Chapter 2 (Text Descriptions)

National Healthcare Quality Report, 2011

Figure 2.1. Women ages 50-74 who reported having a mammogram within the past 2 years, by age and insurance status, 2000, 2003, 2005, and 2008

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000, 2003, 2005, and 2008.

Denominator: Civilian noninstitutionalized women ages 50-74.

Note: Rates are age adjusted to the 2000 U.S. standard population.
2008 Achievable Benchmark: 88%.

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Figure 2.2. Age-adjusted rate of advanced stage breast cancer per 100,000 women age 40 and over, by age, 2000-2007

Source: Centers for Disease Control and Prevention, National Program of Cancer Registries and National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program, 2000-2007. Registries meeting United States Cancer Statistics publication criteria for every year, 2000-2007, are included and cover 89.3% of the total U.S. population. States excluded are Arkansas, DC, Mississippi, Nevada, North Carolina, South Dakota, Tennessee, and Virginia.

Denominator: Women age 40 and over.

Note: For this measure, lower rates are better. Age adjusted to the 2000 U.S. standard population. Advanced stage breast cancer is defined as local stage with tumor size greater than 2 cm diameter, regional stage or distant stage.
2007 achievable benchmark: 79.

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Figure 2.3. Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of lumpectomy or mastectomy, by age and insurance status (under age 65), 2004-2008

Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2004-2008.

Denominator: Women with Stage I-IIb breast cancer undergoing lumpectomy or mastectomy.
2008 achievable benchmark: 97%.

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Figure 2.4. 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 age and insurance status (ages 65-69), 2004-2008

Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2004-2008.

Denominator: Women under age 70 undergoing breast-conserving surgery.
2008 achievable benchmark: 93%.

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Figure 2.5. Age-adjusted breast cancer deaths per 100,000 women, by age, 2000-2007, and residence location, 2004-2007

Key: MSA = metropolitan statistical area.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System-Mortality, 2000-2007.

Denominator: U.S. female population age 18 and over.

Note: For this measure, lower rates are better. Total rate is age adjusted to the 2000 U.S. standard population.
2006 achievable benchmark: 20.

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Figure 2.6. Adults who reported they had a blood cholesterol measurement in the past 5 years, by age and insurance status, 1998, 2003, and 2008

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1998, 2003, and 2008.

Denominator: Civilian noninstitutionalized people age 18 and over.

Note: Rates are age adjusted to the 2000 U.S. standard population. Insurance status refers to adults ages 18-64.

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Figure 2.7. Inpatient deaths per 1,000 adult hospital admissions with heart attack, by age and geographic location, 2004-2008

Key: MSA = metropolitan statistical area.

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators modified version 4.1, 2004-2008.

Denominator: Adults age 18 and over admitted to a non-Federal community hospital in the United States with acute myocardial infarction as principal discharge diagnosis.

Note: For this measure, lower rates are better. Rates are adjusted by age and all payer refined-diagnosis related group scoring of risk of mortality. Rates by age are not age-adjusted. Rates for 2006 were not available.
2008 achievable benchmark: 47.

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Figure 2.8. Hospital patients with heart failure and left ventricular systolic dysfunction prescribed ACE inhibitor or ARB at discharge, by age and gender, 2005-2009

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

Denominator: Patients hospitalized with a principal diagnosis of acute heart failure with left ventricular systolic dysfunction.
2009 achievable benchmark: 96%.

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Figure 2.9. Admissions for congestive heart failure per 100,000 population, age 18 and over, by age and gender, 2004-2008

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators modified version 4.1, 2004-2008.

Denominator: U.S. resident population age 18 and over.

Note: For this measure, lower rates are better. Age rates are adjusted by gender; gender rates are adjusted by age. Rates for 2006 were not available.
2008 achievable benchmark: 195.

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Figure 2.10. Patients beginning nephrology care more than 12 months before start of dialysis, by age and gender, 2006-2008

Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2006-2008.

Denominator: New end stage renal disease patients.

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Figure 2.11. Incident adult hemodialysis patients who used an arteriovenous fistula at first outpatient dialysis, by age and gender, 2008-2010

Source: Centers for Medicare & Medicaid Services, Fistula First Incident AVF Dataset, 2008-2010.

Denominator: New ESRD hemodialysis patients.
2009 achievable benchmark: 27%.

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Figure 2.12. Standardized mortality rates on dialysis, by State or territory, 2009

Source: University of Michigan Kidney Epidemiology and Cost Center, 2010 Dialysis Facility Report.

Denominator: End stage renal disease hemodialysis patients age 20 and over.

Note: For this measure, lower rates are better.

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Figure 2.13. Dialysis patients who were registered on a waiting list for transplantation, by age and gender, 2000-2007

Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2000-2007.

Denominator: End stage renal disease hemodialysis patients and peritoneal dialysis patients under age 70.
2006 achievable benchmark: 27%

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Figure 2.14. Adults age 40 and over with diagnosed diabetes who reported receiving four recommended services for diabetes in the calendar year (2+ hemoglobin A1c tests, foot exam, dilated eye exam, and flu shot), by age, 2008

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

Denominator: Civilian noninstitutionalized population with diagnosed diabetes, age 40 and over.

Note: Data include people with both type 1 and type 2 diabetes. Rates are age adjusted to the 2000 U.S. standard population.

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Figure 2.15. Hospital admissions for diabetes with short-term complications per 100,000 population age 18 and over, by age and residence location, 2004-2008

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.1, 2004-2008.

Denominator: U.S. resident population age 18 and over.

Note: For this measure, lower rates are better. Short-term complications include ketoacidosis, hyperosmolarity, or coma and exclude obstetric admissions and transfers from other institutions. Data are adjusted for age and gender. Rates by age are not age-adjusted.
2008 achievable benchmark: 38.

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Figure 2.16. End stage renal disease due to diabetes per million population, by age and gender, 2000-2008

Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2000-2008.

Denominator: U.S. resident population.

Note: For this measure, lower rates are better. Rates are age adjusted.

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Figure 2.17. Population ages 15-44 years who ever had an HIV test outside of blood donation, by age and gender, 2006-2010

Source: Special tabulations based on National Survey of Family Growth, 2006-2010, conducted by the National Center for Health Statistics. PLEASE DO NOT QUOTE OR CITE WITHOUT PERMISSION. The data are not yet released for public use.

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Figure 2.18. Percentage of women ages 15-44 years with a completed pregnancy who had an HIV test as part of prenatal care, United States, by age, 2006-201

Source: Special tabulations based on National Survey of Family Growth, 2006-2010, conducted by the National Center for Health Statistics. PLEASE DO NOT QUOTE OR CITE WITHOUT PERMISSION. The data are not yet released for public use.

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Figure 2.19. Adult patients with HIV who received care, by age, 2008

Source: Agency for Healthcare Research and Quality, HIV Research Network, 2008.

Note: For HAART measure, adult HIV patients had to be enrolled in an HIV network clinic and receive at least one CD4 test and have at least one outpatient visit in addition to having at least one CD4 test result of 350 or less.

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Figure 2.20. HIV infection deaths per 100,000 population, by age and gender, 2004-2007

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System-Mortality, 2004-2007.

Denominator: Civilian noninstitutionalized population.

Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 U.S. standard population. Age data are unadjusted.

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Figure 2.21. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by age and payment source, 2004-2008

Key: Private indicates private health insurance as the payment source; self-pay indicates self-pay, uninsured, and no charge as the payment source.

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample 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. Rates by age are not age-adjusted.
2008 achievable benchmark: 17.

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Figure 2.22. Children ages 19-35 months who received the 4:3:1:3:3:1:4 vaccine series, by income, 2007-2009

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.
2009 achievable benchmark: 72%.

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Figure 2.23. Rate of emergency department visits for asthma per 10,000 population among 2-19 year olds, by gender and insurance, 2005-2007 combined

Source: National Center for Health Statistics, Centers for Disease Control and Prevention, National Hospital Ambulatory Care Survey-Emergency Department, 2005-2007.

Note: For this measure, lower rates are better.

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Figure 2.24. Children ages 2-17 with a dental visit in the calendar year, by age and insurance status, 2002-2008

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

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

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Figure 2.25. Adolescents ages 13-17 with untreated dental caries, by insurance status, 2005-2008 combined

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

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Figure 2.26. Children ages 10-17 with a well-visit in last 12 months, by insurance status, 2009

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.

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Figure 2.27. Adolescents 13-17 years of age who ever received at least 1 dose of the meningococcal vaccine as of 2009, by State quartiles

Source: Centers for Disease Control and Prevention, National Center for Health Statistics and National Center for Immunization and Respiratory Diseases, National Immunization Survey, 2009.

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Figure 2.28. Sexually active female managed care plan enrollees ages 16-20 years with one or more chlamydia tests performed in the plan year, by plan type, 2001-2009

Source: National Committee for Quality Assurance, 2001-2009.

Denominator: Female managed care enrollees ages 16-20 who were sexually active based on claims for oral contraceptive prescriptions or for visits with STD- or pregnancy-related diagnosis or procedure codes.

Note: The chlamydia tests counted in the numerator include tests performed during workups for suspected STDs, as well as screening tests performed in asymptomatic patients. In addition, claims-based estimates of sexually active women identify smaller proportions of women as sexually active compared with self-report. Thus, the data reported here likely overestimate the proportions of sexually active asymptomatic women undergoing true chlamydia screening.

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Figure 2.29. Adults with a major depressive episode in the past year who received treatment for depression in the past year, by age and gender, 2008-2009

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2009.

Denominator: Adults age 18 and over with a major depressive episode in the last 12 months.

Note: Total includes adults age 65 and over, but sample sizes are too small to allow separate estimates for this age group. 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.

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Figure 2.30. Suicide deaths per 100,000 population, by age and gender, 2000-2007

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System-Mortality. 2000-2007.

Denominator: Civilian noninstitutionalized population.

Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 standard population.

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Figure 2.31. 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 age and education, 2008-2009

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2009.

Denominator: Civilian noninstitutionalized population age 12 and over who needed treatment for any illicit drug use or alcohol problem.

Note: Total includes people age 65 and over, but data were not statistically reliable enough to produce specific estimates for this group. Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient hospital setting, or mental health center.

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Figure 2.32. People age 12 and over treated for substance abuse who completed treatment course, by age and gender, 2005-2008

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.

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Figure 2.33. Rate of emergency department visits with a principal diagnosis of mental health, alcohol, or substance abuse, per 100,000 population, by age, gender, area income, and region, 2008

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2008.

Denominator: U.S. population.

Note: For this measure, lower rates are better.

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Figure 2.34. Female Medicare beneficiaries age 65 and over who reported ever being screened for osteoporosis with a bone mass or bone density measurement, by age and insurance, 2000, 2003, 2006, and 2008

Key: HMO = health maintenance organization; FFS = fee for service.

Source: Medicare Current Beneficiary Survey, 2000, 2002, 2006, and 2008.

Denominator: Female Medicare beneficiaries age 65 and over living in the community.

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Figure 2.35. 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 age and gender, 2006 and 2009

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.

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Figure 2.36. Adults with doctor-diagnosed arthritis who reported they received health care provider counseling about physical activity or exercise, by age and gender, 2006 and 2009

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.

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Figure 2.37. Overweight adults with doctor-diagnosed arthritis who reported they received health care provider counseling about weight reduction, by age and gender, 2006 and 2009.

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.

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Figure 2.38. Adults age 65 and over who reported ever having pneumococcal vaccination, by insurance and income, 2000-2009

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000-2009.

Denominator: Civilian noninstitutionalized population age 65 and over.

Note: Age adjusted to the 2000 U.S. standard population. Benchmark is derived from the Behavioral Risk Factor Surveillance System (BRFSS); see Introduction and Methods for details.
2008 achievable benchmark: 67%.

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Figure 2.39. Hospital patients with pneumonia who received recommended hospital care, by age, 2007-2009

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2007-2009.

Denominator: Patients hospitalized with a principal discharge diagnosis of pneumonia or a principal discharge diagnosis of either septicemia or respiratory failure and secondary diagnosis of pneumonia.
2008 achievable benchmark: 93.5%.

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Figure 2.40. Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment, by age and gender, 2000-2007

Source: Centers for Disease Control and Prevention, National Tuberculosis Surveillance System, 2000-2007.

Denominator: U.S. civilian noninstitutionalized population treated for tuberculosis.
2006 Achievable Benchmark: 91.5%.

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Figure 2.41. People with current asthma who reported taking preventive asthma medicine daily or almost daily, by age and insurance, 2003-2008

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2003-2007.

Denominator: Civilian noninstitutionalized population with asthma.

Note: Age adjusted to the 2000 U.S. standard population. People with current asthma report that they still have asthma or had an asthma attack in the last 12 months. Insurance groups presented are for patients under age 65.

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Figure 2.42. Adult current smokers with a checkup in the last 12 months who received advice to quit smoking, by age and geographic location, 2002-2008

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

Denominator: Civilian noninstitutionalized adult current smokers who had a checkup in the last 12 months.

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Figure 2.43. Adults with obesity who ever received advice from a health provider to exercise more, by age and gender, 2002-2008

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

Denominator: Civilian noninstitutionalized adults age 18 and over with obesity.

Note: Obesity is defined as a body mass index of 30 or higher.

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Figure 2.44. Adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least three times a week, by age and gender, 2002-2008

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

Denominator: Civilian noninstitutionalized population age 18 and over.

Note: Obesity is defined as a body mass index of 30 or higher.

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Figure 2.45. Children ages 2-17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have, by age and special health care needs, 2002-2008

Key: CSHCN = children with special health needs.

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

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

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Figure 2.46. Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods, by age and gender, 2002-2008

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

Denominator: Civilian noninstitutionalized population age 18 and over.

Note: Obesity is defined as a body mass index of 30 or higher.

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Figure 2.47. Children ages 2-17 for whom a health provider ever gave advice about healthy eating, by age and insurance, 2002-2008

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

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

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Figure 2.48. Adult home health care patients whose ability to walk or move around improved, by age, 2002-2009

Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set (OASIS), 2002-2009.

Denominator: Adult nonmaternity patients completing an episode of skilled home health care and not already performing at the highest level at the start of the episode, according to the OASIS question on ambulation.
2008 achievable benchmark: 54%.

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Figure 2.49. Long-stay nursing home residents whose need for help with daily activities increased, by age, 2000-2009

Source: Centers for Medicare & Medicaid Services, Minimum Data Set, 2000-2009. Data are from the third quarter of each calendar year.

Denominator: All long-stay residents in Medicare or Medicaid certified nursing home facilities.

Note: For this measure, lower rates are better.
2008 achievable benchmark: 13%.

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Figure 2.50. Mean locomotion score gain among patients in an inpatient rehabilitation facility for stroke, by age, 2002-2007

Source: Centers for Medicare & Medicaid Services, Inpatient Rehabilitation Facility Patient Assessment Instrument, 2002-2007.

Denominator: Medicare patients in an inpatient rehabilitation facility for stroke for initial rehabilitation and discharged home.

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Figure 2.51. Mean communication score gain among patients in an inpatient rehabilitation facility for stroke, by side of body affected and age, 2002-2007

Left Body Stroke

Right Body Stroke

Source: Centers for Medicare & Medicaid Services, Inpatient Rehabilitation Facility Patient Assessment Instrument, 2002-2007.

Denominator: Medicare patients in an inpatient rehabilitation facility for stroke for initial rehabilitation and discharged home.

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Figure 2.52. Adult home health care patients who had less shortness of breath between the start and end of a home health care episode, by age, 2002-2009

Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set, 2002-2009.

Denominator: Adult nonmaternity patients completing an episode of skilled home health care.
2008 achievable benchmark: 68%.

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Figure 2.53. Short-stay (top) and high-risk (bottom) long-stay nursing home residents with pressure sores, by gender, 2000-2009

Source: Centers for Medicare & Medicaid Services, Minimum Data Set, 2000-2009. Data for long-stay residents are from the third quarter of each calendar year. Data for short-stay residents are full calendar-year estimates.

Denominator: Short-stay and high-risk long-stay nursing home residents in Medicare or Medicaid certified nursing and long-term care facilities.

Note: For this measure, lower rates are better.
Figure 2.53a (short stay). 2008 achievable benchmark: 12%; Figure 2.53b (long stay). 2008 achievable benchmark: 7%.

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Figure 2.54. Hospice patients age 18 and over who did NOT receive the right amount of help for feelings of anxiety or sadness, by age, 2008-2010

Source: National Hospice and Palliative Care Organization, Family Evaluation of Hospice Care, 2008-2010.

Denominator: Adult hospice patients.
2009 achievable benchmark: 6.4%.

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Figure 2.55. Hospice patients age 18 and over whose family caregivers wanted more information about what to expect while the patient was dying, by age, 2008-2010

Source: National Hospice and Palliative Care Organization, Family Evaluation of Hospice Care, 2008-2010.

Denominator: Adult hospice patients.
2009 achievable benchmark: 12%.

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Figure 2.56. Hospice patients age 18 and over who did NOT receive care consistent with their stated end-of-life wishes, by age, 2008-2010

Source: National Hospice and Palliative Care Organization, Family Evaluation of Hospice Care, 2005-2010.

Denominator: Adult hospice patients.
2009 Achievable benchmark: 4%