and 2007-2010

Population Subgroups

Age, sex, location of residence, median income of patient’s ZIP code, region

Data Sources

National

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1

State

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

Denominator

U.S. population age 65 and over

Numerator

Subset of the denominator with any diagnosis of immunization-preventable influenza, excluding transfers from other institutions

Comments

This measure is referred to as measure 1-9c in Healthy People 2010 documentation.

Rates 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, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multistate comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.

The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 37 States: AK, AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, IN, KS, KY, MA, MD, MI, MO, MS, NC, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, and WY.

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Measure Title

Deaths per 1,000 adult hospital admissions with pneumonia

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Inpatient Quality Indicators (IQIs)

Table Description

Geographic Representation

National, State

Years Available

National: 2000-2001; 2004-2010

State: 2000; 2004; 2007-2010

Population Subgroups

Age, bed size of hospital, insurance, location of hospital, location of residence, median income of patient’s ZIP code, control of hospital, region, teaching status

Data Sources

National

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1

State

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

Denominator

All discharges age 18 and over with principal diagnosis code of pneumonia, excluding patients transferring to another short-term hospital, obstetric admissions, and cases with a missing discharge disposition

Numerator

Subset of the denominator who died

Comments

Rates are adjusted by age, gender, age-gender interactions, major diagnostic category (MDC), all patient refined-diagnosis related group (APR-DRG) risk of mortality score, and transfers to the hospital. When reporting is by age, the adjustment is by gender, MDC, APR-DRG risk of mortality score, and transfers to the hospital; when reporting is by gender, the adjustment is by age, MDC, APR-DRG risk of mortality score, and transfers to the hospital. The AHRQ IQI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multistate comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.

The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 37 States: AK, AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, IN, KS, KY, MA, MD, MI, MO, MS, NC, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, and WY.

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Measure Title

Hospital admissions for asthma per 100,000 population by age group

Measure Source

Healthy People 2020

Table Description

Geographic Representation

National, State

Years Available

National: 2000-2001; 2004-2010

State: 2000; 2004; 2007-2010

Population Subgroups

Age, sex, location of residence, median income of patient’s ZIP code, region

Data Sources

National

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1

State

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

Denominator

As appropriate to each measure, the U.S. population of children ages 2-17, adults age 18 and over, or adults age 65 and over, excluding admissions with cystic fibrosis or anomalies of the respiratory system, transfers from other institutions and obstetric admissions

Numerator

Subset of the denominator admitted to an acute care or community hospital with a principal diagnosis of asthma

Comments

This measure is referred to as measure RD-2 in Healthy People 2020 documentation.

Rates are adjusted by age and gender, using the 2000 U.S. standard population.

Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multistate comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.

The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 37 States: AK, AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, IN, KS, KY, MA, MD, MI, MO, MS, NC, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, and WY.

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Measure Title

Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment

Measure Source

American Thoracic Society Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination

Table Description

Geographic Representation

National

Years Available

2000-2009

Population Subgroups

Age, ethnicity, race

Data Sources

CDC, National Tuberculosis Surveillance System (NTBSS)

Denominator

U.S. resident population with verified tuberculosis who are eligible to complete therapy within 1 year

Numerator

Subset of the denominator completing therapy within 1 year

Comments

Race designations changed in 2003; estimates in 2003 and later differ slightly from estimates in previous reports.

More information regarding current tuberculosis treatment guidelines is available from: American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America. Treatment of tuberculosis. American Journal of Respiratory Critical Care Medicine 2003;167:603-62.

For a discussion of completion of tuberculosis therapy, refer to Appendix A of the publication: Reported tuberculosis in the United States, 2000.

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Measure Title

People with asthma who are taking daily or almost daily preventive medicine

Measure Source

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

Table Description

Geographic Representation

National

Years Available

2003-2010

Population Subgroups

Age, sex, race, ethnicity, activity limitation, employment status, income, perceived health status, preferred language, insurance, U.S. born, education, location of residence

Data Sources

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 population who currently have active asthma

Numerator

Subset of the denominator who report taking preventive medicine on a daily or almost daily basis

Comments

Estimates are age adjusted to the 2000 U.S. standard population using four age groups: 0-17, 18-44, 45-64, and 65 and over. Excludes cases for which information on presence of asthma is missing.

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Measure Title

Hospital patients with pneumonia who received recommended hospital care

Measure Source

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Hospital Inpatient Quality Reporting (HIQR) Program

Table Description

Geographic Representation

National, State

Years Available

State: 2007-2011

National: 2007-2011

Population Subgroups

Age, sex, race/ethnicity

Data Sources

National and State

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Clinical Data Warehouse (CDW) for Hospital Inpatient Quality Reporting (HIQR) Program

Denominator

Medicare hospital discharges age 18 and over meeting either of the following criteria: (1) principal diagnosis of pneumonia or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia or respiratory failure.

Numerator

Subset of the denominator who received recommended care, if indicated and appropriate

Comments

Recommended hospital care practices for pneumonia include:

  • Collecting blood cultures in the Emergency Department before administering the first dose of antibiotics.
  • Administering the first dose of antibiotics within 6 hours of patient’s arrival at the hospital.
  • Administering the recommended empirical antibiotic regimen consistent with current guidelines.
  • Screening for influenza vaccine status and vaccinating prior to discharge for patients age 50 and over discharged during the winter.
  • Screening for pneumococcal vaccine status and vaccinating prior to discharge for patients age 65 and over.

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Measure Title

Hospital patients with pneumonia who had blood cultures performed in the Emergency Department prior to initial antibiotic received in the hospital

Measure Source

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Hospital Inpatient Quality Reporting (HIQR) Program

Table Description

Geographic Representation

National, State

Years Available

State: 2007-2011

National: 2007-2011

Population Subgroups

Age, sex, race/ethnicity

Data Sources

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Clinical Data Warehouse (CDW) for Hospital Inpatient Quality Reporting (HIQR) Program

Denominator

Patients 18 years of age and older meeting either of the following criteria: (1) principal diagnosis of pneumonia or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia or respiratory failure who have an initial blood culture collected as an emergency department patient.

Numerator

Subset of the denominator whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics

Comments

Estimates are calculated using hospital-level scores.

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Measure Title

Hospital patients with pneumonia who received the initial antibiotic dose within 6 hours of arrival

Measure Source

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) for Hospital Inpatient Quality Reporting (HIQR) Program

Table Description

Geographic Representation

National, State

Years Available

State: 2007-2011

National: 2007-2011

Population Subgroups

Age, sex, race/ethnicity

Data Sources

National and State

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Clinical Data Warehouse (CDW) for Hospital Inpatient Quality Reporting (HIQR) Program

Denominator

Discharged hospital patients meeting either of the following criteria: (1) principal diagnosis of pneumonia or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia or respiratory failure.

Numerator

Subset of the denominator who received their first dose of antibiotics within 6 hours after arrival at the hospital

Comments

Estimates are calculated using hospital-level scores.

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Measure Title

Hospital patients with pneumonia who received the initial antibiotic dose consistent with current recommendations

Measure Source

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Hospital Inpatient Quality Reporting (HIQR) Program

Table Description

Geographic Representation

National, State

Years Available

State: 2005-2011

National: 2005-2011

Population Subgroups

Age, sex, race/ethnicity

Data Sources

National and State

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Clinical Data Warehouse (CDW) for Hospital Inpatient Quality Reporting (HIQR) Program

Denominator

Discharged hospital patients meeting either of the following criteria: (1) principal diagnosis of pneumonia or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia or respiratory failure.

Numerator

Subset of the denominator who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization

Comments

Excluded from the denominator are patients with healthcare-associated pneumonia. Estimates are calculated using hospital-level scores.

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Measure Title

Hospital patients with pneumonia who received influenza screening or vaccination

Measure Source

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) for Hospital Inpatient Quality Reporting (HIQR) Program

Table Description

Geographic Representation

National, State

Years Available

State: 2005-2011

National: 2005-2011

Population Subgroups

Age, sex, race/ethnicity

Data Sources

National and State

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Clinical Data Warehouse (CDW) for Hospital Inpatient Quality Reporting (HIQR) Program

National Denominator

Medicare patients age 50 and over discharged from an acute care hospital during the months of October, November, December, January, and March meeting either of the following criteria: (1) principal diagnosis of pneumonia or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia or respiratory failure.

National Numerator

Subset of the denominator screened for influenza vaccine status and were vaccinated prior to discharge, if indicated

Comments

Estimates are calculated using hospital-level scores.

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Measure Title

Hospital patients with pneumonia who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated

Measure Source

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) for Hospital Inpatient Quality Reporting (HIQR) Program

Table Description

Geographic Representation

National, State

Years Available

State: 2005-2011

National: 2005-2011

Population Subgroups

Age, sex, race/ethnicity

Data Sources

National and State

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Clinical Data Warehouse (CDW) for Hospital Inpatient Quality Reporting (HIQR) Program

Denominator

Discharged hospital patients age 65 and over meeting either of the following criteria: (1) principal diagnosis of pneumonia or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia or respiratory failure.

Numerator

Subset of the denominator screened for pneumococcal vaccine status and were vaccinated prior to discharge, if indicated

Comments

Estimates are calculated using hospital-level scores.

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Measure Title

Hospital admissions for immunization-preventable influenza per 100,000 population age 65 and over

Measure Source

Healthy People 2010

Table Description

Geographic Representation

National, State

Years Available

National: 2000-2001; 2004-2010

State: 2000; 2004; 2007-2010

Population Subgroups

Age, sex, location of residence, median income of patient’s ZIP code, region

Data Sources

National

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1

State

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

Denominator

U.S. population age 65 and over

Numerator

Subset of the denominator with any diagnosis of immunization-preventable influenza, excluding transfers from other institutions

Comments

This measure is referred to as measure 1-9c in Healthy People 2010 documentation.

Rates 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, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multistate comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.

The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 37 States: AK, AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, IN, KS, KY, MA, MD, MI, MO, MS, NC, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, and WY.

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Measure Title

Ability to control/manage asthma

Measure Source

University of California, Los Angeles (UCLA), Center for Health Policy Research (CHPR), California Health Interview Survey (CHIS)

Table Description

Geographic Representation

National

Years Available

2003, 2005, 2007, 2009; 2011-2012

Population Subgroups

Education, English proficiency, health insurance, income, U.S. born

Data Sources

UCLA, CHPR, CHIS

Denominator

California civilian noninstitutionalized population adults who have been told they have asthma

Numerator

Subset of the denominator who report being able to control/manage asthma

Comments

This measure is based on responses to the CHIS adult measure AB108, teen TB33, and child CA51, which asked respondents, "How confident are you that you can manage your asthma?" For children ages 0-11, answered by adult proxy respondent.

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Page last reviewed July 2014
Page originally created July 2014
Internet Citation: National Healthcare Quality & National Healthcare Disparities Reports: Measure Specification Appendix, 2013. Content last reviewed July 2014. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/research/findings/nhqrdr/nhqrdr13/measurespec/respiratory_diseases.html

 

The information on this page is archived and provided for reference purposes only.

 

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