Chapter 7. Efficiency (Text Descriptions)

National Healthcare Disparities Report, 2011


Figure 7.1. Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year, by race/ethnicity and gender, 2002-2008

Race / Ethnicity2002200320042005200620072008
White (percent)19.819.017.017.615.915.813.3
Black (percent)18.917.616.818.918.114.715.4
Hispanic (percent)18.113.213.813.513.514.214.4

Gender2002200320042005200620072008
Male (percent)15.413.412.814.312.311.810.5
Female (percent)22.222.319.720.218.418.115.6
Total (percent)19.318.516.717.715.815.413.4

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2008.

Denominator: Civilian noninstitutionalized population age 65 and over.

Note: For this measure, lower rates are better. Prescription medications received include all prescribed medications initially purchased or otherwise obtained, as well as any refills. Whites and Blacks are non-Hispanic. Hispanic includes all races.

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Figure 7.2. Potentially avoidable hospitalization rates, by race/ethnicity and area income, 2001-2008

Race / Ethnicity20012002200320042005200620072008
White (rate per 100,000 pop.)1,433.31,447.21,380.61,356.61,384.61,282.71,277.81,260.5
Black (rate per 100,000 pop.)3,286.03,257.92,847.32,995.02,753.12,728.22,763.82,574.2
API (rate per 100,000 pop.)1,051.01,072.51,020.61,071.7901.4788.0828.0810.9
Hispanic (rate per 100,000 pop.)1,711.72,125.92,205.72,104.61,907.51,649.51,612.31,376.3

Income Quartile20012002200320042005200620072008
1st Quartile (lowest)21072141221120842090207319881946
2nd Quartile17381802169316191598155115031487
3rd Quartile14031507140613381376128812721248
4th Quartile (highest)13171263120311931249115510761097

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, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version 4.1, 2001-2008.

Denominator: Civilian noninstitutionalized adults age 18 and over.

Note: For this measure, lower rates are better. Annual rates are adjusted for age and gender. White, Black, and Asian or Pacific Islander populations are non-Hispanic. Income quartiles are based on median income of ZIP Code of patient's residence.
2008 Achievable Benchmark: 818.

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Figure 7.3. Excess number of potentially preventable hospitalizations, by race/ethnicity, 2008

Potentially Preventable HospitalizationsWhiteBlackHispanic
Expected at Best Rate (hospitalizations)1,306,217217,766253,084
Excess (hospitalizations)706,545467,541172,733

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version 4.1, 2008.

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Figure 7.4. Excess number of potentially preventable hospitalizations, by income, 2008

Potentially Preventable HospitalizationsFirst Quartile (lowest)Second QuartileThird QuartileFourth Quartile (highest)
Expected at Best Rate (hospitalizations)453,956.2496,224.2458,397.8471,579.4
Excess (hospitalizations)625,870.2405,711.2241,140.2160,779.8

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version 4.1, 2008.

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Figure 7.5. Medicare home health patients with potentially avoidable hospitalizations within 30 days of start of care, by race/ethnicity, 2000-2010

Race / Ethnicity20002001200220032004200520062007200820092010
White (hospitalizations)4.64.64.64.54.34.13.93.93.83.73.6
Black (hospitalizations)5.25.45.35.14.84.64.34.34.24.04.0
Other (hospitalizations)4.14.04.24.04.23.73.73.43.53.43.1
Asian (hospitalizations)2.93.33.12.92.93.13.13.02.92.92.8
Hispanic (hospitalizations)5.14.84.74.44.14.03.53.33.33.12.9
AI/AN (hospitalizations)5.05.85.05.05.24.84.84.44.34.53.3

Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set linked with Medicare Part A claims (100%), 2000-2010.

Denominator: Adult nonmaternity patients starting an episode of skilled home health care.

Note: For this measure, lower rates are better. Rates standardized to the 2006 patient population according to Medicare enrollment category. Hispanics could include other races. All race categories could include Hispanics.

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Figure 7.6. Perforated appendixes per 1,000 admissions for appendicitis, age 18 and over, by race/ethnicity and area income, 2004-2008

Race / Ethnicity2004200520072008
White (rate per 1,000 admissions)287.8282.8271.3275.7
Black (rate per 1,000 admissions)308.7317.3302.1298.2
API (rate per 1,000 admissions)266.8270.3268.5261.9
Hispanic (rate per 1,000 admissions)291.8283.3276.2271.9

Income Quartile2004200520072008
Highest Income Quartile (rate per 1,000 admissions)270.4265.9258.7254.3
Third Income Quartile (rate per 1,000 admissions)291.2284.4282.1276.8
Second Income Quartile (rate per 1,000 admissions)298.9294.2274.1288.3
Lowest Income Quartile (rate per 1,000 admissions)309.1308.9299.1301.2

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project State Inpatient Databases disparities analysis file, 2004, 2005, 2007, and 2008.

Note: For this measure, lower rates are better. Data for 2006 were not available this year, because a new version of the PQI software was used to calculate rates and 2006 was not included in the calculation.

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Figure 7.7. Perforated appendixes per 1,000 admissions for appendicitis, age 18 and over, in IHS, Tribal, and contract hospitals, by age and gender, 2004-2008

Age20042005200620072008
Total (rate per 1,000 admissions)310.6318.3286.0345.7283.7
18-44 (rate per 1,000 admissions)268.7254.8247.8275.4219.8
45-64 (rate per 1,000 admissions)415.9469.8356.2509.7387.9
65-69 (rate per 1,000 admissions)514.3428.6560.0583.3656.3

Gender20042005200620072008
Male (rate per 1,000 admissions)309.1355.6315.0378.2333.3
Female (rate per 1,000 admissions)312.3277.2253.4309.1229.0

Source: Indian Health Service, National Patient Information Reporting System, National Data Warehouse, Workload and Population Data Mart, 2004-2008.

Note: For this measure, lower rates are better.

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Figure 7.8. Males age 75 and over who reported having a prostate-specific antigen test or a digital rectal exam within the last 12 months, by race and income, 2004-2010

Race2004200620082010
White (percent)72.373.975.674.8
Black (percent)59.865.863.969.3
Asian (percent)-65.843.472.5
AI/AN (percent)--62.769.0
Other/missing (percent)58.265.265.969.7

Income2004200620082010
$50,000 or More (percent)80.379.082.179.8
$35,000 to $49,999 (percent)73.177.178.176.9
$15,000 to $34,999 (percent)69.369.571.770.7
Less Than $15,000 (percent)63.060.956.261.0

Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2004-2010.

Denominator: Adult males age 75 and over with no history of prostate cancer.

Note: For this measure, lower rates are better. Data for 2004, 2006, and part of 2008 precede the U.S. Preventive Services Task Force recommendation against screening men age 75 and over. It should be noted that PSA tests and DREs are provided to this population for purposes unrelated to prostate cancer screening. Data to determine the purpose of these services was unavailable and all reported PSA tests and DREs are reflected in the data shown. Data for AI/ANs were statistically unreliable for 2004 and 2006.
2008 Achievable Benchmark: 62%

Footnote: - = no data value available.

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Page last reviewed April 2012
Internet Citation: Chapter 7. Efficiency (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/chap7txt.html