Timeliness

2010 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.

Timeliness

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

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
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 sometimes or never 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 sometimes or never got appointments as soon as wanted, United States, 2002-2007

13_1_1.2a-d Adults who made an appointment for routine health care in the last 12 months who sometimes or never got an appointment as soon as wanted, United States, 2007 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 past 12 months and had a valid response to the MEPS question, "In the last 12 months, how often did you get an appointment for regular or routine health care as soon as you wanted?"

National Numerator

Subset of the denominator who answered "sometimes" or "never" to the question in the denominator.

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

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety (CQUIPS), National CAHPS® Benchmarking Database.

State Tables

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, Medicare fee for service, by State, 2007-2009

13_1_1.4 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, 2007-2009

13_1_1.5 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, 2007-2009

State Data Source

AHRQ, CQUIPS, CAHPS.

State Denominator

Adults age 18 and over who made an appointment for regular or routine health care in the past 12 months and had a valid response to the MEPS question, "In the last 12 months [6 months for Medicaid], how often did you get an appointment for regular or routine health care as soon as you wanted?"

State Numerator

Subset of the denominator who answered the above question "always."

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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 sometimes or never 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 sometimes or never got appointments as soon as wanted, United States, 2002-2007

13_1_2.2a-c Children who had an appointment for routine health care in the last 12 months who sometimes or never got an appointment for routine care as soon as wanted, United States, 2007 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 past 12 months and with a valid response 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?"

National Numerator

Subset of the denominator who, according to their parents or guardians, answered the above question "sometimes" or "never."

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Getting Appointments for Care

Measure Title

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.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) , Center for Quality Improvement and Patient Safety (CQUIPS), National CAHPS Benchmarking Database.

State Table

13_1_2.3 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, 2007-2009

State Data Source

AHRQ, CQUIPS, CAHPS.

State Denominator

Medicaid and State Children's Health Insurance Plans (SCHIP) enrollees.

State Numerator

Subset of the denominator who, according to their parents or guardians, answered the above question "always."

Comments

The National Table reports data from the MEPS Child Health section. See the MEPS entry in the Data Sources appendix for more information Nonrespondents, as well as "don't know" responses, were excluded.

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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 sometimes or never 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 sometimes or never got care as soon as wanted, United States, 2002-2007

13_1_3.2a-d 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, 2007, by:

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

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Adults age 18 and over who in the past 12 months had an illness or injury that needed care right away and had a valid response to 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?"

National Numerator

Subset of the denominator who responded "sometimes" or "never" to the above question.

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.

Nonrespondents, as well as "don't know" responses, were excluded.

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Getting Appointments for Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety (CQUIPS), National Consumer Assessment of Healthcare Providers and Systems (CAHPS) Benchmarking Database.

State Tables

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, Medicare fee for service, by State, 2007-2009

13_1_3.4 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, 2007-2009

13_1_3.5 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, 2007-2009

State Data Source

AHRQ, CQUIPS, CAHPS.

State Denominator

For Medicaid, adults who reported having an illness, injury, or condition who 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 who 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?"

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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 sometimes or never 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 sometimes or never got care as soon as wanted, United States, 2002-2007

13_1_4.2a-c 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, 2007, 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 in the past 12 months, with a valid response 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?"

National Numerator

Subset of the denominator whose parents or guardians answered the above question "sometimes" or "never."

Comments

Nonrespondents and respondents indicating "don't know" were excluded.

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

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.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety (CQUIPS) , National Consumer Assessment of Healthcare Providers and Systems (CAHPS) Benchmarking Database.

State Table

13_1_4.3 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, 2007-2009

State Data Source

AHRQ, CQUIPS, CAHPS.

State Denominator

Members of Medicaid and SCHIP enrollees.

State Numerator

Subset of the denominator whose parents or guardians indicated that needed care was "sometimes" or "never" received as soon as wanted.

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

National 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, 2007-2008

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 2001-2007

13_2_1.3a-b 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, 2007-2008, by:

  • Race.
  • Source of payment.

  • National Data Source

    CDC, NCHS, NHAMCS.

    National Denominator

    Visits to the ED where the patient was later admitted to the hospital or intensive care unit/critical care unit or transferred to another facility.

    National Numerator

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

    Comments

    The NHAMCS ED question refers to "Visit Disposition," where disposition includes admission to a hospital, admission to an intensive care unit or critical care unit, or transfer to another 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), National Hospital Ambulatory Medical Care Survey (NHAMCS).

    National Tables

    13_2_2.1 Emergency department visits where patients left without being seen, United States, 2007-2008

    13_2_2.2 Emergency department visits where patients left without being seen, United States, 1999-2007

    13_2_2.3a Emergency department visits where patients left without being seen, United States, 2007-2008, by:

    • Race.

    National Data Source

    CDC, NCHS, NHAMCS.

    National Denominator

    Visits to 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.

    National Numerator

    Subset of the denominator with a visit disposition indicating the patient "left before being seen" as recorded 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), Medicare Quality Improvement Organization (QIO) Program.

    National Table

    13_2_3.1 Hospital patients with heart attack who received percutaneous coronary intervention (PCI) within 90 minutes of arrival, United States, 2005-2008

    National Data Source

    CMS, QIO Program.

    National Denominator

    Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented receipt of percutaneous transluminal angioplasty or stent placement during the hospital stay; excluding persons under age 18 and patients transferred from other acute care hospitals (including other emergency departments) and patients administered thrombolytic agents.

    National Numerator

    Subset of denominator who received PCI (angioplasty or stent placement) within 90 minutes of arrival.

    State Table

    13_2_3.2 Hospital patients with heart attack who received percutaneous coronary intervention (PCI) within 90 minutes of arrival, by State, 2005-2008

    State Data Source

    CMS, QIO.

    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 reports.

    ICD-9-CM 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.

    Time is measured in minutes from arrival to receipt of percutaneous transluminal coronary angiopathy (PTCA) in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time.

    State Tables using Hospital Compare (HC) data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates are calculated using hospital-level scores.

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

    Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

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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), Medicare Quality Improvement Organization (QIO) Program.

    National Table

    13_2_4.1 Hospital patients with heart attack who received fibrinolytic medication within 30 minutes of arrival, United States, 2005-2008

    National Data Source

    CMS, QIO Program.

    National Denominator

    Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and thrombolytic therapy documented during the hospital stay, excluding patients under age 18 and patients transferred from another acute care hospital (including another emergency department).

    National Numerator

    Subset of denominator who received thrombolytic therapy within 30 minutes of arrival.

    State Table

    13_2_4.2 Hospital patients with heart attack who received fibrinolytic medication within 30 minutes of arrival, by State, 2005-2008.

    State Data Source

    CMS, QIO Program.

    State Denominator

    Same as National.

    State Numerator

    Same as National.

    Comments

    ICD-9-CM 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.

    Time is measured 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.

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

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

    Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

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

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Current as of February 2011
Internet Citation: Timeliness: 2010 National Healthcare Quality and Disparities Reports. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr10/measurespec/timeliness.html