Effectiveness of Care: Respiratory Diseases

2008 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Vaccinations for Respiratory Infections
Adults ages 18-64 at high risk (e.g., COPD) who received an influenza vaccination in the last 12 months
Adults age 65 and over who received an influenza vaccination in the last 12 months
Hospital admissions for immunization-preventable influenza per 100,000 population age 65 and over
Adults ages 18-64 at high risk (e.g., COPD) who ever received pneumococcal vaccination
Adults age 65 and over who ever received pneumococcal vaccination

Treatment of Respiratory Infections
Composite measure: Hospital patients with pneumonia who received recommended hospital care (blood cultures collected before antibiotics are administered, initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and influenza and pneumococcal screening or vaccination)
Hospital patients with pneumonia who had blood cultures collected before antibiotics were administered
Hospital patients with pneumonia who received the initial antibiotic dose within 4 hours of hospital arrival
Hospital patients with pneumonia who received the initial antibiotic consistent with current recommendations
Hospital patients with pneumonia who received influenza screening or vaccination
Hospital patients with pneumonia who received pneumococcal screening or vaccination
Deaths per 1,000 adult hospital admissions with pneumonia
Visits with antibiotics prescribed for a diagnosis of common cold per 10,000 population
Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment

Management of Asthma
People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler)
Hospital admissions for asthma per 100,000 population (2-17, 18-64, 65 and over)
People with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma (inhaled corticosteroids)
 


Vaccinations for Respiratory Infections

Measure Title

Adults ages 18-64 at high risk (e.g., COPD) who received an influenza vaccination in the last 12 months.

Measure Source

Healthy People 2010.

National Tables

8_1_1.1 Adults ages 18-64 at high risk (e.g., COPD) who received an influenza vaccination in the last 12 months, United States, 1999 and 2006.

8_1_1.2 Adults ages 18-64 at high risk (e.g., COPD) who received an influenza vaccination in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. civilian noninstitutionalized population of high-risk adults ages 18-64.

National Numerator

Subset of the denominator who report receiving an influenza vaccination in the last 12 months.

State Tables

8_1_1.3 Adults ages 18-64 at high risk (e.g., COPD) who received an influenza vaccination in the last 12 months, by State, 2001 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of high-risk adults ages 18-64.

State Numerator

Number of high-risk adults ages 18-64 who answered “Yes” to the question, “During the past 12 months, have you had a flu shot?”

Comments

High-risk conditions include chronic obstructive pulmonary disease (COPD), diabetes, heart disease, lung disease, kidney disease, liver disease, and cancer. Not all high-risk conditions for complications of influenza and pneumococcal disease can be ascertained by NHIS (e.g., immunocompromised), and the sample size may be too small for some groups.

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

Race categories have changed since 2001. Data for 2001 and later years may not be comparable with data from previous years.

This measure is referred to as measure 14-29c in Healthy People 2010 documentation.

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Vaccinations for Respiratory Infections

Measure Title

Adults age 65 and over who received an influenza vaccination in the last 12 months.

Measure Source

Healthy People 2010.

National Tables

8_1_2.1 Adults age 65 and over who received an influenza vaccination in the last 12 months, United States, 1999 and 2006.

8_1_2.2 Adults age 65 and over who received an influenza vaccination in the last 12 months, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. civilian noninstitutionalized population age 65 and over.

National Numerator

Number of adults age 65 and over who reported receiving an influenza vaccination in the last 12 months.

State Tables

8_1_2.3 Adults age 65 and over who received an influenza vaccination in the last 12 months, by State, 2001 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of adults age 65 and over.

State Numerator

Number of adults age 65 and over who reported receiving an influenza vaccination in the last 12 months.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

Race categories in the national table have changed since 2001. Data for 2001 and later years may not be comparable with data from previous years.

This measure is referred to as measure 14-29a in Healthy People 2010 documentation.

This measure is one of the components of the Immunization Leading Health Indicator, which further defines the measure as pertaining to high-risk adults. See Appendix H of Tracking Healthy People 2010 for a complete listing of Leading Health Indicators.

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Vaccinations for Respiratory Infections

Measure Title

Hospital admissions for immunization-preventable influenza per 100,000 population age 65 and over.

Measure Source

Healthy People 2010.

National Tables

8_1_3.1 Immunization-preventable influenza admissions (excluding transfers from other institutions) per 100,000 population, age 65 and over, United States, 2000 and 2005.

8_1_3.2 Immunization-preventable influenza admissions (excluding transfers from other institutions) per 100,000 population, age 65 and over, United States, 2005, by:

  • Race/ethnicity.

National Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

U.S. population age 65 and over by subcategories (age group, gender, region, median household income level, and urbanization).

National Numerator

Hospital discharges, age 65 and over, with any diagnosis of immunization-preventable influenza (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 487.0, 487.1, 487.8), excluding transfers from other institutions.

State Tables

8_1_3.3 Immunization-preventable influenza admissions (excluding transfers from other institutions) per 100,000 population, age 65 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

This measure is referred to as measure 1-9c in Healthy People 2010 documentation.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

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Vaccinations for Respiratory Infections

Measure Title

Adults ages 18-64 at high risk (e.g., COPD) who ever received pneumococcal vaccination.

Measure Source

Healthy People 2010.

National Tables

8_1_4.1 Adults ages 18-64 at high risk (e.g., COPD) who ever received pneumococcal vaccination, United States, 1999 and 2006.

8_1_4.2 Adults ages 18-64 at high risk (e.g., COPD) who ever received pneumococcal vaccination, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. civilian noninstitutionalized population of high-risk adults ages 18-64.

National Numerator

Subset of the denominator who answered “Yes” to the question, “Have you ever had a pneumonia vaccination, sometimes called a pneumonia shot? This shot is usually given only once in a person's lifetime and is different from the flu shot.”

State Tables

8_1_4.3 High-risk people ages 18-64 who ever received a pneumococcal vaccination, by State, 2001 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of high-risk adults ages 18-64.

State Numerator

Number of high-risk adults ages 18-64 who answered “Yes” to the question, “Have you ever had a pneumonia vaccination?”

Comments

See Appendix H of Tracking Healthy People 2010 for a complete listing of Leading Health Indicators. High-risk conditions include chronic obstructive pulmonary disease (COPD), diabetes, heart disease, lung disease, kidney disease, liver disease, and cancer. Not all high-risk conditions for complications of pneumococcal disease can be ascertained by NHIS (for example, immunocompromised), and the sample size may be too small for some groups.

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

Race categories in the national table have changed since 2001. Data for 2001 and later years may not be comparable with data from previous years.

This measure is referred to as measure 14-29d in Healthy People 2010 documentation.

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Vaccinations for Respiratory Infections

Measure Title

Adults age 65 and over who ever received pneumococcal vaccination.

Measure Source

Healthy People 2010.

National Tables

8_1_5.1 Adults age 65 and over who ever received pneumococcal vaccination, United States, 1999 and 2006.

8_1_5.2 Adults age 65 and over who ever received pneumococcal vaccination, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. civilian noninstitutionalized population age 65 and over.

National Numerator

Number of adults age 65 and over who had a pneumococcal vaccination.

State Tables

8_1_5.3 Adults age 65 and over who ever received pneumococcal vaccination, by State, 2001 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Number of adults age 65 and over.

State Numerator

Number of adults age 65 and over who had a pneumococcal vaccination.

Comments

Race categories in the national table have changed since 2001. Data for 2001 and later years may not be comparable with data from previous years.

State tables are age adjusted to the 2000 standard population.

This measure is referred to as measure 14-29b in Healthy People 2010 documentation.

This measure is one of the components of the Immunization Leading Health Indicator, which further defines the measure as pertaining to high-risk adults. See Appendix H of Tracking Healthy People 2010 for a complete listing of Leading Health Indicators.

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5 of Tracking Healthy People 2010.

This measure and its tables are also presented in other relevant sections of the National Healthcare Disparities Report.

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Treatment of Respiratory Infections

Measure Title

Composite measure: Hospital patients with pneumonia who received recommended hospital care (blood cultures collected before antibiotics are administered, initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and influenza and pneumococcal screening or vaccination).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

8_2_1.1 Hospital patients with pneumonia who received recommended hospital care, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Medicare hospital discharges age 65 and over meeting either of the following criteria: (1) principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 481-483.8, 485-486, 487.0), or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM codes 038.0-038.9) or respiratory failure (acute, ICD-9-CM code 518.81 or 518.84).

National Numerator

Subset of instances in which the denominator population received recommended care, if indicated and appropriate: blood cultures collected before antibiotics are administered, initial antibiotic dose within 4 hours of hospital arrival and consistent with current recommendations, and influenza and pneumococcal screening or vaccination.

State Tables

8_2_1.2 Hospital patients with pneumonia who received recommended hospital care, by State, 2005 and 2006.

8_2_1.3 Hospital patients with pneumonia who received recommended hospital care, by State, 2006 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, recommended hospital care for pneumonia includes having blood cultures collected before the administration of the first antibiotic dose, receiving the first dose of antibiotic within 4 or 6 hours of arrival at the hospital, receiving the recommended empirical antibiotic regimen that is consistent with current guidelines, being screened for influenza vaccine status and vaccinated prior to discharge for patients age 50 and over discharged during the winter, and being screened for pneumococcal vaccine status and vaccinated prior to discharge for patients age 65 and over. Data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Treatment of Respiratory Infections

Measure Title

Hospital patients with pneumonia who had blood cultures collected before antibiotics were administered.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

8_2_2.1 Hospital patients with pneumonia who had blood cultures collected before antibiotics were administered, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients with a blood culture performed, meeting either of the following criteria: (1) principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 480-483.8, 485-486, 487.0), or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM codes 038.0-038.9) or respiratory failure (acute or chronic, ICD-9-CM code 518.81).

National Numerator

Subset of the denominator population who had blood cultures performed prior to antibiotic administration.

State Tables

8_2_2.2 Hospital patients with pneumonia who had blood cultures collected before antibiotics were administered, by State, 2005 and 2006.

8_2_2.3 Hospital patients with pneumonia whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores. The 2004 measure title is pneumonia patients having a blood culture performed prior to first antibiotic received in hospital.

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Treatment of Respiratory Infections

Measure Title

Hospital patients with pneumonia who received the initial antibiotic dose within 4 hours of hospital arrival.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

8_2_3.1 Hospital patients with pneumonia who received the initial antibiotic dose within 4 hours of hospital arrival, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients meeting either of the following criteria: (1) principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 480-483.8, 485-486, 487.0), or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM codes 038.0-038.9) or respiratory failure (acute or chronic, ICD-9-CM code 518.81).

National Numerator

Subset of the denominator population who received their first dose of antibiotics within 4 hours after arrival at the hospital.

State Tables

8_2_3.2 Hospital patients with pneumonia who received the initial antibiotic dose within 4 hours of hospital arrival, by State, 2005 and 2006.

8_2_3.3 Hospital patients with pneumonia who received the initial antibiotic dose within 6 hours after arrival, by State, 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national for Table 8_2_3.2.

Subset of the denominator population who received their first dose of antibiotics within 6 hours after hospital arrival for Table 8_2_3.3.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Treatment of Respiratory Infections

Measure Title

Hospital patients with pneumonia who received the initial antibiotic consistent with current recommendations.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

8_2_4.1 Hospital patients with pneumonia who received the initial antibiotic dose consistent with current recommendations, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients meeting either of the following criteria: (1) Principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 480-483.8, 485-486, 487.0), or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM codes 038.0-038.9) or respiratory failure (acute or chronic, ICD-9-CM code 518.81)

National Numerator

Subset of the denominator population who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization.

State Tables

8_2_4.2 Hospital patients with pneumonia who received the initial antibiotic consistent with current recommendations, by State, 2005 and 2006.

8_2_4.3 Hospital patients with pneumonia given the most appropriate initial antibiotics, by State, 2005 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

The specification for the denominator of this measure has changed to exclude patients with health care-associated pneumonia. Reported rates may not be comparable with those reported in earlier years of the National Healthcare Quality Report.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Treatment of Respiratory Infections

Measure Title

Hospital patients with pneumonia who received influenza screening or vaccination.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

8_2_5.1 Hospital patients age 50 and over with pneumonia discharged during October-February who were screened for influenza vaccine status and were vaccinated prior to discharge, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Medicare hospital discharges age 50 and over during October, November, December, January, and February meeting either of the following criteria: (1) principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 480-483.8, 485-486, 487.0), or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM codes 038.0-038.9) or respiratory failure (acute or chronic, ICD-9-CM code 518.81).

National Numerator

Subset of the denominator population who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated.

State Tables

8_2_5.2 Hospital patients age 50 and over with pneumonia discharged during October-February who were screened for influenza vaccine status and were vaccinated prior to discharge, by State, 2005 and 2006.

8_2_5.3 Hospital patients with pneumonia who received influenza screening or vaccination, by State, 2006 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Treatment of Respiratory Infections

Measure Title

Hospital patients with pneumonia who received pneumococcal screening or vaccination.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

8_2_6.1 Hospital patients age 65 and over with pneumonia who received pneumococcal screening or vaccination, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients age 65 and over meeting either of the following criteria: (1) principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 480-483.8, 485-486, 487.0), or (2) secondary diagnosis of pneumonia and a principal diagnosis of either septicemia (ICD-9-CM codes 038.0-038.9) or respiratory failure (acute or chronic, ICD-9-CM code 518.81).

National Numerator

Subset of the denominator population who were screened for pneumococcal vaccine status and were vaccinated prior to discharge, if indicated.

State Tables

8_2_6.2 Hospital patients age 65 and over with pneumonia who received pneumococcal screening or vaccination, by State, 2005 and 2006.

8_2_6.3 Hospital patients with pneumonia who received pneumococcal screening or vaccination, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Further information about this and other pneumonia measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Treatment of Respiratory Infections

Measure Title

Deaths per 1,000 adult hospital admissions with pneumonia.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Inpatient Quality Indicators (IQIs).

National Tables

8_2_7.1 Deaths per 1,000 adult hospital admissions with pneumonia as principal diagnosis (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2000 and 2005.

8_2_7.2 Deaths per 1,000 adult hospital admissions with pneumonia as principal diagnosis (excluding obstetric and neonatal admissions and transfers to another hospital), United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

All discharges age 18 and over with principal diagnosis code of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 003.22, 021.2, 039.1, 052.1, 055.1, 073.0, 112.4, 114.0, 114.4, 114.5, 115.05, 115.15, 115.95, 130.4, 136.3, 480.0-482.9). Excludes patients transferring to another short-term hospital and obstetric and neonatal admissions.

National Numerator

Number of deaths with a principal diagnosis code of pneumonia.

State Tables

8_2_7.3 Deaths per 1,000 adult hospital admissions with pneumonia as principal diagnosis (excluding obstetric and neonatal admissions and transfers to another hospital), by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Rates are adjusted by age, gender, age-gender interactions, and All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age and APR-DRG risk of mortality score.

This table was created using version 3.1 of the AHRQ IQI software. This measure is referred to as IQI 20 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

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Treatment of Respiratory Infections

Measure Title

Visits with antibiotics prescribed for a diagnosis of common cold per 10,000 population.

Measure Source

Healthy People 2010.

Tables

8_2_8.1 Emergency and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, United States, 2000-2001 and 2005-2006.

8_2_8.2 Emergency and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, United States, 2005-2006, by:

  • Race.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).

Denominator

Number of outpatient and emergency department visits.

Numerator

Number of antibiotic courses ordered, supplied, administered, or continued at a specific visit for people diagnosed with the common cold (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 460, 465, 472.0).

Comments

This measure is referred to as measure 14-19 in Healthy People 2010 documentation. The age range has been modified from the original specification.

Estimates of metropolitan and nonmetropolitan statistical areas used in calculating visit rates are preliminary figures based on Census 2000 data and were obtained through the Office of Research and Methodology and Division of Health Interview Statistics, NCHS. They are based on U.S. Census Bureau estimates of the civilian noninstitutionalized population of the United States as of July 1 of the period of study.

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Treatment of Respiratory Infections

Measure Title

Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment.

Measure Source

American Thoracic Society.

Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination.

Tables

8_2_9.1 Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment, United States, 1998 and 2004.

8_2_9.2 Patients with tuberculosis who completed a curative course of treatment within 1 year of initiation of treatment, United States, 2004, by:

  • Race.
  • Ethnicity.
  • Race. (foreign born only)
  • Ethnicity. (foreign born only)

Data Source

CDC, National Tuberculosis Surveillance System (NTBSS).

Denominator

U.S. resident population with verified tuberculosis (TB), eligible to complete therapy within 1 year.

Numerator

TB cases completing therapy within 1 year.

Comments

For further information regarding current tuberculosis treatment guidelines, see American Thoracic Society, CDC, Infectious Diseases Society of America. Treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-62.

For a discussion of completion of TB therapy, see Appendix A of the CDC publication Reported Tuberculosis in the United States, 2000.

Due to a change in the data source race variable effective in 2003, results have changed slightly from previous years' calculations.

This measure and its tables are also presented in other relevant sections of the National Healthcare Disparities Report.

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Management of Asthma

Measure Title

People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler).

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Tables

8_3_1.1 People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler), United States, 2005.

8_3_1.2 People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler), United States, 2003.

8_3_1.3 People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler), United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

U.S. civilian noninstitutionalized population with asthma who currently have active asthma, excluding missing values.

Numerator

People with current active asthma who are taking preventive medicine daily.

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Management of Asthma

Measure Title

Hospital admissions for asthma per 100,000 population (2-17, 18-64, 65 and over).

Measure Source

Healthy People 2010.

Agency for Healthcare Research and Quality (AHRQ), Pediatric Quality Indicators (PDIs).

National Tables

8_3_2.1 Pediatric asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system and transfers from other institutions) per 100,000 population, ages 2-17, United States, 2000 and 2005.

8_3_2.2 Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2000 and 2005.

8_3_2.3 Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 65 and over, United States, 2000 and 2005.

8_3_2.4 Pediatric asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system and transfers from other institutions) per 100,000 population, ages 2-17, United States, 2005, by:

  • Race/ethnicity.

8_3_2.5 Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2005, by:

  • Race/ethnicity.

8_3_2.6 Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 65 and over, United States, 2005, by:

  • Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS).

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

U.S. population ages 2-17, 18-64, and 65 and over by subcategories (age group, gender, region, median household income level, and urbanization).

National Numerator

Number of discharges with principal diagnosis of asthma (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 493.00-493.92) among children ages 2-17, adults ages 18-64, and adults age 65 and over. Excludes patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions.

State Tables

8_3_2.7 Pediatric asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system and transfers from other institutions) per 100,000 population, ages 2-17, by State, 2000 and 2005.

8_3_2.8 Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2000 and 2005.

8_3_2.9 Asthma admissions (excluding patients with cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions) per 100,000 population, age 65 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

U.S. population ages 2-17, 18 and over, and age 65 and over, by State.

State Numerator

Same as national.

Comments

Rates are adjusted by age and gender, using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

The tables related to children were created using version 3.1 of the AHRQ PDI software. This measure is referred to as PDI 14 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

The tables related to adults age 18 and over were created using version 3.1 of the AHRQ PQI software. This measure is referred to as PQI 15 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

The tables related to adults age 65 and over were created using version 3.1 of the AHRQ PQI software. This measure is a modified version of PQI 15 in the software documentation. It excludes all patients under age 65. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure is referred to as measure 24-2 in Healthy People 2010 documentation. The age range has been modified from the original specification.

For age 65 and over, this measure is referred to as measure 24-2c in Healthy People 2010 documentation.

The SID disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, VT, and WI.

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Management of Asthma

Measure Title

People with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma (inhaled corticosteroids).

Measure Source

National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS).

Tables

8_3_3.1 People ages 5-56 with persistent asthma who were prescribed medications acceptable as primary therapy for long-term control of asthma, United States, 2005 and 2007.

Data Source

NCQA, HEDIS.

Denominator

Eligible health plan members with persistent asthma, defined as meeting at least one of four criteria during both the measurement year and the year prior to the measurement year:

  • At least one emergency department visit with a principal diagnosis of asthma.
  • At least one acute inpatient discharge with a principal diagnosis of asthma.
  • At least four outpatient asthma visits, with any listed diagnosis of asthma and at least two asthma medication dispensing events.
  • At least four asthma medication dispensing events; additional criteria apply if only leukotriene modifiers were dispensed. Criteria need not be the same in both years.

Numerator

Eligible health plan members with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma: antiasthmatic combinations, inhaled steroid combinations, inhaled corticosteroids, leukotriene modifiers, mast cell stabilizers, or methylxanthines.

Comments

The specifications for this measure have changed; 2005 reported rates may not be comparable with rates reported in prior years of the NHQR. Refer to HEDIS 2006 technical specifications for a more thorough discussion of measure requirements.

Return to Measure Specifications

Current as of September 2009
Internet Citation: Effectiveness of Care: Respiratory Diseases: 2008 National Healthcare Quality and Disparities Reports. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr08/measurespec/respiratory_diseases.html