Chapter 3. Patient Safety (Text Descriptions)

National Healthcare Disparities Report, 2011

Figure 3.1. Adult surgery patients who received appropriate care, by gender and race/ethnicity, 2009

Gender2009
Male85.2%
Female86.8%

Race / Ethnicity2009
White86.4%
African American85.8%
Hispanic84.5%
AI/AN82.0%
Asian84.2%

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2009.

Denominator: Hospitalized patients having surgery.
2009 Achievable Benchmark: 91%.

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Figure 3.2. Adult surgery patients who received appropriate timing of antibiotics: Overall composite, by race/ethnicity and gender, 2005-2009

Race / Ethnicity20052006200720082009
White75.280.786.891.894.9
Black75.279.985.891.094.3
Hispanic69.874.780.986.893.8
AI/AN77.480.885.289.893.1
Asian70.878.084.690.694.3

Gender20052006200720082009
Total74.980.386.491.494.8
Male71.478.685.691.094.5
Female76.781.286.891.694.9

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005-2009.

Denominator: Hospitalized patients having surgery.

Note: Populations not specifically noted as Hispanic are non-Hispanic.
2008 Achievable Benchmark: 95%.

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Figure 3.3. Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure, by race/ethnicity and insurance status, 2008

Race / Ethnicity2008 (rate per 1,000)
White14.8
Black19.6
API14.7
Hispanic16.9

Insurance TypeRate per 1,000
Private Insurance13.8
Medicare16.2
Medicaid19.1
Uninsured/Self-Pay11.0

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases, disparities analysis file, 2007, and AHRQ Quality Indicators, modified version of 4.1.

Denominator: All elective hospital surgical discharges, age 18 and over, with length of stay of 4 or more days, excluding patients admitted for infection, patients with cancer or immunocompromised states, patients with obstetric conditions, and admissions specifically for sepsis.

Note: For this measure, lower rates are better.

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Figure 3.4. Ambulatory medical care visits due to adverse effects of medical care per 1,000 people, by race and gender, 2006-2009

Race2006 - 20072007-20082008-2009
White (rate per 1,000 people)37.043.033.6
Black (rate per 1,000 people)29.842.242.1

Gender2006-20072007-20082008-2009
Male (rate per 1,000 people)25.832.825.0
Female (rate per 1,000 people)43.150.241.0

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2007-2008.

Denominator: U.S. Census Bureau estimated civilian noninstitutionalized population on July 1, 2007, and July 1, 2008.

Note: For this measure, lower rates are better.

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Figure 3.5. Composite: Mechanical adverse events associated with central venous catheter placement, by race and gender, 2005-2009

Race2005200620072009
White3.14.32.93.2
Black3.83.13.28.5

Gender2005200620072009
Male3.64.22.83.7
Female2.74.02.84.1

Source: Centers for Medicare & Medicaid Services, Medicare Patient Safety Monitoring System (MPSMS), 2005-2009.

Denominator: Adult hospitalized Medicare fee-for-service discharges from the MPSMS sample with central venous catheter placement.

Note: For this measure, lower rates are better.

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Figure 3.6. Postoperative respiratory failure per 1,000 elective-surgery discharges after an operating room procedure, by race/ethnicity and income area, 2004-2008

YearWhiteBlackAPIHispanic
2004 (rate postop. respiratory failure per 1,000 disch.)9.913.411.411.7
2005 (rate postop. respiratory failure per 1,000 disch.)10.012.910.811.5
2006 (rate postop. respiratory failure per 1,000 disch.)10.112.612.912.3
2007 (rate postop. respiratory failure per 1,000 disch.)9.912.011.110.9
2008 (rate postop. respiratory failure per 1,000 disch.)9.211.211.210.8

YearFirst Quartile (Lowest)Second QuartileThird QuartileFourth Quartile (Highest)
2004 (rate postop. respiratory failure per 1,000 disch.)11.010.710.09.0
2005 (rate postop. respiratory failure per 1,000 disch.)11.110.29.88.9
2006 (rate postop. respiratory failure per 1,000 disch.)10.910.410.19.1
2007 (rate postop. respiratory failure per 1,000 disch.)10.810.29.98.7
2008 (rate postop. respiratory failure per 1,000 disch.)10.09.49.58.8

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases, disparities analysis file, 2007, and AHRQ Quality Indicators, modified version of 4.1.

Denominator: All elective hospital surgical discharges age 18 and over, excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, selected surgeries for craniofascial anomalies, and secondary procedure of tracheostomy before or after surgery or as the only procedure.

Note: For this measure, lower rates are better.

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Figure 3.7. Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue), ages 18-89, by race/ethnicity and income area, 2004-2008

Race / Ethnicity20042005200620072008
White (rate of deaths per 1,000 discharges)135.8112.5106.2122.2120.5
Black (rate of deaths per 1,000 discharges)162.7128.8116.7132.6133.2
Asian (rate of deaths per 1,000 discharges)166.9142.1134.2137.8130.7
Hispanic (rate of deaths per 1,000 discharges)153.7128.6117.9138.0142.4

Income Quartile20042005200620072008
First Quartile (Lowest) (rate of deaths per 1,000 discharges)147.5116.2106.9121.5127.2
Second Quartile (rate of deaths per 1,000 discharges)135.1113.7110.4125.4118.2
Third Quartile (rate of deaths per 1,000 discharges)137.9106.5105.7116.9123.4
Fourth Quartile (Highest) (rate of deaths per 1,000 discharges)129.9101.199.9112.4120.4

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases, disparities analysis file, 2007, and AHRQ Quality Indicators, modified version of 4.1.

Denominator: Patients ages 18-89 years from U.S. community hospitals whose hospitalizations are complicated by pneumonia, thromboembolic events, sepsis, acute renal failure, gastrointestinal bleeding or acute ulcer, shock, or cardiac arrest.

Note: For this measure, lower rates are better.

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Figure 3.8. Deaths per 1,000 hospital admissions with pneumonia as principal diagnosis, age 18 and over, by race/ethnicity and income area, 2004-2008

Race / Ethnicity2004200520072008
White (rate of deaths per 1,000)54.749.740.936.4
Black (rate of deaths per 1,000)49.743.234.732.4
API (rate of deaths per 1,000)57.851.642.837.2
Hispanic (rate of deaths per 1,000)46.942.335.231.3

Income Quartile20042005200620072008
First Quartile (Lowest) (rate of deaths per 1,000)56.049.746.141.938.5
Second Quartile (rate of deaths per 1,000)53.449.245.839.735.8
Third Quartile (rate of deaths per 1,000)52.845.740.437.933.2
Fourth Quartile (Highest) (rate of deaths per 1,000)51.746.642.138.233.2

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases, disparities analysis file, 2007, and AHRQ Quality Indicators, modified version of 4.1.

Denominator: All discharges age 18 and over with principal diagnosis code of pneumonia, excluding patients transferred to another short-term hospital and obstetric and neonatal admissions.

Note: For this measure, lower rates are better.
2007 Achievable Benchmark: 28.

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Current as of April 2012
Internet Citation: Chapter 3. Patient Safety (Text Descriptions): National Healthcare Disparities Report, 2011. April 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/chap3txt.html