Timeliness

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.


Getting Appointments for Care
Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted
Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted
Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted
Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted

Waiting Time
Emergency department (ED) visits lasting 6 or more hours and resulting in admission to the hospital or transfer to another facility, per 1,000 ED visits
Emergency department (ED) visits where patients left without being seen
Hospital patients with heart attack who received percutaneous coronary intervention (PCI) within 90 minutes of arrival
Hospital patients with heart attack who received fibrinolytic medication within 30 minutes of arrival
 


Getting Appointments for Care

Measure Title

Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted.

Measure Source

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

National Tables

13_1_1.1 Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2006.

13_1_1.2 Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2002.

13_1_1.3 Adults who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, United States, 2006, by:

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

13_1_1.4 Adults who had an appointment for routine health care in the last 12 months who usually got appointments for routine care as soon as wanted, United States, 2006, by:

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

13_1_1.5 Adults who had an appointment for routine health care in the last 12 months who sometimes or never got appointments for routine care as soon as wanted, United States, 2006, by:

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

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Adults age 18 and over who made an appointment for regular or routine health care in the last 12 months and answered the question, “In the last 12 months, how often did you get an appointment for regular or routine health care as soon as you wanted?” Nonresponses as well as “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in three categories according to their answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

13_1_1.6 Adults who had an appointment for routine health care in the last 6 months who always got appointments for routine care as soon as wanted, Medicaid, by State, 2007 and 2008

13_1_1.7 Adults who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, Medicare managed care, by State, 2007 and 2008

13_1_1.8 Adults who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, Medicare fee for service, by State, 2007 and 2008

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

For Medicaid, respondents who answered "Yes" to the question, "In the last 6 months did you make any appointments with a doctor or other health care provider for regular or routine health care?"

For Medicare managed care and Medicare fee for service, respondents who answered "Yes" to the question, "In the last 12 months did you make any appointments with a doctor or other health care provider for regular or routine health care?"

State Numerator

For Medicaid, subset of the denominator population who answered "Always" to the question, "In the last 6 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?"

For Medicare managed care and Medicare fee for service, subset of the denominator population who answered "Always" to the question, "In the last 12 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?"

Comments

National tables report data from the MEPS Self-Administered Questionnaire (SAQ). See the MEPS entry in the Data Sources appendix for more information on the SAQ.

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Getting Appointments for Care

Measure Title

Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted.

Measure Source

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

National Tables

13_1_2.1 Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2006.

13_1_2.2 Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2002.

13_1_2.3 Children who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

13_1_2.4 Children who had an appointment for routine health care in the last 12 months who usually got appointments for routine care as soon as wanted, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

13_1_2.5 Children who had an appointment for routine health care in the last 12 months who sometimes or never got appointments for routine care as soon as wanted, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Children who had an appointment for regular or routine health care in the last 12 months and with a valid answer to the question, “In the last 12 months, how often did [the person] get an appointment for regular or routine health care as soon as you wanted?” Nonresponses, as well as “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in three categories according to their parents or guardian's answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

13_1_2.6 Children who had an appointment for routine health care in the last 6 months who always got appointments for routine care as soon as wanted, Medicaid, by State, 2007 and 2008

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

Children with Medicaid benefits who had appointments with a doctor or other health care provider for regular or routine health care in the last 6 months.

State Numerator

Subset of the denominator population with their parent or guardian's answer of “Always” to the question, “In the last 6 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?”

Comments

The national table reports data from the MEPS Child Health section. See the MEPS entry in the Data Sources appendix for more information.

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Getting Appointments for Care

Measure Title

Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted.

Measure Source

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

National Tables

13_1_3.1 Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2006.

13_1_3.2 Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2002.

13_1_3.3 Adults who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, United States, 2006, by:

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

13_1_3.4 Adults who needed care right away for an illness, injury, or condition in the last 12 months who usually got care as soon as wanted, United States, 2006, by:

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

13_1_3.5 Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, United States, 2006, by:

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

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Adults age 18 and over who had an illness or injury that needed care right away from a doctor's office, clinic, or emergency room in the last 12 months and also answered the question, “In the last 12 months, when you needed care right away for an illness or injury, how often did you get care as soon as you wanted?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in 3 categories according to their answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

13_1_3.6 Adults who needed care right away for an illness, injury, or condition in the last 6 months who always got care as soon as wanted, Medicaid, by State, 2007 and 2008

13_1_3.7 Adults who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, Medicare managed care, by State, 2007 and 2008

13_1_3.8 Adults who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, Medicare fee for service, by State, 2007 and 2008

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

For Medicaid, adults who reported having an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office in the last 6 months.

For Medicare managed care and Medicare fee for service, adults who reported having an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office in the last 12 months

State Numerator

For Medicaid, subset of the denominator who answered “Always” to the question, “In the last 6 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?”

For Medicare managed care and Medicare fee for service, subset of the denominator who answered “Always” to the question, “In the last 12 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?”

Comments

National tables report data from the MEPS Self-Administered Questionnaire (SAQ). See the MEPS entry in the Data Sources appendix for more information on the SAQ.

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Getting Appointments for Care

Measure Title

Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted.

Measure Source

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

National Tables

13_1_4.1 Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2006.

13_1_4.2 Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2002.

13_1_4.3 Children who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

13_1_4.4 Children who needed care right away for an illness, injury, or condition in the last 12 months who usually got care as soon as wanted, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

13_1_4.5 Children who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, United States, 2006, by:

  • Race.
  • Ethnicity.
  • Family income.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Children under age 18 who had an illness or injury that needed care right away from a doctor's office, clinic, or emergency room in the last 12 months, with a valid answer to the question, “In the last 12 months, when [the person] needed care right away for an illness or injury, how often did [person] get care as soon as you wanted?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in 3 categories according to their parents or guardians' answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

13_1_4.6 Children who needed care right away for an illness, injury, or condition in the last 6 months who always got care as soon as wanted, Medicaid, by State, 2007 and 2008

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

Children with Medicaid benefits who had an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office in the last 6 months.

State Numerator

Subset of the denominator with their parent or guardian's answer of “Always” to the question, “In the last 6 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?”

Comments

The national table reports data from the MEPS Child Health section. See the MEPS entry in the Data Sources appendix for more information.

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Waiting Time

Measure Title

Emergency department (ED) visits lasting 6 or more hours and resulting in admission to the hospital or transfer to another facility, per 1,000 ED visits.

Measure Source

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

Tables

13_2_1.1 Emergency department (ED) visits in which patient was admitted to the hospital or transferred to another facility whose ED visit was 6 hours or more, United States, 2000-2001 and 2006-2007.

13_2_1.2 Emergency department (ED) visits in which patient was admitted to the hospital or transferred to another facility whose ED visit was 6 hours or more, United States, 2006-2007, by:

  • Race.

Data Source

CDC, NCHS, National Hospital Ambulatory Medical Care Survey (NHAMCS).

Denominator

Visits to the emergency department (ED) resulting in admission to the hospital or ICU/CCU, or transfer to another facility.

Numerator

Subset of the denominator with those who remained in the ED for 6 hours or more.

Comments

The NHAMCS ED question is “Visit Disposition,” where disposition is admit to hospital, admit to intensive care unit or critical care unit, or transfer to other facility.

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Waiting Time

Measure Title

Emergency department (ED) visits where patients left without being seen.

Measure Source

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

Tables

13_2_2.1 Emergency department visits where patients left without being seen, United States, 1997-1998 and 2006-2007.

13_2_2.2 Emergency department visits where patients left without being seen, United States, 2006-2007, by:

  • Race.

Data Source

CDC, NCHS, National Hospital Ambulatory Medical Care Survey (NHAMCS).

Denominator

Visits to the emergency departments (EDs) and outpatient departments of noninstitutional general and short-stay hospitals, exclusive of Federal, military, and Veterans Affairs hospitals located in the 50 States and the District of Columbia.

Numerator

Subset of the denominator with a visit disposition of “left before being seen” on the NHAMCS Emergency Department Patient Record Form.

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Waiting Time

Measure Title

Hospital patients with heart attack who received percutaneous coronary intervention (PCI) within 90 minutes of arrival.

Measure Source

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

National Tables

13_2_3.1 Hospital patients with heart attack who received percutaneous coronary intervention (PCI) within 90 minutes of arrival, United States, 2005 and 2007.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented percutaneous transluminal angioplasty or stent placement during the hospital stay.

National Numerator

Subset of denominator given percutaneous coronary intervention (angioplasty or stent placement) within 90 minutes of arrival.

State Tables

13_2_3.2 Hospital patients with heart attack who received percutaneous coronary intervention (PCI) within 90 minutes of arrival, by State, 2005 and 2007.

13_2_3.3 Hospital patients with heart attack who were given percutaneous coronary intervention within 90 minutes of arrival, by State, 2005 and 2008.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Effective October 2003, CMS revised this measure. Rates may not be comparable with earlier versions of the report.

Median time is time in minutes from arrival to percutaneous transluminal angioplasty (PTCA) in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time.

International Classification of Diseases, Ninth Revision, Clinical Modification codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18 and patients transferred from other acute care hospitals, including other emergency departments, and patients administered thrombolytic agents. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

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

For QIO tables, the estimate for the Total row is based on State-level estimates whereas the estimates for the demographic categories are based on patient/episode-level data.

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Waiting Time

Measure Title

Hospital patients with heart attack who received fibrinolytic medication within 30 minutes of arrival.

Measure Source

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

National Tables

13_2_4.1 Hospital patients with heart attack who received fibrinolytic medication within 30 minutes of arrival, United States, 2005 and 2007.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented thrombolytic therapy during the hospital stay.

National Numerator

Subset of denominator with thrombolytic therapy within 30 minutes of arrival.

State Tables

13_2_4.2 Hospital patients with heart attack who received fibrinolytic medication within 30 minutes of arrival, by State, 2005 and 2007.

13_2_4.3 Hospital patients with heart attack who were given fibrinolytic medication within 30 minutes of arrival, by State, 2005 and 2008.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The 2006 and 2006 estimates are within 120 minutes of arrival.

Effective October 2003, CMS revised this measure. Rates may not be comparable with earlier versions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

Median time is in minutes from arrival to initiation of a thrombolytic agent in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time.

International Classification of Diseases, Ninth Revision, Clinical Modification codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18 and patients transferred from another acute care hospital, including another emergency department. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

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

For QIO tables, the estimate for the Total row is based on State-level estimates whereas the estimates for the demographic categories are based on patient/episode-level data.


 

Current as of March 2010
Internet Citation: Timeliness: 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/timeliness.html