Chapter 2. Effectiveness (continued, 2)

National Healthcare Quality Report, 2008

Maternal and Child Health

Importance

Type of statisticNumber
Mortality
Number of maternal deaths (2005)6232
Number of infant deaths (2005)28,4402
Demographics
Number of children under 18 (2006)73,460,56726
Number of babies born in United States (2005)4,138,34927
Cost
Total cost of health care for children (2002)$79 billion28
Cost effectiveness of vision screening for children$0-$14,0006
Cost effectiveness of childhood immunization seriesxvicost saving6

Note: Statistics may vary from previous years due to revised and updated source statistics or addition of data sources.

Measures

The NHQR tracks several prevention and treatment measures related to maternal and child health care throughout the report. The core report measures highlighted in this section are:

  • Prenatal care in the first trimester.
  • Receipt of all recommended immunizations by young children.
  • Vision checks for children.
  • Counseling for children about physical activity.
  • Counseling for children about healthy eating.

In addition, one noncore measure is presented:

  • Weight monitoring of overweightxvii children.

xvi The childhood immunization series includes vaccinations for diphtheria-tetanus-pertussis, measles-mumps-rubella, inactivated polio virus, Haemophilus influenzae type B, hepatitis B, and varicella.
xvii Children and youth can be categorized as acceptable, underweight, at risk of overweight, or overweight. Children with body mass index values at or above the 95th percentile of the sex-specific body mass index growth charts are categorized as overweight.


 

Findings

Prevention: Prenatal Care in the First Trimester

Pregnant women are at risk for high blood pressure, gestational diabetes, and other disorders. Prenatal care is a preventive service intended to identify and manage risk factors in pregnant women and their unborn children to improve the chances of a healthy mother and child during pregnancy, birth, and early childhood. Prenatal care is recommended during the first trimester and throughout pregnancy.

Figure 2.25. Women who completed a pregnancy in the last 12 months who first received prenatal care in the first trimester, 37 reporting States, the District of Columbia, and New York City, 2003-2005

Figure 2.25. Women who completed a pregnancy in the last 12 months who first received prenatal care in the first trimester, 37 reporting States, the District of Columbia, and New York City, 2003-2005. trend line graph. percent. HP2010 Target: 90%; 2003, 84.4; 2004, 84.2; 2005, 83.9.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System-Natality, 2003-2005.

Reference population: Women with live births.

Note: Excludes data from the following States that implemented the 2003 revisions to the U.S. Standard Birth Certificate: FL, ID, KS, KY, NE, NH, NY (not including New York City), PA, SC, TN, TX, and WA. Please go to the Measure Specifications appendix for details.

  • There is no significant difference between 2003 and 2005 in the percentage of women who received prenatal care in the first trimester of pregnancy (Figure 2.25).
  • As of 2005, the percentage of women who received prenatal care in the first trimester of pregnancy had not yet achieved the Healthy People 2010 target of 90%. At the current average annual rate of change, this target is not projected to be met.

Prevention: Receipt of All Recommended Immunizations by Young Children

Immunizations are important for reducing mortality and morbidity. They protect recipients from illness and disability, as well as others in the community who cannot be vaccinated. In 2006, recommended vaccines for children that should have been completed by ages 19-35 months included four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, one dose of measles-mumps-rubella vaccine, three doses of Haemophilus influenzae type B vaccine, and three doses of hepatitis B vaccine.

Figure 2.26. Composite measure: Children ages 19-35 months who received all recommended vaccines, 1998-2006

Figure 2.26. Children ages 19-35 months who received all recommended vaccines, 1998-2006. trend line graph. HP 2010 target: 80%. Percent; 1998, 72.7; 1999, 73.2; 2000, 72.8; 2001, 73.7; 2002, 74.8; 2003, 79.4; 2004, 80.9; 2005, 80.8; 2006, 80.6.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Immunization Survey, 1998-2006.

Reference population: U.S. civilian noninstitutionalized population ages 19-35 months.

Note: The vaccines included in this measure are based on the corresponding Healthy People 2010 objective, which does not include varicella vaccine or vaccines added to the recommended schedule after 1998 for children up to 35 months of age. More information can be found in the Measure Specifications appendix.

  • From 1998 to 2006, the percentage of children ages 19-35 months who received all recommended vaccines increased from 72.7% to 80.6% (Figure 2.26).

Prevention: Vision Checks for Children

Vision checks for children may detect problems of which children and their parents were previously unaware. Early detection also improves the chances that corrective treatments will be successful.

Figure 2.27. Children ages 3-6 who ever had their vision checked by a health provider, 2001-2005

Figure 2.27. Children ages 3-6 who ever had their vision checked by a health provider, 2001-2005. trend line graph. percent. 2001, 59.3; 2002, 59.8; 2003, 60.7; 2004, 57.6; 2005, 60.2.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2005.

Reference population: U.S. civilian noninstitutionalized population ages 3-6.

  • There is no significant difference from 2001 to 2005 in the percentage of children ages 3-6 who ever received a vision check (Figure 2.27).

Prevention: Counseling for Children About Physical Activity

Childhood represents a period when healthy, lifelong habits such as exercise can be formed, and physicians play an important role in encouraging these healthy behaviors in children.

Figure 2.28. Children ages 2-17 for whom a health provider ever gave advice about the amount and kind of exercise, sports, or physically active hobbies they should have, by age group, 2001-2005

Figure 2.28. Children ages 2-17 for whom a health provider ever gave advice about the amount and kind of exercise, sports, or physically active hobbies they should have, by age group, 2001-2005. trend line chart. percent. Total, 2001, 28.0, 2002, 31.9, 2003, 31.0, 2004, 33.1, 2005, 34.8, Ages 2-5, 2001, 19.9, 2002, 25.1, 2003, 24.2, 2004, 27.6, 2005, 31.6, ages 6-17, 2001, 30.6, 2002, 34.0, 2003, 33.2, 2004, 34.9, 2005, 35.8.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2005.

Reference population: U.S. civilian noninstitutionalized population ages 2-17.

  • From 2001 to 2005, the percentage of children for whom a health provider ever gave advice about the amount and kind of exercise, sports, or physically active hobbies they should have improved from 28.0% to 34.8% (Figure 2.28).
  • The percentage of children for whom a health provider ever gave advice about the amount and kind of exercise, sports, or physically active hobbies they should have increased from 2001 to 2005 for both age groups—children ages 2-5 (from 19.9% to 31.6%) and children ages 6-17 (from 30.6% to 35.8%).
  • In all 5 data years, advice from a health provider about the amount and kind of exercise, sports, or physically active hobbies they should have was more likely for children ages 6-17 than for children ages 2-5.

Prevention: Counseling for Children About Healthy Eating

Physicians play an important role in encouraging children's healthy eating. Overweight and obesity during childhood often persist into adulthood, with consequences that are numerous and costly. Unfortunately, overweight and obesity among children under age 18 has risen dramatically in the past two decades.29 The American Academy of Pediatrics recommends that pediatricians discuss and promote healthy diets with their patients.29

Figure 2.29. Children ages 2-17 for whom a health provider ever gave advice about healthy eating, by age group, 2001-2005

Figure 2.29. Children ages 2-17 for whom a health provider ever gave advice about eating healthy, by age group, 2001-2005. trend line chart. percent. Total, 2001, 47.7, 2002, 51.0, 2003, 51.6, 2004, 53.3, 2005, 54.5, ages 2-5, 2001, 45.4, 2002, 48.7, 2003, 49.2, 2004, 51.0, 2005, 52.1, Ages 6-17, 2001, 54.7, 2002, 58.0, 2003, 59.1, 2004, 60.5, 2005, 62.0.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2005.

Reference population: U.S. civilian noninstitutionalized population ages 2-17.

  • In 2005, the percentage of all children ages 2-17 for whom a health provider ever gave advice about healthy eating was just over half. From 2001 to 2005, the percentage of children for whom a health provider ever gave advice about eating healthy improved from 47.7% to 54.5% (Figure 2.29).
  • The percentage of children for whom a health provider ever gave advice about healthy eating rose from 2001 to 2005 for both age groups—children ages 2-5 (from 54.7% to 62.0%) and children ages 6-17 (from 45.4% to 52.1%).
  • In all 5 data years, advice from a health provider about healthy eating was less likely for children ages 6-17 than for children ages 2-5.

Prevention: Weight Monitoring of Overweight Children

Pediatricians are advised to monitor body mass index and excessive weight gain in children in order to recognize and address cases of overweight and obesity.29 When health care providers alert young patients and their parents about their overweight status, a new opportunity is created to develop healthy diet and exercise habits that may be carried into adulthood.30

Figure 2.30. People ages 2-19 who were overweight who were told by a health provider they were overweight, by age group, 2003-2006

Figure 2.30. People ages 2-19 who were overweight who were told by a health provider they were overweight, by age group, 2003-2006. bar chart. percent. Total, 39.4; ages 2 to 5, 22.3; ages 6 to 11, 35.7; ages 12 to 19, 47.5.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 2003-2006.

Reference population: U.S. civilian noninstitutionalized population ages 2-19.

Note: Overweight children are identified using age-and sex-specific reference data from the 2000 Centers for Disease Control and Prevention body mass index (BMI) for age growth charts. Children and youth can be categorized as acceptable, underweight, at risk of overweight, or overweight. Children with BMI values at or above the 95th percentile of the sex-specific BMI growth charts are categorized as overweight.

  • In 2003-2006, 39.4% of overweight children and teens ages 2-19 were told by a health provider that they were overweight (Figure 2.30).
  • In 2003-2006, overweight children ages 2-5 (22.3%) and 6-11 (35.7%) were less likely than overweight children and teens ages 12-19 (47.5%) to be told by a health provider that they were overweight.

 

 

Mental Health and Substance Abuse

Importance

Type of statisticNumber
Mortality
Number of deaths due to suicide (2005)32,6372
Rank among causes of death in the United States—suicide (2005)11th2
Alcohol-related motor vehicle deaths (2006)17,60231
Prevalence
Adults age 18 and over with any mental disorder or substance abuse disorder in the past year (2007)32.4%32
People age 12 and over with alcohol and/or illicit drug dependence or abuse in the past year (2006)22.6 million (9.2%)33
Adults age 18 and over with serious psychological distress in the past year (2006)24.9 million (11.3%)33
Adults age 18 and over with a major depressive episode during the past year (2006)15.8 million (7.2%)33
Lifetime prevalence of major depressive disorder (2006)30.4 million (13.9%)33
Cost
National expenditures for the treatment of mental health services and substance abuse disorders (2003)$121 billion34
Cost effectiveness of problem drinking screening and brief counseling$14,000-$35,000/QALY6

Note: Statistics may vary from previous years due to revised and updated source statistics or addition of data sources.

Measures

The NHQR tracks measures for the treatment of diagnosable mental disorders in general, substance abuse, and major depression. Mental health treatment is defined as counseling, inpatient care, outpatient care, or prescription medications for problems with emotions or anxiety and does not include alcohol or drug treatment. Because improved outcomes are correlated with treatment completion and length of stay in substance abuse treatment, the measure of the quality of substance abuse treatment presented in this report is the rate of people who complete all parts of their treatment plan. This section highlights two core measures of mental health and substance abuse treatment:

  • Suicide deaths.
  • Receipt of needed treatment for illicit drug use.

In addition, a noncore measure is presented:

  • Receipt of minimally adequate treatment for mental disorders.

 

Findings

Treatment: Suicide Deaths

Suicide is often the result of untreated depression and may be prevented when its warning signs are detected and treated.

Figure 2.31. Suicide deaths per 100,000 population, 1999-2005

Figure 2.31. Suicide deaths per 100,000 population, 1999-2005. trend line chart. deaths per 100,000 population. HP 2010; Target 4.8 per 100,000 population; Total, 1999, 10.5; 2000, 10.6; 2001, 10.7, 2002, 10.9, 2003, 10.8, 2004, 10.9, 2005, 10.9;  Ages 0-17, 1999, no data; 2000, 1.5; 2001, 1.4, 2002, 1.3, 2003, 1.3, 2004, 1.4, 2005, 1.4;  Ages 18-44, 1999, no data; 2000, 13.0; 2001, 13.3, 2002, 13.4, 2003, 13.2, 2004, 13.5; 2005, 13.2;  Ages 45-64, 1999, 13.2; 2000, 13.5; 2001, 14.4, 2002, 14.9, 2003, 15.0,

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System-Mortality, 1999-2005.

Note: Total rate is age adjusted to the 2000 U.S. standard population. Healthy People 2010 target is revised. Please go to Chapter 1, Introduction and Methods, for details. The 1999 data for ages 0-17 and 18-44 are not available.

  • From 1999 to 2005, the age-adjusted suicide death rate increased for the population as a whole (from 10.5 to 10.9 deaths per 100,000 population), moving farther away from the Healthy People 2010 target of 4.8 suicide deaths per 100,000 population (Figure 2.31).
  • From 1999 to 2005, the age-adjusted rate of suicide deaths per 100,000 population for adults ages 45-64 increased from 13.2 to 15.4. During the same period, the rate decreased for adults age 65 and over (from 15.8 to 14.7).

Figure 2.32. State variation: Suicide deaths per 100,000 population, 2005

Figure 2.32. State variation: Suicide deaths per 100,000 population, 2005. map of United States. states with lower than reported average rate: California, New York, Massachusetts, Rhode Island, Connecticut, New Jersey, Maryland, Illinois, D.C., Hawaii. States with  higher than reported average rate: Alaska, Florida, Mississippi, Arizona, New Mexico, Oklahoma, Arkansas, Tennessee, Indiana, Kentucky, Missouri, Kansas, Colorado, West Virginia, Utah, Nevada, Oregon, Idaho, Wyoming, South Dakota, Montana, Washin

Key: Higher rate = rate is significantly above the reporting States average in 2005. Lower rate = rate is significantly below the reporting States average in 2005.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System-Mortality, 2005.

Reference population: U.S. population.

Note: Rates are age adjusted to the 2000 standard population. The "reporting States average" is the average of all reporting States (51 in this case, including the District of Columbia), which is a separate figure from the national average.

  • The State rates of suicide deaths per 100,000 population ranged from a low of 5.5 to a high of 21.5.
  • In 2005, 9 Statesxviii and the District of Columbia had rates of suicide deaths that were lower than the reporting States average of 10.9 per 100,000 population (Figure 2.32), with a combined average rate of 7.3 per 100,000 population. No State has yet reached the Healthy People 2010 goal of 4.8 per 100,000 population.
  • In 2005, 22 Statesxix had rates of suicide deaths that were higher than the reporting States average, with a combined average rate of 15.3 per 100,000 population.
  • Ten States showed a significant change in the rate of suicide deaths from 1999 to 2005, with 7 States reporting an increase and 3 States a decrease in suicide death rates (data not shown).

xviii The States are California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, and Rhode Island.
xixThe States are Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Kansas, Kentucky, Mississippi, Missouri, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Tennessee, Utah, Washington, West Virginia, and Wyoming.


Treatment: Receipt of Needed Treatment for Illicit Drug Use

Substance abuse is a medical problem that requires timely treatment, not only because of its health effects but also because drug use is associated with other adverse effects, such as violent behavior. In addition, because overall health care costs may be reduced by effective substance abuse and mental health treatment,35, 36 appropriate receipt and completion of treatment have both clinical and economic implications.

Figure 2.33. People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months, 2002-2006

Figure 2.33. People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months, 2002-2006. HP 2010 target:  24%. trend line chart. percent. Total, 2002, 18.2%, 2003, 15.0%, 2004, 17.7%, 2005, 17.0%, 2006, 20.3; Ages 12-17, 2002, 10.1%, 2003, 8.5%, 2004, 9.6%, 2005, 11.3%, 2006, 11.2 Ages 18-44, 2002, 17.2%, 2003, 16.0%, 2004 18.0%, 2005, 17.5%, 2006, 20.

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2002-2006.

Reference population: Civilian noninstitutionalized population age 12 and over who needed treatment for any illicit drug use.

Note: Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient hospital care, or a mental health center.

  • Overall, 20.3% of persons age 12 and over who met criteria for needing treatment for illicit drug use actually received it in 2006. This rate has not changed significantly since 2002 (Figure 2.33).
  • Of people who needed treatment for illicit drug use in 2006, only 20.0% of adults ages 18-44 and 11.2% of children ages 12-17 received it. These rates remain significantly unchanged from 2002.
  • In all 5 data years, children ages 12-17 who needed treatment for illicit drug use were less likely than adults ages 18-44 to receive such treatment.
  • As of 2006, the percentage of people age 12 and over who met criteria for needing treatment for illicit drug use who actually received it had not yet achieved the Healthy People 2010 target of 24%. At the current average annual rate of change, this target is projected to be met.

Treatment: Receipt of Minimally Adequate Treatment for Mental Disorders

Receipt of any treatment for a major depressive episode is a relatively low standard against which to assess quality of mental health care. The Collaborative Psychiatric Epidemiology Surveys (CPES) allow more detailed examination of mental health care. The CPES join together three nationally representative surveys, the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS). Together, these surveys can provide national estimates of mental disorders and mental health care for majority and minority populations in the United States in much greater detail than other data sources.

To better assess quality of mental health care, a higher standard of care, minimally adequate treatment, has been specified using the CPES. This measure defines minimally adequate treatment as pharmacotherapy, including at least 60 days of an appropriate medication and 4 visits to a physician, or psychotherapy, including at least 8 visits to a health care or human services professional lasting an average of 30 minutes or more.37

Figure 2.34. Adults with a mood, anxiety, or impulse control disorder in the last 12 months who received minimally adequate treatment, 2001-2003

Figure 2.34. Adults with a mood, anxiety, or impulse control disorder in the last year who received minimally adequate treatment, 2001-2003; bar chart; percent; Total, 29.4; ages 18 to 44, 30.8; ages 45-64, 26.9; age 65 and over, 27.3.

Source: National Institutes of Health, National Institute of Mental Health, Collaborative Psychiatric Epidemiology Surveys, 2001-2003.

Reference population: U.S. population age 18 and over who had a mood, anxiety, or impulse control disorder in the last year.

Note:The Composite International Diagnostic Interview (CIDI) was used to make psychiatric diagnoses consistent with the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). "Minimally adequate treatment" is defined as at least 60 days of an appropriate medication and 4 visits to a physician OR at least 8 visits to a health care or human services professional lasting an average of 30 minutes or more in the last year.

  • In 2001-2003, nearly 30% of adults with mood, anxiety, or impulse control disorders in the last 12 months received minimally adequate treatment (Figure 2.34).
  • There were no significant differences by age for adults with mood, anxiety, or impulse control disorders in the last 12 months who received minimally adequate treatment.
Current as of March 2009
Internet Citation: Chapter 2. Effectiveness (continued, 2): National Healthcare Quality Report, 2008. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqr08/Chap2b.html