Chapter 2. Quality of Health Care

National Healthcare Disparities Report, 2009

Contents

Components of Health Care Quality
How This Chapter Is Organized
Categorization of Effectiveness Measures by Health Care Need
Effectiveness
   Cancer
   Diabetes
   End Stage Renal Disease (ESRD)
   Heart Disease
   HIV and AIDS
   Mental Health and Substance Abuse
   Respiratory Diseases
   Lifestyle Modification
   Functional Status Preservation and Rehabilitation
   Supportive and Palliative Care
Patient Safety
   Health Care-Associated Infections
   Other Complications of Hospital Care
   Complications of Medications
Timeliness
   Getting Care for Illness or Injury As Soon As Wanted
   Emergency Department Visits in Which Patients Left Without Being Seen
   Timeliness of Cardiac Reperfusion for Heart Attack Patients
Patient Centeredness
   Patients' Experience of Care
   Diversity of the Dental Professionals Workforce
   Focus on Care Coordination
Summary Tables
References

As better understanding of health and sickness has led to superior ways of preventing, diagnosing, and treating diseases, the health of most Americans has improved dramatically. However, ample evidence indicates that some Americans do not receive the full benefits of high-quality care. Specifically, a substantial body of public health, social science, and health services research has shown extensive disparities in health care related to race, ethnicity, and socioeconomic factors. These disparities have been confirmed in previous releases of the National Healthcare Disparities Report (NHDR).

 

Components of Health Care Quality

Quality health care means doing the right thing, at the right time, in the right way, for the right people—and having the best possible results.1 Quality health care is care that is2:

  • Effective—Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit.
  • Safe—Avoiding injuries to patients from the care that is intended to help them.
  • Timely—Reducing waits and sometimes harmful delays for both those who receive and those who give care.
  • Patient centered—Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
  • Equitable—Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic factors.
  • Efficient—Avoiding waste, including waste of equipment, supplies, ideas, and energy.

Health care quality is measured in several ways, including:

  • Clinical performance measures of how well providers deliver specific services needed by specific patients, such as whether children get the immunizations they need.
  • Assessments by patients of how well providers meet health care needs from the patient's perspective, such as whether providers communicate clearly.
  • Outcome measures, such as death rates from cancers detectable by screening, that may be affected by the quality of health care received. 

 

How This Chapter Is Organized

This chapter presents information about disparities in the quality of health care in America, with a presentation of a subset of core measures. The measures used here are the same as those used in the National Healthcare Quality Report (NHQR). This chapter is constructed to mirror sections in the NHQR—effectiveness, patient safety, timeliness, and patient centeredness. Due to constraints on the length of this report, only a subset of the core measures is presented.

The effectiveness of care section has been reorganized into seven clinical areas (cancer, diabetes, end stage renal disease (ESRD), heart disease, HIV and AIDS, mental health and substance abuse, and respiratory diseases) and three types of health care services that typically cut across clinical conditions (lifestyle modification, functional status preservation and rehabilitation, and supportive and palliative care). Maternal and child health is discussed in Chapter 4, Priority Populations, in the sections on women and children.

As in previous NHDRs, this chapter's discussion of quality of care focuses on disparities in quality related to race, ethnicity, and socioeconomic factors 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 by race, ethnicity, and socioeconomic factors, as well as some stratified analyses. 

 

Categorization of Effectiveness Measures by Health Care Need

In the effectiveness section of this chapter, measures are organized into categories related to the patient's need for preventive care, treatment of acute illness, and chronic disease management. There is sizable overlap among these categories, and some measures may be considered to belong in more than one category. Outcome measures are organized separately, because prevention, treatment, and management can all play important roles in affecting outcomes.

  • Prevention—Caring for healthy people is an important component of health care. Educating people about healthy behaviors can help to postpone and avoid illness and disease. In addition, detecting health problems at an early stage increases the chances of effectively treating them, often reducing suffering and costs.
  • Treatment—Even when preventive care is ideally implemented, it cannot entirely avert the need for acute care. Delivering optimal treatment for acute illness can help reduce the effects of illness and promote the best recovery possible.
  • Management—Some diseases, such as diabetes and ESRD, 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 healthy living and frequent medical problems.
  • Outcomes—Many factors other than health care influence health outcomes, including a person's genes, lifestyle, and social and physical environment. However, for many individuals, appropriate preventive services, timely treatment of acute illness or injury, and meticulous management of chronic disease can positively affect mortality, morbidity, and quality of life.

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. Effectiveness measures presented in this section are organized within the categories of prevention, treatment, management, and outcomes. For findings related to all core measures of effectiveness, refer to Tables 2.1a and 2.1b.

SectionMeasure
Prevention
CancerBreast cancer screening
Respiratory diseasesPneumococcal vaccination
Lifestyle modificationCounseling smokers to quit smoking
Lifestyle modificationCounseling obese adults about healthy eating
Functional status preservation and rehabilitationOsteoporosis screening in women
Priority populations—Women (Chapter 4)Counseling obese adults about exercise
Priority populations—Children (Chapter 4)Early childhood vaccinations
Priority populations—Children (Chapter 4)Counseling about healthy eating
Priority populations—Children (Chapter 4)Dental visits
Treatment
CancerWomen with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy*
CancerWomen treated with breast-conserving surgery who received radiation therapy*
Heart diseaseReceipt of angiotensin-converting enzyme or angiotensin receptor blocker for heart attack
Mental health and substance abuseReceipt of treatment for depression
Mental health and substance abuseReceipt of needed treatment for illicit drug use or alcohol problem
Respiratory diseasesReceipt of recommended care for pneumonia
Management
DiabetesReceipt of three recommended diabetes services
DiabetesShort-term complications
End stage renal diseaseRegistration for transplantation
HIV and AIDSPCP and MAC prophylaxis*
Respiratory diseasesDaily asthma medication
Supportive and palliative careUse of physical restraints on nursing home residents
Supportive and palliative careHospice care*,i
Outcomes
CancerAdvanced stage breast cancer
End stage renal diseaseAdequate hemodialysis
HIV and AIDSNew AIDS cases
Functional status preservation and rehabilitationImprovement in ambulation in home health care patients
Supportive and palliative carePressure sores in nursing home residents
Supportive and palliative careAcute care hospitalization of home health care patients
Priority populations—Women (Chapter 4)Heart attack mortality

* Noncore measure. 

 

Effectiveness

Cancer

Mortality
Number of deaths (2009)562,3403
Cause of death rank (2006)2nd4
Prevalence
Number of living Americans who have been diagnosed with cancer (2005)11,098,4505
Incidence
New cases of cancer (2009)1,479,3503
New cases of breast cancer (2009)192,3703
Cost
Total costii (2009)$243.4 billion6
Direct costsiii (2009)$99 billion6
Cost-effectivenessiv of colorectal cancer screening$0-$14,000/QALY7
Cost-effectiveness of breast cancer screening$35,000-$165,000/QALY7
Cost-effectiveness of cervical cancer screening$14,000-$35,000/QALY7

Prevention: Breast Cancer Screening

Ensuring that all populations have access to appropriate cancer screening services is a core element of reducing cancer health disparities.8 This year the NHDR focuses on breast cancer; findings for colorectal cancer are found in the 2008 NHDR. Screening mammography is an effective way to significantly reduce breast cancer mortality.9

 

Figure 2.1. Women age 40 and over who report they had a mammogram within the past 2 years, by race, ethnicity, and income, 2000-2005

 Trend line charts. percentage. race. Total, 2000, 70.4, 2003, 69.5, 2005, 66.6. White, 2000, 71.4, 2003, 69.9, 2005, 67.3. Black, 2000, 67.8, 2003, 69.9, 2005, 64.3. Asian, 2000, 55.6, 2003, 58.2, 2005, 54.0. AI/AN, 2000, 48.8, 2003, no data, 2005, 67.1. More than 1 Race, 2000, 69.2, 2003, 67.7, 2005, 63.6.

Trend line charts; in percentages. Ethnicity, 2005, Non-Hispanic White, 2000, 72.2, 2003, 70.4, 2005, 68.2; Hispanic, 2000, 61.8, 2003, 65.1, 2005, 58.9.

Trend line charts; in percentages. income. Poor, 2000, 54.7, 2003, 55.4, 2005, 48.5. Near Poor, 2000, 57.3, 2003, 60.3, 2005, 55.1. Middle Income, 2000, 68.6, 2003, 69.7, 2005, 66.8. High Income, 2000, 81.2, 2003, 76.4, 2005, 75.3.

Key: AI/AN = American Indian or Alaska Native.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS), 2000, 2003, and 2005.

Denominator: Women age 40 and over in the civilian noninstitutionalized population.

Note: Data were insufficient for this analysis for American Indians and Alaska Natives in 2003 and for Native Hawaiians and Other Pacific Islanders. The apparent decline in mammography rates between 2003 and 2005 based on the NHIS is due at least in part to changes in the methodology for the 2005 NHIS mammography questions.

  • In 2005, Blacks were less likely than Whites to report they had a mammogram within the past 2 years (64.3% compared with 67.3%).
  • In 2005, Asians were less likely than Whites to report they had a mammogram within the past 2 years (54% compared with 67.3%).
  • In 2005, mammography rates remained significantly lower for Hispanic women than for non-Hispanic White women (58.9% compared with 68.2%).
  • In 2005, the mammography rate for poor women was about two-thirds that for high-income women (48.5% compared with 75.3%).
  • In 2005, the only groups to achieve the Healthy People 2010 target of 70% of women age 40 and over receiving a mammogram within the past 2 years were women with high income (75.3%), women with at least some college education (72.5%, data not shown), and women with private insurance (74.2%, data not shown).

Racial and ethnic minorities, as well as people with low incomes, have disproportionate rates of individuals with public insurance or no insurance. To distinguish the effects of race, ethnicity, and income on cancer screening, this measure is stratified by insurance status (Figures 2.2 and 2.3).

 

Figure 2.2. Women ages 40-64 who report they had a mammogram within the past 2 years, by race/ethnicity, stratified by insurance, 2000-2005

Trend line charts; in percentages. Private insurance; Non-Hispanic White, 2000, 78.0; 2003, 76.2; 2005, 74.7. Non-Hispanic Black,  2000, 78.3; 2003, 80.9; 2005, 76.3. Hispanic, 2000, 70.2; 2003, 71.5; 2005, 70.2.

Trend line charts; in percentages. Public insurance; Non-Hispanic White, 2000, 63.9; 2003, 67.8; 2005, 59.7. Non-Hispanic Black,  2000, 64.3; 2003, 65.9; 2005, 58.6. Hispanic, 2000, 72.3; 2003, 68.5; 2005, 54.6.

Trend line charts; in percentages. Uninsurance; Non-Hispanic White, 2000, 43.6; 2003, 34.9; 2005, 34.4. Non-Hispanic Black,  2000, 43.1; 2003, 51.7; 2005, 44.2. Hispanic, 2000, 37.3; 2003, 51.4; 2005, 41.0.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS), 2000, 2003, and 2005.

Denominator: Women age 40 and over in the civilian noninstitutionalized population.

Note: The apparent decline in mammography rates between 2003 and 2005 based on the NHIS is due at least in part to a change in the methodology for the 2005 NHIS mammography questions.

  • In 2005, among those with private insurance, there was no statistically significant difference between non-Hispanic Blacks and non-Hispanic Whites in the percentage of women age 40 and over who had a mammogram within the past 2 years (Figure 2.2).
  • In 2005, among those with private insurance, there was no statistically significant difference between Hispanics and non-Hispanic Whites in the percentage of women ages 40 and over who had a mammogram within the past 2 years.
  • In 2005, among those with public insurance, there was no statistically significant difference between non-Hispanic Blacks and non-Hispanic Whites in the percentage of women age 40 and over who had a mammogram within the past 2 years.
  • In 2005, among those with public insurance, there was no statistically significant difference between Hispanics and non-Hispanic Whites in the percentage of women age 40 and over who had a mammogram within the past 2 years.
  • Among people who were uninsured during this period, the gap between non-Hispanic Blacks and non-Hispanic Whites increased. In 2005, uninsured non-Hispanic Black women age 40 and over were more likely than uninsured non-Hispanic White women to have had a mammogram within the past 2 years (44.2% compared with 34.4%). Also, uninsured non-Hispanic White women were least likely to have had a mammogram within the past 2 years.
  • Among people who were uninsured during this period, the gap between Hispanics and non-Hispanic Whites increased. However, in 2005, there was no statistically significant difference between Hispanics and non-Hispanic Whites in the percentage of women age 40 and over who had a mammogram within the past 2 years.
 

Figure 2.3. Women ages 40-64 who report they had a mammogram within the past 2 years, by family income, stratified by insurance, 2000-2005

Trend line charts; in percentages.  Private insurance; Poor; 2000, 70.2; 2003, 62.3; 2005, 52.6; Near Poor; 2000, 62.9; 2003, 65.9; 2005, 66.3; Middle Income; 2000, 71.8; 2003, 72.8; 2005, 71.0; High Income; 2000, 82.3; 2003, 79.9; 2005, 78.1.

Trend line charts; in percentages. Public insurance; Poor; 2000, 61.3; 2003, 61.5; 2005, 56.0; Near Poor; 2000, 64.1; 2003, 65.4; 2005, 54.7; Middle Income; 2000, 68.5; 2003, 75.8; 2005, 54.7; High Income; 2000, 71.9; 2003, 73.6; 2005, 80.1.

Trend line charts; in percentages. Public insurance; Poor; 2000, 61.3; 2003, 61.5; 2005, 56.0; Near Poor; 2000, 64.1; 2003, 65.4; 2005, 54.7; Middle Income; 2000, 68.5; 2003, 75.8; 2005, 54.7; High Income; 2000, 71.9; 2003, 73.6; 2005, 80.1.

Trend line charts; in percentages. Uninsurance; Poor; 2000, 35.8; 2003, 40.8; 2005, 32.3; Near Poor; 2000, 40.1; 2003, 45.0; 2005, 34.9; Middle Income; 2000, 40.2; 2003, 40.7; 2005, 44.1; High Income; 2000, 59.3; 2003, 38.9; 2005, 47.1.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS), 2000, 2003, and 2005.

Denominator: Women age 40 and over in the civilian noninstitutionalized population.

Note: The apparent decline in mammography rates between 2003 and 2005 based on the NHIS is due at least in part to a change in the methodology for the 2005 NHIS mammography questions.

  • From 2000 to 2005, the percentage of women age 40 and over with private insurance who had a mammogram within the past 2 years decreased significantly (from 76.9% to 74.2%; data not shown). In 2005, among those with private insurance, women in all other income groups were less likely than high-income women to have had a mammogram within the past 2 years (Figure 2.3).
  • During this period, the percentage of women age 40 and over with public insurance who had a mammogram within the past 2 years decreased significantly (from 64.7% to 57.9%; data not shown). In 2005, among those with public insurance, women in all other income groups were less likely than high-income women to have had a mammogram within the past 2 years (56% for poor, 54.7% for near poor, and 54.7% for middle income, compared with 80.1% for high income).
  • Also during this period, the percentage of uninsured women age 40 and over who had a mammogram within the past 2 years remained the same (data not shown). In 2005, among women uninsured all year, poor and near-poor groups were less likely to have had a mammogram within the past 2 years than the high-income group (32.3% for poor and 34.9% for near poor compared with 47.1% for high income).

Each year, multivariate analyses are conducted in support of the NHDR to identify the independent effects of race and socioeconomic factors on quality of health care. Past reports have listed some of these findings as odds ratios. This year, the NHDR presents the results of a multivariate model as adjusted percentages. Adjusted percentages are presented for several measures, including women ages 40-64 who had a mammogram within the past 2 years. Adjusted percentages show the expected percentage for a given subpopulation after controlling for a number of factors, which in this case include race/ethnicity, family income, education, health insurance status, and geographic location. For more information on adjusted percentages, refer to the Methods section in Chapter 1.

 

Figure 2.4. Adjusted percentages of women ages 40-64 who had a mammogram within the past 2 years, by race/ethnicity, family income, education, insurance status, and residence location, 2005

Bar charts. Percentages,  Race/ethnicity; non-Hispanic white, 68; non-Hispanic black, 72; Hispanic, 68; Family income; poor, 58; low income, 61; middle income, 67; high income, 75; Education, less than high school, 67; high school grad, 67; some college, 70; Insurance status; private insurance, 73; public insurance only, 66; uninsured 45; Residence location; large fringe metro area; 68; noncore area, 64.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2005.

Note: Adjusted percentages are predicted marginals from a statistical model that includes the covariates race/ethnicity, family income, education, health insurance, and residence location. The adjusted percentages generated from this model control for these multiple factors simultaneously. Refer to Chapter 1, Introduction and Methods, for more information. Geographic typologies are based on Urban Influence Codes using a methodology developed by the National Center for Health Statistics. The Residents of Rural Areas section in Chapter 4 contains more information on geographic typologies and definitions.

  • In the multivariate model used, after adjustment, 72% of non-Hispanic Black women ages 40-64 would have had a mammogram within the past 2 years compared with 68% of non-Hispanic White women (Figure 2.4).
  • After adjustment, a lower percentage of poor, low-income, and middle-income women ages 40-64 (58%, 61%, and 67%, respectively) would have had a mammogram within the past 2 years compared with high-income women (75%).
  • After adjustment, 45% of women ages 40-64 who were uninsured at the time of interview and 66% of women with only public insurance would have had a mammogram within the past 2 years compared with 73% of women who had private insurance.
  • After adjustment, 64% of women ages 40-64 who were residing in noncore areas would have had a mammogram within the past 2 years compared with 68% of women who were residing in large fringe metropolitan areas.
 

Figure 2.5. Adjusted percentages of women age 65 and over who had a mammogram within the past 2 years by race/ethnicity, family income, education, insurance status, and residence location, 2005

Bar charts. Percentages, Race/ethnicity; non-Hispanic white, 64; non-Hispanic black, 67; Hispanic, 73; Family income; poor, 57; low income, 59; middle income, 68; high income, 70; Education, less than high school, 54; high school grad, 65; some college, 72; Insurance status; Medicare and private, 66; Medicare and Public, 64; Medicare only 62; Residence location; large fringe metro; 63; noncore, 64.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2005.

Note: Adjusted percentages are predicted marginals from a statistical model that includes the covariates race/ethnicity, family income, education, health insurance, and residence location. Go to Chapter 1, Introduction and Methods, for more information.

  • In the multivariate model used, after adjustment, 73% of Hispanic women age 65 and over would have had a mammogram within the past 2 years compared with 64% of non-Hispanic White women (Figure 2.5).
  • After adjustment, 57% of poor women and 59% of low-income women would have had a mammogram within the past 2 years compared with 70% of high-income women.
  • After adjustment, 54% of women with less than a high school education and 65% of high school graduates would have had a mammogram within the past 2 years compared with 72% of those with some college education.
  • After adjustment, 64% of women who were residing in noncore areas (micropolitan areas) would have had a mammogram within the past 2 years compared with 63% of those who were residing in large fringe metropolitan areas (metropolitan areas).

Outcome: Advanced Stage Breast Cancer

Cancers can be diagnosed at different stages. The rate of cancers that are diagnosed at advanced stages is a measure of the effectiveness of cancer screening efforts. Differences in rates may vary across racial and ethnic groups due to differences in underlying prevalence of breast cancer.

 

Figure 2.6. Age-adjusted rate of advanced stage (stage II or higher) breast cancer per 100,000 women age 40 and over, by race and ethnicity, 2000-2006

Trend line chart; rate per 100,000.  White, 2000, 106.7, 2001, 108.0; 2002, 104.9; 2003, 98.4, 2004, 96.7; 2005, 97.0; 2006, 93.7; Black, 2000, 116.7, 2001, 112.1; 2002, 112.9; 2003, 117.6, 2004, 113.2; 2005, 105.1; 2006, 111.1; Asian/Pacific Islander, 2000, 67.7, 2001, 67.9; 2002, 70.6; 2003, 65.4, 2004, 69.6; 2005, 68.2; 2006, 64.3; AI/AN, 2000, 41.8, 2001, 37.8; 2002, 41.7; 2003, 45.0, 2004, 43.0; 2005, 52.1; 2006, 40.3.

Trend line chart; rate per 100,000.  Non-Hispanic white; 2000, 109.2, 2001, 111.3; 2002, 107.8; 2003, 101.6, 2004, 99.6; 2005, 99.6; 2006, 96.9; Hispanic; 2000, 85.4, 2001, 82.2; 2002, 83.0; 2003, 75.6, 2004, 75.2; 2005, 78.4; 2006, 73.0.

Key: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander.

Source: National Cancer Institute, Surveillance, Epidemiology, and End Results Program, 2000-2006.

Denominator: Women age 40 and over.

  • From 2000 to 2006, statistically significant differences in the rate of advanced stage breast cancer were seen between Asians and Pacific Islanders (APIs) and Whites, and between American Indians and Alaska Natives (AI/ANs) and Whites (Figure 2.6). In 2006, the rate of advanced stage breast cancer was lower for APIs and AI/ANs than for Whites (64.3 per 100,000 for APIs and 40.3 per 100,000 for AI/ANs compared with 93.7 per 100,000 for Whites). The rate was higher for Blacks compared with Whites (111.1 per 100,000 compared with 93.7 per 100,000).

Treatment: Recommended Care for Breast Cancer Patients

Different diagnostic and treatment options exist for various types of cancer. Some aspects of cancer care are well established as beneficial and are commonly recommended. The appropriateness of recommended care depends on different factors, such as the stage or the extent of the cancer within the body (especially whether the disease has spread from the original site to other parts of the body). Other types of care are important for accurate diagnosis, such as ensuring the adequate examination of lymph nodes when surgery (e.g., to remove breast cancer) is performed.

Among women diagnosed with breast cancer who receive surgical therapy, approximately 63% undergo breast-conserving surgery.10 Randomized controlled trials have shown that women who undergo breast-conserving surgery and postoperative radiation therapy have significantly reduced their rates of localized disease recurrence compared with those who underwent total mastectomy and compared with those who did not receive postoperative radiation.11-13

 

Figure 2.7. Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of surgery (lumpectomy or mastectomy), by race and ethnicity, 2000-2006

Trend line charts. percentage.  Total; 2000, 78.0, 2001, 79.7; 2002, 80.7; 2003, 84.5, 2004, 85.4; 2005, 86.7; 2006, 87.8; White; 2000, 77.9, 2001, 79.7; 2002, 80.7; 2003, 84.5, 2004, 85.3; 2005, 86.5; 2006, 87.8; Black; 2000, 78.6, 2001, 79.4; 2002, 79.5; 2003, 83.9, 2004, 84.8; 2005, 87.3; 2006, 87.5; Asian; 2000, 85.9, 2001, 84.2; 2002, 86.9; 2003, 87.4, 2004, 87.8; 2005, 88.8; 2006, 89.6.

Trend line charts. percentage.  Non-Hispanic white; 2000, 78.0, 2001, 79.5; 2002, 80.7; 2003, 84.4, 2004, 85.2; 2005, 86.4; 2006, 88.0; Hispanic; 2000, 81.4, 2001, 84.4; 2002, 83.6; 2003, 85.6, 2004, 86.2; 2005, 88.2; 2006, 88.9.

Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2000-2006.

Denominator: U.S. population, women.

  • From 2000 to 2006, there was improvement in the percentage of women with clinical Stage I-IIb breast cancer who received an axillary node dissection or sentinel lymph node biopsy at the time of surgery (from 78% to 87.8%; Figure 2.7).
  • The percentage of women with clinical Stage I-IIb breast cancer who received an axillary node dissection was lower for people with no insurance than for people with private insurance (90.0% compared with 91.2%; data not shown).
  • There were no statistically significant differences by race or ethnicity.
 

Figure 2.8. Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, by race and ethnicity, 2000-2006

Trend line charts. percentage.  Total; 2000, 73.3; 2001, 73.5; 2002, 73.6; 2003, 75.9; 2004, 75.0; 2005, 74.3; 2006, 75.2; White, 2000, 74.2; 2001, 74.5; 2002, 74.8; 2003, 77.1; 2004, 76.3; 2005, 75.6; 2006, 76.5; Black, 2000, 67.2; 2001, 67.5; 2002, 67.2; 2003, 70.7; 2004, 68.3; 2005, 68.1; 2006, 68.5; Asian, 2000, 75.9; 2001, 72.3; 2002, 71.7; 2003, 72.9; 2004, 71.2; 2005, 71.6; 2006, 72.5.

Trend line charts. percentage.  Non-Hispanic white; 2000, 74.4; 2001, 74.6; 2002, 75.1; 2003, 77.7; 2004, 77.1; 2005, 76.6; 2006, 77.4; Hispanic; 2000, 64.9; 2001, 64.8; 2002, 63.6; 2003, 63.5; 2004, 61.8; 2005, 60.4; 2006, 61.6.

Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2000-2006.

Denominator: U.S. population, women under age 70 treated for breast cancer (American Joint Committee on Cancer Stage I, II, or III primary invasive epithelial breast cancer) with breast-conserving surgery.

  • In 2006, Black patients with Stage I, II, or III breast cancer were less likely than Whites to receive radiation therapy to the breast within 1 year of diagnosis (68.5% compared with 76.5%; Figure 2.8).
  • From 2000 to 2006, the gap between Hispanics and non-Hispanic Whites increased. In 2006, Hispanic patients with breast cancer were less likely than non-Hispanic Whites to receive radiation therapy to the breast within 1 year of diagnosis (61.6% compared with 77.4%).

i Two noncore measures of hospice care are from the National Hospice and Palliative Care Organization Family Evaluation of Hospice Care: hospice patients who were not referred to hospice care at the right time and hospice patients who did not receive the right amount of medicine for pain.
ii Total cost is composed of the cost of medical care itself (direct cost) and the economic costs of morbidity and mortality (indirect cost).
iii Direct costs are defined as "personal health care expenditures for hospital and nursing home care, drugs, home care, and physician and other professional services."
iv Cost-effectiveness is measured here by the average net cost of each quality-adjusted life year (QALY) that is saved by the provision of a particular health intervention. QALYs are a measure of survival adjusted for its value: 1 year in perfect health is equal to 1.0 QALY, while a year in poor health would be something less than 1.0. A lower cost per QALY saved indicates a greater degree of cost-effectiveness.



Proceed to Next Section

Current as of March 2010
Internet Citation: Chapter 2. Quality of Health Care: National Healthcare Disparities Report, 2009. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhdr09/Chap2.html