Chapter 2. Effectiveness of Care (continued, 2)

National Healthcare Disparities Report, 2011

Maternal and Child Health

Importance

Mortality
Number of maternal deaths (2007)548 (Xu, et al., 2010)
Number of infant deaths (2009)29,138 (Xu, et al., 2010)
Demographics
Number of childrenxvi (2009)74,225,447 (U.S. Census Bureau, 2009)
Number of babies born in United States (2009)4,130,665 (Martin, et al., 2011)
Cost
Total cost of health care for children (2007)$102.4 billion (MEPS, 2007)
Cost-effectiveness of vision screening for children$0-$14,000/QALY (Maciosek, et al., 2006)
Cost-effectiveness of childhood immunization series (2001)approx $16 (Zhou, et al., 2005)

Measures

The NHQR and NHDR track several prevention, treatment, and outcome measures related to maternal and child health care. The measures highlighted in this section are:

  • Obstetric trauma.
  • Recommended immunizations for young children.
  • Emergency department visits for asthma.
  • Dental visits.
  • Untreated dental caries.

In addition, this year we include a focus on health care for adolescents. Measures for adolescents include:

  • Well visit in the last year.
  • Receipt of meningococcal vaccine.

Findings

New! Outcome: Obstetric Trauma

Childbirth and reproductive care are the most common reasons for women of childbearing age to use health care services. As there are roughly 11,300 births each day in the United States (Martin, et al., 2011), childbirth is the most common reason for hospital admission among women.

Obstetric trauma involving a severe tear to the vagina or surrounding tissues during delivery is a common complication of childbirth. Higher risks of severe (i.e., 3rd or 4th degree) perineal laceration may be related to the degree of fetal-maternal size disproportion. Adolescents, who often have smaller body sizes because they have not finished growing, may be more likely to experience obstetric trauma than older women. In addition, although any delivery can result in trauma, existing evidence shows that severe perineal trauma can be reduced by restricting the use of episiotomies and forceps (Kudish, et al., 2008).

Previous reports used AHRQ Quality Indicators version 3.1 to generate obstetric trauma rates. The 2011 reports use a modified version 4.1 of the software. While the effects of version change are extremely small, these estimates should not be compared with estimates in previous reports.

 

Figure 2.24. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by race/ethnicity and area income, 2001-2008

Figure 2.24. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by race/ethnicity and area income, 2001-2008. For details, go to [D] Text Description below.

Figure 2.24. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by race/ethnicity and area income, 2001-2008. For details, go to [D] Text Description below.

[D] Select for Text Description.

Key: Asian or Pacific Islander; Q1 represents the lowest income quartile and Q4 represents the highest income quartile based on the median income of a patient's ZIP Code of residence.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, State Inpatient Databases disparities analysis file, and AHRQ Quality Indicators, version 4.1.
Denominator: All patients hospitalized for vaginal delivery without indication of instrument assistance.
Note: For this measure, lower rates are better. Rates are adjusted by age. White, Black, and API groups are non-Hispanic; Hispanic includes all races.

  • From 2004 to 2008, rates of obstetric trauma with 3rd or 4th degree laceration decreased from 36 to 24 per 1,000 vaginal deliveries without instrument assistance (Figure 2.24). Declines were observed in all racial/ethnic and area income groups.
  • In all years, Black and Hispanic mothers had lower rates of obstetric trauma than White mothers. In addition, residents of the lower three area income quartiles had lower rates than residents of the highest area income quartile.
  • In all years, API mothers had higher rates than White mothers.
  • The 2008 top 3 State achievable benchmark was 17 per 1,000 deliveries.xvii Black mothers have already attained the benchmark. At the current annual rate of decrease, this benchmark could be attained overall and by most racial/ethnic and area income groups in about 4 years. Residents of the highest area income quartile would need 5 years while APIs would need more than 13 years to attain the benchmark.

Also, in the NHQR:

  • In all years, mothers ages 18-24 and 35-54 had lower rates of obstetric trauma than mothers ages 25-34.
  • In all years, mothers whose payment source was Medicare, Medicaid, or self pay/unininsured/no charge had lower rates of obstetric trauma than mothers whose payment source was private health insurance.
New! Prevention: Receipt of Recommended Immunizations by Young Children

Immunizations are important in reducing mortality and morbidity. They protect recipients from illness and protect others in the community who are not vaccinated. Beginning in 2007, recommended vaccines for children that should have been completed by ages 19-35 months included diphtheria-tetanus-pertussis vaccine, polio vaccine, measles-mumps-rubella vaccine, Haemophilus influenzae type B vaccine, hepatitis B vaccine, varicella vaccine, and pneumococcal conjugate vaccine. These vaccines constitute the 4:3:1:3:3:1:4 vaccine series tracked in Healthy People 2020.

 

Figure 2.25. Children ages 19-35 months who received the 4:3:1:3:3:1:4 vaccine series, by race/ethnicity, 2007-2009

Figure 2.25. Children ages 19-35 months who received the 4:3:1:3:3:1:4 vaccine series, by race/ethnicity, 2007-2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics and National Center for Immunization and Respiratory Diseases, National Immunization Survey, 2007-2009.
Denominator: U.S. civilian noninstitutionalized population ages 19-35 months.
Note: White, Black, Asian, and more than one race are non-Hispanic groups; Hispanic includes all races.

  • In 2009, fewer than two-thirds of children ages 19-35 months received all recommended vaccinations (Figure 2.25).
  • In 2007 and 2009, Black children were less likely than White children to receive all recommended vaccinations.
  • The 2009 top 5 State achievable benchmark was 72%.xviii No group has attained this benchmark.

Also, in the NHQR:

  • In 2008 and 2009, children with family incomes below the poverty level were less likely to receive all recommended vaccinations compared with children with family incomes at or above the poverty level.
Outcome: Emergency Department Visits for Asthma

Asthma is a chronic respiratory disease that causes wheezing, coughing, chest tightness, and shortness of breath. In 2009, approximately 7.1 million children had a diagnosis of asthma in the United States, and 4 million had had at least one asthma attack in the previous year (Akinbami, et al., 2011). However, asthma attacks can largely be prevented using medications and avoiding the triggers that cause attacks. Visits to the emergency department (ED) for asthma attacks are, therefore, generally considered to be markers of inadequate preventive asthma care.

 

Figure 2.26. Rate of emergency department visits for asthma per 10,000 population, people ages 2-19 years, by race/ethnicity, 2005-2007 combined

Figure 2.26. Rate of emergency department visits for asthma per 10,000 population, people ages 2-19 years, by race/ethnicity, 2005-2007 combined. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Care Survey-Emergency Department, 2005-2007.
Note: For this measure, lower rates are better. White and Black groups are non-Hispanic; Hispanic includes all races.

  • In 2005-2007, people ages 2-19 had 81 ED visits for asthma per 10,000 population. Children ages 2-9 had higher rates than adolescents ages 10-19 (Figure 2.26).
  • Overall and among both age groups, non-Hispanic Black children had higher rates of ED visits for asthma than non-Hispanic White children. Overall and among children ages 2-9, Hispanics had higher rates than non-Hispanic Whites.

Also, in the NHQR:

  • Overall and among both age groups, children with public health insurance had higher rates of ED visits for asthma than children with private health insurance.
Prevention: Children's Dental Care

According to the National Institute of Dental and Craniofacial Research, presence of dental caries is the single most common chronic disease of childhood, occurring five to eight times as frequently as asthma (HHS, 2000), the second most common chronic disease in children. Regular dental visits help to improve overall oral health and prevent dental caries.

 

Figure 2.27. Children ages 2-17 with a dental visit in the calendar year, by race/ethnicity and income, 2002-2008

Figure 2.27. Children ages 2-17 with a dental visit in the calendar year, by race/ethnicity and income, 2002-2008. For details, go to [D] Text Description below.

Figure 2.27. Children ages 2-17 with a dental visit in the calendar year, by race/ethnicity and income, 2002-2008. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2008.
Denominator: U.S. civilian noninstitutionalized population ages 2-17.
Note: White and Black groups are non-Hispanic; Hispanic includes all races.

  • Between 2002 and 2008, there were no statistically significant changes in the percentage of children ages 2-17 who had a dental visit in the calendar year (Figure 2.27). Increases were observed among Black, Hispanic, poor, and low-income children.
  • In all years, non-Hispanic Black and Hispanic children were less likely than non-Hispanic White children and poor, low-income, and middle-income children were less likely than high-income children to have a dental visit.

Also, in the NHQR:

  • In all years, children ages 2-5 were less likely than adolescents ages 13-17 and children with public insurance only or no insurance were less likely than children with any private insurance to have a dental visit.
Outcome: Untreated Dental Caries

Figure 2.28. Adolescents ages 13-17 with untreated dental caries, by race/ethnicity and income level, 2005-2008 combined

Figure 2.25. Adolescents ages 13-17 with untreated dental caries, by race/ethnicity and income level, 2005-2008 combined. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 2005-2008.
Denominator: U.S. civilian noninstitutionalized population ages 13-17.
Note: For this measure, lower rates are better. White and Black groups are non-Hispanic.

  • Overall, 11% of adolescents ages 13-17 had untreated dental caries (Figure 2.28).
  • Mexican-American (19%) and non-Hispanic Black (19%) adolescents were more likely than non-Hispanic White adolescents (7%) to have untreated dental caries.
  • Adolescents in poor families (18%) were more likely than adolescents in high-income families (8%) to have untreated dental caries.

Also, in the NHQR:

  • Uninsured adolescents and those with public insurance were more likely to have untreated caries than privately insured adolescents.

Focus on Adolescents

Individuals 10-14 years old made up 6.7% of the 2010 U.S. population while those 15-19 years old made up 7.1% (U.S. Census Bureau, 2010). Survey data indicate that roughly 21% of children ages 12-17 have special health care needs (Bethell, et al., 2008). Adolescents frequently engage in high-risk behaviors resulting in morbidity and mortality, including injuries, unintended pregnancies, sexually transmitted diseases, and alcohol, tobacco, and substance abuse. Many adult chronic diseases and adverse health behaviors begin in adolescence (Forrest & Riley, 2004).

Prevention: Well Visits by Adolescents in the Last Year

The American Academy of Pediatrics recommends annual preventive health care visits for all individuals between ages 11 and 21 years (AAP, 2008). For the purposes of this measure, adolescents are children ages 10-17.

 

Figure 2.29. Adolescents ages 10-17 years with a well visit in the last 12 months, by race/ethnicity and income relative to poverty threshold, 2009

Figure 2.29. Adolescents ages 10-17 years with a well visit in the last 12 months, by race/ethnicity and income relative to poverty threshold, 2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2009.
Denominator: U.S. civilian noninstitutionalized population ages 10-17.
Note: White and Black groups are non-Hispanic; Hispanic includes all races.

  • Non-Hispanic Black adolescents had higher rates of well visits than non-Hispanic White or Hispanic adolescents (Figure 2.29).
  • Compared with adolescents with family incomes of 600% of the poverty line and over, those with family incomes less than 400% of the poverty line had lower rates of well visits.
New! Prevention: Receipt of Meningococcal Vaccine

Meningitis is an infection of the membranes that cover the brain and spinal cord. If meningitis is caused by bacteria, it is often life threatening. Meningococcal diseases are infections caused by the bacteria Neisseria meningitidis. Although Neisseria meningitidis can cause various types of infections, it is most important as a potential cause of meningitis. The meningococcal vaccine can prevent most cases of meningitis caused by Neisseria meningitidis and is recommended for all children ages 11-12 years. Effective in January 2011, a second dose has been recommended at age 16.

 

Figure 2.30. Adolescents ages 13-17 who ever received at least 1 dose of the meningococcal vaccine, by race/ethnicity and income, 2009

Figure 2.30. Adolescents ages 13-17 who ever received at least 1 dose of the meningococcal vaccine, by race/ethnicity and income, 2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Key: AI/AN = American Indian/Alaska Native.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics and National Center for Immunization and Respiratory Diseases, National Immunization Survey, 2009.
Note: White, Black, AI/AN, and Asian groups are non-Hispanic; Hispanic includes all races.

  • In 2009, 54% of adolescents ages 13-17 had ever received meningococcal vaccine. There were no statistically significant differences related to race/ethnicity or income (Figure 2.30).
  • The 2009 top 5 State achievable benchmark was 74%.xix No group has attained this benchmark.

Also, in the NHQR:

  • Rates varied considerably by State, ranging from 19% to 78%.

 

 

Mental Health and Substance Abuse

Importance

Mortality
Number of deaths due to suicide (2009)34,598 (Kochanek, et al., 2011)
Rank among causes of death in the United States—suicide (2009)10th (Kochanek, et al., 2011)
Alcohol-impaired driving fatalities (2009)10,839 (NHTSA, 2009)
Prevalence
People age 12 and over with alcohol and/or illicit drug dependence or abuse in the past year (2009)22.5 million (8.9%) (SAMHSA, 2010)
Youths ages 12-17 with a major depressive episode during the past year (2009)2.0 million (8.1%) (SAMHSA, 2010)
Adults age 18 and over with a major depressive episode during the past year (2009)14.8 million (6.5%) (SAMHSA, 2010)
Adults with at least one major depressive episode in their lifetime (2006)30.4 million (13.9%) (SAMHSA, 2007)
Cost
National expenditures for treatment of mental health and substance abuse disorders (2014 est.)$239 billion (SAMHSA, 2008)
Cost-effectiveness of screening & brief counseling for problem drinking$0-$14,000/QALY (Maciosek, et al., 2006)

Measures

The NHQR and NHDR track measures of the quality of treatment for major depression and substance abuse. Mental health treatment includes counseling, inpatient care, outpatient care, and prescription medications. This section highlights four measures of mental health and substance abuse treatment:

  • Receipt of treatment for depression.
  • Suicide deaths.
  • Receipt of treatment for illicit drug use or alcohol problem.
  • Completion of substance abuse treatment.

Findings

Treatment: Receipt of Treatment for Depression

In 2006, approximately 1.4 million hospitalizations were specifically for mental health conditions and one in five hospital stays included some mention of a mental health condition as either a principal or secondary diagnosis (Saba, et al., 2008). Mood disorders were the most common principal diagnosis for all nonelderly people.

Treatment for depression can be very effective in reducing symptoms and associated illnesses and returning individuals to a productive lifestyle. The Sequenced Treatment Alternatives to Relieve Depression study, funded by the National Institute of Mental Health, was the largest clinical trial ever conducted to help determine the most effective treatment strategies for major depressive disorder. It involved both primary care and specialty care settings. Participants included people with complex health conditions, such as multiple concurrent medical and psychiatric conditions.

This study found that between 28% and 33% of participants achieved a symptom-free state after the first round of medication, and nearly 70% achieved remission after 12 months (Insel & Wang, 2009). Strategies for treating depression in primary care settings, such as the collaborative care model, have also been shown to generate positive net social benefits in cost-benefit analyses compared with usual care (Glied, et al., 2010).

Barriers to high-quality mental health care include cost of care, lack of sufficient insurance for mental health services, social stigma, fragmented organization of services, and mistrust of providers. In rural and remote areas, limited availability of skilled care providers is also a major problem. For racial and ethnic populations, these problems are compounded by the lack of culturally and linguistically competent providers.

 

Figure 2.31. Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, by race/ethnicity and education, 2008-2009

Figure 2.31. Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, by race/ethnicity and education, 2008-2009. For details, go to [D] Text Description below.

Figure 2.31. Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, by race/ethnicity and education, 2008-2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2009.
Denominator: U.S. population age 18 and over who had a major depressive episode in the last 12 months.
Note: Major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression. White and Black groups are non-Hispanic; Hispanic includes all races.

  • In 2009, less than two-thirds of adults with a major depressive episode received treatment for depression (Figure 2.31).
  • In both years, Blacks and Hispanics were less likely to receive treatment for depression than Whites.
  • In 2009, people with less than a high school education and high school graduates were less likely to receive treatment for depression than people with any college education.

Also, in the NHQR:

  • In 2008 and 2009, adults ages 18-44 were less likely than those ages 45-64 and men were less likely than women to receive treatment for depression.
Outcome: Suicide Deaths

Most individuals who die by suicide have mental illnesses, such as depression or schizophrenia, or have substance abuse problems (Moscicki, 2001). Suicide may be prevented when its warning signs are detected and treated. A previous suicide attempt is among the strongest predictors of subsequent suicide. Cognitive-behavioral therapy can significantly help those who have attempted suicide consider alternative actions when thoughts of self-harm arise and may reduce suicide attempts (Tarrier, et al., 2008)

 

Figure 2.32. Suicide deaths per 100,000 population, by race and ethnicity, 2000-2007

Figure 2.32. Suicide deaths per 100,000 population, by race and ethnicity, 2000-2007. For details, go to [D] Text Description below.

Figure 2.32. Suicide deaths per 100,000 population, by race and ethnicity, 2000-2007. For details, go to [D] Text Description below.

[D] Select for Text Description.

Key: API = Asian and Pacific Islander; AI/AN = American Indian or Alaska Native.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System—Mortality, 2000-2007.
Denominator: U.S. population.
Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 standard population.

  • Overall, from 2000 to 2007, the rate of suicide deaths did not change significantly (Figure 2.32). Increases were observed among Whites and AI/ANs; decreases were observed among Blacks.
  • In all years, Blacks and APIs had lower suicide death rates than Whites. Hispanics had lower suicide death rates than non-Hispanic Whites.

Also, in the NHQR:

  • In all years, people ages 0-17 had lower suicide death rates than people ages 18-44. Since 2002, people ages 45-64 have had higher suicide death rates than people ages 18-44. Females had lower rates than males.
Treatment: Receipt of Treatment for Illicit Drug Use or Alcohol Problem

Illicit drugxx use is a medical problem that can have a direct toxic effect on a number of bodily organs and exacerbate numerous health and mental health conditions. Alcohol problems also can lead to serious health risks. Heavy drinking can increase the risk of certain cancers and cause damage to the liver, brain, and other organs. In addition, alcohol can cause birth defects, including fetal alcohol syndrome. Alcoholism and illicit drug use increase the risk of death from car crashes and other injuries (Ringold, et al., 2006). Illicit drug use and alcohol problems can be effectively treated at specialty facilities.

 

Figure 2.33. People age 12 and over who needed treatment for illicit drug use or an alcohol problem and who received such treatment at a specialty facility in the last 12 months, by race and ethnicity, 2002-2009

Figure 2.33. People age 12 and over who needed treatment for illicit drug use or an alcohol problem and who received such treatment at a specialty facility in the last 12 months, by race and ethnicity, 2002-2009. For details, go to [D] Text Description below.

Figure 2.33. People age 12 and over who needed treatment for illicit drug use or an alcohol problem and who received such treatment at a specialty facility in the last 12 months, by race and ethnicity, 2002-2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Key: AI/AN = American Indian or Alaska Native.
Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2002-2009.
Denominator: Civilian noninstitutionalized population age 12 and over who needed treatment for illicit drug use or an alcohol problem in the last 12 months.
Note: Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient hospital setting, or a mental health center. Data are not statistically reliable for AI/ANs in 2004 and 2007. Hispanics and non-Hispanics include all races.

  • From 2002 to 2009, there was no statistically significant change in the percentage of people age 12 and over who needed treatment for illicit drug use or an alcohol problem and received it at a specialty facility in the last 12 months (Figure 2.33).
  • From 2002 to 2009, Blacks were more likely to receive needed treatment for illicit drug use or an alcohol problem than Whites in 6 of the 8 years.
  • During the same period, Hispanics were significantly less likely to receive treatment than non-Hispanics in 4 of the 8 years.

Also, in the NHQR:

  • In 2008 and 2009, people with any college were less likely to receive needed treatment for illicit drug use or an alcohol problem than people with less than a high school education.
  • In 2009, people ages 12-17 were less likely to receive treatment than people ages 45-64.
Treatment: Completion of Substance Abuse Treatment

Completion of substance abuse treatment is strongly associated with improved outcomes, such as long-term abstinence from substance use. Dropout from treatment often leads to relapse and return to substance use.

 

Figure 2.34. People age 12 and over treated for substance abuse who completed treatment course, by race/ethnicity and education, 2005-2008

Figure 2.34. People age 12 and over treated for substance abuse who completed treatment course, by race/ethnicity and education, 2005-2008. For details, go to [D] Text Description below.

Figure 2.34. People age 12 and over treated for substance abuse who completed treatment course, by race/ethnicity and education, 2005-2008. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set, Discharge Data Set, 2005-2008.
Denominator: Discharges age 12 and over from publicly funded substance abuse treatment facilities.
Note: White and Black groups are non-Hispanic; Hispanic includes all races.

  • From 2005 to 2008, there were no statistically significant changes in the percentage of people age 12 and over treated for substance abuse who completed the treatment course (Figure 2.34).
  • In all years, non-Hispanic Blacks who were treated for substance abuse were significantly less likely than non-Hispanic Whites to complete treatment.
  • In all years, people with less than a high school education who were treated for substance abuse were significantly less likely than people with any college to complete treatment.

Also, in the NHQR:

  • In all years, people ages 12-19 and 20-39 were less likely than those age 40 and over to complete substance abuse treatment. Females were less likely than males to complete treatment.

 

 

New! Musculoskeletal Diseases

Importance

Prevalence
People diagnosed with arthritis, rheumatoid arthritis, lupus, or fibromyalgia (2007-2009)50 million (22%) (MMWR, 2010a)
Number of people with low bone density34 million (NOF, 2011)
Morbidity
Activity limitations attributable to diagnosed arthritis among U.S. population (2007)21 million (42%) (MMWR, 2010a)
Lifetime osteoporosis-related fractures among women over age 50approx. 50% (NOF, 2011)
Lifetime osteoporosis-related fractures among men over age 50approx. 25% (NOF, 2011)
Cost
Total cost of arthritis and other rheumatic conditions (2003)$128 billion (MMWR, 2007)
Direct medical cost of arthritis and other rheumatic conditions (2003)$81 billion (MMWR, 2007)
Indirect costs of arthritis and other rheumatic conditions (2003)$47 billion (MMWR, 2007)
Total cost of osteoporosis-related fractures (2005)$19 billion (NOF, 2011)

Measures

This section on musculoskeletal diseases is new in the 2011 NHQR and NHDR. It tracks several quality measures for prevention and management of this broad category of illnesses that includes osteoporosis and arthritis. One measure was moved from the section on functional status and highlighted here:

  • Osteoporosis screening among older women.

In addition, three new measures related to the management of arthritis are shown. These measures are part of the Arthritis Foundation's Quality Indicator Set for Osteoarthritis. A multidisciplinary panel of experts on arthritis and pain reviewed scientific evidence to help develop the Quality Indicator Set (Pencharz & MacLean, 2004). The measures were tracked as part of Healthy People 2010 and continue to be tracked in Healthy People 2020:

  • Arthritis education among adults with arthritis.
  • Counseling about physical activity among adults with arthritis.
  • Counseling about weight reduction among overweight adults with arthritis.

Findings

Prevention: Osteoporosis Screening Among Older Women

Osteoporosis is a disease characterized by loss of bone tissue. Osteoporosis increases the risk of fractures of the hip, spine, and wrist. About half of all postmenopausal women will experience an osteoporotic fracture. Osteoporotic fractures cause considerable morbidity and mortality. For example, of patients with hip fractures, one-fifth will die during the first year, one-third will require nursing home care, and only one-third will return to the functional status they had before the fracture. The remaining 13 percent have other outcomes (Lane, 2006).

Because older women are at highest risk for osteoporosis, the U.S. Preventive Services Task Force recommends routine osteoporosis screening of women age 65 and over. Women with low bone density can reduce their risk of fracture and subsequent functional impairment by taking appropriate medications and engaging in weight-bearing exercise (USPSTF, 2002).

 

Figure 2.35. Female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosis with a bone mass or bone density measurement, by race/ethnicity and income, 2000-2008

Figure 2.35. Female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosis with a bone mass or bone density measurement, by race/ethnicity and income, 2000-2008. For details, go to [D] Text Description below.

Figure 2.35. Female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosis with a bone mass or bone density measurement, by race/ethnicity and income, 2000-2008. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Medicare Current Beneficiary Survey, 2000-2008.
Denominator: Female Medicare beneficiaries age 65 and over living in the community.
Note: White and Black groups are non-Hispanic; Hispanic includes all races.

  • From 2000 to 2008, the percentage of female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosis with a bone mass or bone density measurement increased from 34% to 71% (Figure 2.35). Improvements were observed among all racial/ethnic and income groups.
  • In all years, Hispanic and non-Hispanic Black women were less likely to be screened for osteoporosis than non-Hispanic White women.
  • In all years, poor, low-income, and middle-income women were less likely to be screened for osteoporosis than high-income women.

Also, in the NHQR:

  • In all years, women age 85 and over were less likely to be screened for osteoporosis than women ages 65-74. Women with Medicare managed care, Medicare and Medicaid, or Medicare fee for service only were less likely to be screened for osteoporosis than women with Medicare and private supplemental insurance.
New! Management: Arthritis Education Among Adults With Arthritis

Osteoarthritis is the most common form of arthritis, affecting about 12% of the general population. Patients with symptomatic osteoarthritis who receive education about the natural history, treatment, and self-management of the disease have better knowledge and self-efficacy and experience less pain and functional impairment (Pencharz & MacLean, 2004).

 

Figure 2.36. Adults with doctor-diagnosed arthritis who reported they had effective, evidence-based arthritis education as an integral part of the management of their condition, by race/ethnicity and health insurance, 2006 and 2009

Figure 2.36. Adults with doctor-diagnosed arthritis who reported they had effective, evidence-based arthritis education as an integral part of the management of their condition, by race/ethnicity and health insurance, 2006 and 2009. For details, go to [D] Text Description below.

Figure 2.36. Adults with doctor-diagnosed arthritis who reported they had effective, evidence-based arthritis education as an integral part of the management of their condition, by race/ethnicity and health insurance, 2006 and 2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2006 and 2009.
Denominator: Adults with doctor-diagnosed arthritis.
Note: Estimates are age adjusted to the 2000 standard population. Health insurance refers to adults under age 65. White and Black groups are non-Hispanic; Hispanic includes all races.

  • In 2009, 11% of adults with doctor-diagnosed arthritis received effective, evidence-based arthritis education (Figure 2.36).
  • In 2006, Hispanics were more likely than non-Hispanic Whites to receive arthritis education.

Also, in the NHQR:

  • In both years, adults age 65 and over were less likely to receive arthritis education than adults ages 45-64.
New! Management: Counseling About Physical Activity Among Adults With Arthritis

Patients with symptomatic osteoarthritis should also receive counseling about muscle strengthening and aerobic exercise programs. Such programs can reduce pain and improve functional ability (Pencharz & MacLean, 2004).

 

Figure 2.37. Adults with doctor-diagnosed arthritis who reported they received health care provider counseling about physical activity or exercise, by race/ethnicity and health insurance, 2006 and 2009

Figure 2.37. Adults with doctor-diagnosed arthritis who reported they received health care provider counseling about physical activity or exercise, by race/ethnicity and health insurance, 2006 and 2009. For details, go to [D] Text Description below.

Figure 2.37. Adults with doctor-diagnosed arthritis who reported they received health care provider counseling about physical activity or exercise, by race/ethnicity and health insurance, 2006 and 2009. For details, go to [D] Text Description below.

 

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2006 and 2009.
Denominator: Adults with doctor-diagnosed arthritis.
Note: Estimates are age adjusted to the 2000 standard population. Health insurance refers to adults under age 65. White and Black groups are non-Hispanic; Hispanic includes all races.

  • In 2009, 57% of adults with doctor-diagnosed arthritis received health care provider counseling about physical activity or exercise (Figure 2.37).
  • In both years, Hispanics were more likely than non-Hispanic Whites to receive exercise counseling.
  • In 2006, non-Hispanic Blacks were also more likely than non-Hispanic Whites to receive exercise counseling.

Also, in the NHQR:

  • In both years, men were less likely than women to receive exercise counseling.
New! Management: Counseling About Weight Reduction Among Overweight Adults With Arthritis

Weight is a risk factor for osteoarthritis and weight loss can prevent the development of osteoarthritis among overweight people. Moreover, overweight people with osteoarthritis who lose weight experience less joint pain and improved function (Pencharz & MacLean, 2004).

 

Figure 2.38. Overweight adults with doctor-diagnosed arthritis who reported they received health care provider counseling about weight reduction, by race/ethnicity and health insurance, 2006 and 2009

Figure 2.38. Overweight adults with doctor-diagnosed arthritis who reported they received health care provider counseling about weight reduction, by race/ethnicity and health insurance, 2006 and 2009. For details, go to [D] Text Description below.

Figure 2.38. Overweight adults with doctor-diagnosed arthritis who reported they received health care provider counseling about weight reduction, by race/ethnicity and health insurance, 2006 and 2009. For details, go to [D] Text Description below.

[D] Select for Text Description.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2006 and 2009.
Denominator: Adults with doctor-diagnosed arthritis.
Note: Estimates are age adjusted to the 2000 standard population. Health insurance refers to adults under age 65. White and Black groups are non-Hispanic; Hispanic includes all races.

  • In 2009, 42% of overweight adults with doctor-diagnosed arthritis received health care provider counseling about weight reduction (Figure 2.38).
  • In both years, overweight non-Hispanic Blacks were more likely than non-Hispanic Whites to receive weight reduction counseling. In 2009, overweight Hispanics were also more likely than non-Hispanic Whites to receive weight reduction counseling.

Also, in the NHQR:

  • In both years, overweight adults age 65 and over were less likely to receive weight reduction counseling than adults ages 45-64.
  • Men were less likely than women to receive weight reduction counseling.

xvi. In this report, children are defined as individuals under age 18.
xvii. The top 3 States contributing to the achievable benchmark are Utah, West Virginia, and Wyoming.
xviii. The top 5 States that contributed to the achievable benchmark are Louisiana, Maryland, Massachusetts, New Hampshire, and Ohio.
xix. The top 5 States that contributed to the achievable benchmark are the District of Columbia, Massachusetts, New Jersey, Pennsylvania, and Rhode Island.
xx. Illicit drugs included in this measure are marijuana/hashish, cocaine (including crack), inhalants (e.g., inhalation of various substances other than for intended use, such as toluene), hallucinogens, heroin, and prescription-type psychotherapeutic drugs (nonmedical use).



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Page last reviewed April 2012
Internet Citation: Chapter 2. Effectiveness of Care (continued, 2): National Healthcare Disparities Report, 2011. April 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/chap2b.html