Effectiveness: Diabetes

2010 National Healthcare Quality and Disparities Reports

Effectiveness of Care: Diabetes

Management of Diabetes
Composite measure: Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year (hemoglobin A1c measurement, dilated eye examination, and foot examination)
Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c measurement in the calendar year
Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year
Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year.
Adults age 40 and over with diagnosed diabetes who received an influenza vaccination in the last 12 months
Adults age 40 and over with diabetes whose condition was diagnosed

Control of Diabetes
Adults age 40 and over with diagnosed diabetes with HbA1c level <7.0% (optimal control)
Adults age 40 and over with diagnosed diabetes with total cholesterol ≤200 mg/dL
Adults age 40 and over with diagnosed diabetes with blood pressure <140/80 mm Hg

Hospitalizations for Diabetes
Hospital admissions for uncontrolled diabetes among adults age 18 and over
Hospital admissions for short-term complications of diabetes per 100,000 population
Hospital admissions for long-term complications of diabetes per 100,000 population age 18 and over
Hospital discharges for lower extremity amputations per 1,000 population age 18 and over with diabetes

Management of Diabetes

Measure Title

Composite measure: Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year (hemoglobin A1c test, dilated eye examination, and foot examination).

Measure Source

National Diabetes Quality Improvement Alliance, National Quality Forum, 2002.

National Tables

2_1_1.1 Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year, United States, 2002-2007

2_1_1.2a-d Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

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

Denominator

U.S. civilian noninstitutionalized population age 40 and over with diabetes, who had a positive Diabetes Care Survey weight and who had at least one No response to the three survey items related to the receipt of diabetes services or who had a Yes response to each survey item pertaining to receipt of diabetes services. Cases with missing values were excluded.

Numerator

U.S. civilian noninstitutionalized population age 40 and over with diabetes who had a positive Diabetes Care Survey weight and who responded Yes to each of three survey items related to receipt of diabetes services.

Comments

The criteria for selecting the diabetes population from the MEPS and the methodology for calculating the diabetes composite measure have changed over time and reported rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

The method for defining the numerator and denominator for the eye exam component of this composite measure changed beginning with the 2008 edition of the report; rates may not be comparable with those reported in earlier editions.

Cases with any missing values for the measures that make up the composite were excluded from the analysis.

See entries for each of the three components of the composite measure for further details about the individual survey questions.

National estimates are age adjusted to the 2000 U.S. standard population with two age groups: 40-59, 60 and over.

The measures that make up this composite measure are referred to as measures 5-12, 5-13, and 5-14 in Healthy People 2010 documentation.

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c test in the calendar year.

Measure Source

National Diabetes Quality Improvement Alliance, National Quality Forum, 2002.

Healthy People 2010.

National Tables

2_1_2.1 Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c test in the calendar year, United States, 2002-2007

2_1_2.2a-d Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c test in the calendar year, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized population age 40 and over with diabetes who had a positive Diabetes Care Survey (DCS) weight and who responded to the DCS question: During the survey year, "How many times did a doctor, nurse, or other health professional check for glycosylated hemoglobin or �hemoglobin A-one-C'?" Nonrespondents and "don't know" responses were excluded.

National Numerator

Subset of the denominator who had a positive Diabetes Care Survey (DCS) weight and who had a hemoglobin A1c test at least once in the preceding calendar year.

State Table

2_1_2.3 Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c test in the calendar year, by State, 2001-2008

State Data Source

Centers for Disease Control and Prevention (CDC),Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Adults with diabetes who had a hemoglobin A1c test at least once in the survey year.

Comments

The criteria for selecting the diabetes population from the MEPS have changed; reported national rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

The National Table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources appendix for more information on the DCS.

Nonrespondents and "don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 U.S. standard population with two age groups: 40-59, 60 and over.

This measure is referred to as measure 5-12 in Healthy People 2010 documentation.

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year.

Measure Source

National Diabetes Quality Improvement Alliance, National Quality Forum, 2002.

Healthy People 2010.

National Tables

2_1_3.1 Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year, United States, 2002-2007

2_1_3.2a-d Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized population age 40 and over with diabetes who responded to the Diabetes Care Survey (DCS) question: "When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to light."

National Numerator

Subset of denominator who indicated they had at least one dilated eye examination in the preceding calendar year.

State Table

2_1_3.3 Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year, by State, 2001-2008

State Data Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Adults with diabetes who had at least one dilated eye examination in the survey years.

Comments

The criteria for selecting the diabetes population from the MEPS have changed; reported national rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

The method for defining the numerator and denominator for this measure changed beginning with the 2008 edition of the report; rates may not be comparable with those reported in earlier editions.

The National Table reports data from the MEPS Diabetes Care Survey (DCS). Go to the MEPS entry in the Data Sources appendix and http://meps.ahrq.gov/ for more information on the DCS and MEPS panels.

There is a slight difference between the text of the question asked in 2003 and later and the question asked in 2002 and earlier. In the earlier years, respondents were asked "When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to light." In 2003 and later, respondents were asked "Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light."

Nonrespondents and "don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 U.S. standard population with two age groups: 40-59, 60 and over.

This measure is referred to as measure 5-13 in Healthy People 2010 documentation.

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year.

Measure Source

Healthy People 2010.

National Diabetes Quality Improvement Alliance , National Quality Forum, 2002.

National Tables

2_1_4.1 Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year, United States, 2002-2007

2_1_4.2a-d Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized population age 40 and over with diabetes who responded to the question: "During [the survey year], how many times did a health professional check your feet for any sores or irritation?" Nonrespondents and "don't know" responses were excluded.

National Numerator

Subset of denominator who had a foot examination one or more times in the survey year.

State Table

2_1_4.3 Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year, by State, 2001-2008

State Data Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Subset of denominator who had one or more foot examinations in the survey years.

Comments

The criteria for selecting the diabetes population from the MEPS have changed; reported national rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

The National Table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources appendix for more information on the DCS.

Nonrespondents and "don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 U.S. standard population with two age groups: 40-59, 60 and over.

This measure is referred to as measure 5-14 in Healthy People 2010 documentation.

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Management of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes who received an influenza vaccination in the last 12 months.

Measure Source

National Diabetes Quality Improvement Alliance, National Quality Forum, 2002.

National Tables

2_1_5.1 Adults age 40 and over with diagnosed diabetes who received a flu shot in the last 12 months, United States, 2002-2007

2_1_5.2a-d Adults age 40 and over with diagnosed diabetes who received a flu shot in the last 12 months, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized adults age 40 and over with diabetes who responded to the question "How long since you had a flu shot?" Nonrespondents and "don't know" responses were excluded.

National Numerator

U.S. civilian noninstitutionalized population age 40 and over with diabetes who had an influenza immunization in the past year.

State Table

2_1_5.3 Noninstitutionalized high-risk adults ages 18-64 with diabetes who had an influenza immunization in the past year, by State, 2001-2008

State Data Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

High-risk adults ages 18-64 with diabetes.

State Numerator

High-risk adults ages 18-64 with diabetes who had an influenza immunization in the past year.

Comments

The criteria for selecting the diabetes population from the MEPS have changed; reported national rates may not be comparable to those found in prior years' editions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

The Healthy People 2010 definition of high-risk conditions include: diabetes, heart disease, lung disease, kidney disease, liver disease, and cancer. High-risk conditions used to define the denominator differ from that in Healthy People 2010 in that only adults with diabetes are included.

The criteria for selecting the diabetes population from the MEPS have changed; reported rates may not be comparable with those found in prior years' editions.

Nonrespondents and "don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 U.S. standard population with two age groups: 40-59, 60 and over.

The National Table reports data from the MEPS Preventive Care section. See the MEPS entry in the Data Sources appendix for more information.

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Management of Diabetes

Measure Title

Adults age 40 and over with diabetes whose condition was diagnosed.

Measure Source

Healthy People 2010.

National Table

2_1_6.1 Adults age 40 and over with diabetes whose condition was diagnosed, United States, 2001-2004 and 2005-2008

National Data Source

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

Denominator

Number of adults age 40 years and over who have a fasting blood glucose level of 126 mg/dL or higher.

Numerator

Subset of denominator who report that they have ever been diagnosed with diabetes.

Comments

This measure is referred to as measure 5-4 in Healthy People 2010 documentation. The age range has been modified from the original specification. Percentages are age adjusted using the 2000 U.S. standard population with two age groups (40-59, 60 and over).

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Control of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes with an HbA1c level <7.0% (optimal control).

Measure Source

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

National Table

2_2_1.1 Adults age 40 and over with diagnosed diabetes with an HbA1c level less than 7.0% (optimal control), United States, 2001-2004 and 2005-2008.

National Data Source

CDC, NCHS, NHANES.

Denominator

Adults age 40 and over with diabetes.

Numerator

Adults with diabetes who had hemoglobin A1c (HbA1c) level less than 7.0% at examination.

Comments

The criteria for selecting the diabetes population from the NHANES have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report.

Percentages are age adjusted using the 2000 standard population with two age groups (40-59, 60 and over).

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Control of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes who have a total cholesterol level ≤200 mg/dL.

Measure Source

National Diabetes Quality Improvement Alliance, National Quality Forum, 2002.

National Table

2_2_2.1 Adults age 40 and over with diagnosed diabetes and a total cholesterol level at or less than 200 mg/dL, United States, 2001-2004 and 2005-2008

National Data Source

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

Denominator

Adults age 40 and over with diabetes.

Numerator

Subset of the denominator with most recent total cholesterol level less than 200 mg/dL at examination.

Comments

The criteria for selecting the diabetes population from the NHANES have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report.

Percentages are age adjusted using the 2000 U.S. standard population with two age groups (40-59, 60 and over).

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Control of Diabetes

Measure Title

Adults age 40 and over with diagnosed diabetes and with blood pressure <140/80 mm Hg.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

2_2_3.1 Adults age 40 and over with diagnosed diabetes with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 80 mm Hg, based on an average of blood pressure measurements, United States, 2001-2004 and 2005-2008.

National Data Source

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

Denominator

Adults age 40 and over with diabetes.

Numerator

Adults with diabetes who have blood pressure less than 140/80 mm Hg at exam.

Comments

The criteria for selecting the diabetes population from the NHANES have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Quality Report.

Percentages are age adjusted using the 2000 U.S. standard population with two age groups (40-59, 60 and over).

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Hospitalizations for Diabetes

Measure Title

Hospital admissions for uncontrolled diabetes among adults age 18 and over.

Measure Source

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

National Tables

2_3_1.1 Admissions for uncontrolled diabetes (without complications) per 100,000 population, age 18 and over, United States, 2000, 2004-2007

2_3_1.2 Admissions for uncontrolled diabetes (without complications) per 100,000 population, age 18 and over, United States, 2007, by:

• Race/ethnicity.

2_3_1.4 Hospital admissions for uncontrolled diabetes per 100,000 population age 18 and over in Indian Health Service, Tribal, and contract hospitals, and community hospitals, 2000-2008

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

AHRQ, CDOM, HCUP, State Inpatient Databases, disparities analysis file.

Indian Health Service (IHS), Office of Information Technology/National Patient Information Reporting System (OIT/NPIRS), National Data Warehouse, Workload and Population Data Mart.

National Denominator

U.S. population age 18 and over.

IHS service population, age 18 and over.

National Numerator

Discharges among adults age 18 and over with a principal diagnosis of uncontrolled diabetes and without mention of short-term complications.

State Table

2_3_1.3 Admissions for uncontrolled diabetes without complications per 100,000 population, age 18 and over, by State, 2000, 2004-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1.

HCUP State Inpatient Databases (SID).

State Denominator

Population age 18 and over, by State.

State Numerator

Same as National.

Comments

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

Short-term complications include ketoacidosis, hyperosmolarity, and coma. Long-term complications include renal, eye, neurological, circulatory, and other unspecified. Excludes obstetric admissions and transfers from other institutions.

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.

Tables were created using version 3.1 of the AHRQ Prevention Quality Indicator (PQI) software. This measure is referred to as PQI 14 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 Nationwide Inpatient Sample 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 to provide national estimates on disparities for the NHQR/NHDR, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

Because both the California and Portland Areas have no IHS or Tribal inpatient facilities, any hospitalizations attributed to either one of these regions were not included; the denominator was correspondingly reduced. Rates were computed using estimates of the American Indian/Alaska Native population as of July 1, 2007, based on the 2000 census.

Data for the total were age adjusted using the 2000 U.S. standard population provided by NCHS: http://www.cdc.gov/nchs/data/statnt/statnt20.pdf (Plugin Software Help).

The numerator and denominator include hospitalizations in IHS hospitals and contract hospitals with admission dates from January 1, 2007, to December 31, 2007, inclusive.

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes used to identify discharges for uncontrolled diabetes are the same as AHRQ PQI 2, but the format of NPIRS did not allow for exclusion of transfers.

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Hospitalizations for Diabetes

Measure Title

Hospital admissions for short-term complications of diabetes per 100,000 population.

Measure Source

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

AHRQ, Pediatric Quality Indicators (PDIs).

National Tables

2_3_2.1 Admissions for diabetes with short-term complications per 100,000 population, age 18 and over, United States, 2000, 2004-2007

2_3_2.2 Admissions for diabetes with short-term complications per 100,000 population, ages 6-17, United States, 2000, 2004-2007

2_3_2.3 Admissions for diabetes with short-term complications per 100,000 population, age 18 and over, United States, 2007, by:

• Race/ethnicity.

2_3_2.4 Admissions for diabetes with short-term complications per 100,000 population, ages 6-17, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

U.S. population ages 6-17 (for pediatric measure) or age 18 and over (for adult measure) by subcategories.

National Numerator

Pediatric discharges ages 6-17 or adult discharges age 18 and over with a principal diagnosis of diabetes with short-term complications - ketoacidosis, hyperosmolarity, and/or coma. (ICD-9-CM codes 250.10-250.13, 250.20-250.23, 250.30-250.33). Obstetric admissions and transfers from other institutions are excluded.

State Tables

2_3_2.5 Admissions for diabetes with short-term complications per 100,000 population, age 18 and over, by State, 2000, 2004-2007

2_3_2.6 Admissions for diabetes with short-term complications per 100,000 population, ages 6-17, by State, 2000, 2004-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1, and State Inpatient Databases (SID).

State Denominator

Population ages 6-17 (for pediatric measure) or age 18 and over (for adult measure), by State.

State Numerator

Same as National.

Comments

Rates are adjusted by age and gender using the 2000 U.S. standard population.

Tables for the adult measure were created using version 3.1 of the AHRQ PQI software. This measure is referred to as PQI 1 in the software documentation. Tables for the pediatric measures were created using version 3.1 of the AHRQ PDI software. This measure is referred to as PDI 15 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 Nationwide Inpatient Sample 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

Measure excludes obstetric admissions and transfers from other institutions.

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Hospitalizations for Diabetes

Measure Title

Hospital admissions for long-term complications of diabetes per 100,000 population age 18 and over.

Measure Source

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

National Tables

2_3_3.1 Admissions for diabetes with long-term complications per 100,000 population, age 18 and over, United States, 2000, 2004-2007

2_3_3.2 Admissions for diabetes with long-term complications per 100,000 population, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

U.S. population age 18 and over.

National Numerator

Hospital inpatient discharges among people age 18 and over with a principal diagnosis code for diabetes long-term complications—renal, eye, neurological, circulatory, or complications not otherwise specified (ICD-9-CM codes 250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93). Obstetric admissions and patients transferred from other institutions are excluded.

State Table

2_3_3.3 Admissions for diabetes with long-term complications per 100,000 population, age 18 and over, by State, 2000, 2004-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1, and State Inpatient Databases (SID).

State Denominator

Population age 18 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.

Tables were created using version 3.1 of the AHRQ PQI software. This measure is referred to as PQI 3 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 Nationwide Inpatient Sample 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, WI, and WY.

Measure excludes obstetric admissions and transfers from other institutions.

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Hospitalizations for Diabetes

Measure Title

Hospital discharges for lower extremity amputations per 1,000 population age 18 and over with diabetes.

Measure Source

Healthy People 2010.

National Tables

2_3_4.1 Hospital admissions for lower extremity amputations per 1,000 population with diabetes, United States, 1998-2007

2_3_4.2 Hospital admissions for lower extremity amputations per 1,000 population with diabetes, United States, 2005-2007, by:

• Race.

National Data Source

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

Denominator

Number of U.S. civilian noninstitutionalized population who report that they have ever been diagnosed with diabetes, excluding women age 18 and over who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes).

Numerator

Subset of the denominator with amputation of the lower extremity (ICD-9-CM code 84.1) as any listed procedure. Amputations due to trauma (ICD-9-CM codes 895-897) are excluded.

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