Efficiency

2009 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.


Potentially Avoidable Hospitalizations and Cost
Trends in potentially avoidable hospitalizations and costs
Medicare home health patients with potentially avoidable hospitalizations within 30 days of start of care
Short-stay and long-stay nursing home residents with potentially avoidable hospitalizations within 30 days of admission
Potentially avoidable hospitalizations and emergency department encounters for congestive heart failure
Rehospitalizations for congestive heart failure (CHF)

Reduction of Unnecessary Costs
Visits with antibiotics prescribed for a diagnosis of common cold per 10,000 population
Average estimated relative hospital cost efficiency index for selected sample of urban general community hospitals
Correlates of hospital cost efficiency
 


Potentially Avoidable Hospitalizations and Cost

Measure Title

Trends in potentially avoidable hospitalizations and costs.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQIs).

Tables

15_1_1.1 Potentially avoidable hospitalizations per 100,000 population for all conditions, age 18 and over, United States, 2000 and 2006.

15_1_1.2 Potentially avoidable hospitalizations per 100,000 population for acute conditions, age 18 and over, United States, 2000 and 2006.

15_1_1.3 Potentially avoidable hospitalizations per 100,000 population for chronic conditions, age 18 and over, United States, 2000 and 2006.

Data Source

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

Denominator

U.S. population age 18 and over.

Numerator

The number of hospitalizations, age 18 and over, who qualified for any individual PQI numerator: 1, 3, 5, 7, 8, 10, 11, 12, 13, 14, 15, and 16 (for Table 15_1_1).
The number of hospitalizations, age 18 and over, who qualified for any individual PQI numerator considered acute: 10, 11, and 12. (for Table 15_1_2).
The number of hospitalizations, age 18 and over, who qualified for any individual PQI numerator considered chronic: 1, 3, 5, 7, 8, 13, 14, 15, and 16 (for Table 15_1_3).

The PQI components of the composites are:
1 Diabetes, short-term complications
3 Diabetes, long-term complications
5 Chronic obstructive pulmonary disease
7 Hypertension
8 Congestive heart failure
10 Dehydration
11 Bacterial pneumonia
12 Urinary tract infections
13 Angina without procedure
14 Uncontrolled diabetes
15 Adult asthma
16 Lower extremity amputations among patients with diabetes

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 table was created using version 3.1 of the AHRQ PQI software. The overall composite: PQI 90 includes all PQIs except 2 and 9 (2: Perforated appendix, 9: Low birth weight). The acute-only composite: PQI 91 includes three PQI conditions considered acute (dehydration, bacterial pneumonia, and urinary tract infection). The chronic-only composite: PQI 92 includes nine PQI indicators that measure chronic conditions (diabetes, chronic obstructive pulmonary disease, hypertension, congestive heart failure, angina, and asthma). For further information, please see Prevention Quality Indicators (PQI) Composite Measure Workgroup Final Report, April 2006, available from http://www.qualityindicators.ahrq.gov/pqi_download.htm.

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Potentially Avoidable Hospitalizations and Cost

Measure Title

Medicare home health patients with potentially avoidable hospitalizations within 30 days of start of care.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQIs).

Table

Data table will not be presented this year.

Data Source

Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organization (QIO) Program..

Denominator

Start of care episodes for adult nonmaternity patients receiving at least some skilled home health care.

Numerator

Subset of the denominator admitted to a hospital within 30 days of start of care.

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Potentially Avoidable Hospitalizations and Cost

Measure Title

Short-stay and long-stay nursing home residents with potentially avoidable hospitalizations within 30 days of admission.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQIs).

Table

Data table will not be presented this year.

Data Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home Minimum Data Set (MDS).

Denominator

Short-stay residents who met the Medicare skilled nursing facility (SNF) criteria for nursing home admission and long-stay residents who did not meet Medicare SNF criteria.

Numerator

Subset of denominator admitted to a hospital within 30 days of nursing home admission..

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Potentially Avoidable Hospitalizations and Cost

Measure Title

Potentially avoidable hospitalizations and emergency department encounters for congestive heart failure.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQIs).

Table

Data table will not be presented this year.

Data Source

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

Denominator

U.S. civilian population age 18 and over.

Numerator

Subset of denominator who were admitted to a hospital or visited an emergency department for congestive heart failure.

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Potentially Avoidable Hospitalizations and Cost

Measure Title

Rehospitalizations for congestive heart failure (CHF).

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQIs).

Table

Data table will not be presented this year.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID).

Denominator

U.S. civilian population age 18 and over in 14 States.

Numerator

Subset of denominator admitted to any hospital in that State with a principal diagnosis of CHF within 30 days of the discharge date of an index CHF admission.

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Reduction of Unnecessary Costs

Measure Title

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

Measure Source

Healthy People 2010.

Tables

15_2_1.1 Doctor's office, emergency department, and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, United States, 1997-1998 and 2006-2007.

15_2_1.2 Doctor's office, emergency department, and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, United States, 2006-2007, 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) (NAMCS-NHAMCS).

Denominator

U.S. civilian noninstitutionalized population.

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 codes 460.0, 465, or 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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Reduction of Unnecessary Costs

Measure Title

Average estimated relative hospital cost efficiency index for selected sample of urban general community hospitals.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT).

Table

Data table will not be presented this year.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID).

Denominator

Not Applicable

Numerator

Not Applicable


Reduction of Unnecessary Costs

Measure Title

Correlates of hospital cost efficiency.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT).

Table

Data table will not be presented this year.

Data Source

American Hospital Association Annual Survey of Hospitals and Medicare Reports.

Denominator

Not Applicable

Numerator

Not Applicable

Current as of March 2010
Internet Citation: Efficiency: 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/measurespec/efficiency.html