2012 National Healthcare Quality and Disparities Reports
Effectiveness of Care: Cardiovascular Disease
Prevention of Heart Disease
Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high
Adults with controlled hypertension
Adults who received a blood cholesterol measurement in the last 5 years
Treatment of Heart Attack
Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI)
Treatment of Heart Failure
Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) at discharge
Hospital admissions for congestive heart failure (CHF) per 100,000 population
Deaths per 1,000 adult hospital admissions with congestive heart failure (CHF)
Surgery for Heart and Vascular Disease
Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair
Deaths per 1,000 hospital admissions with coronary artery bypass surgery (CABG), age 40 and over
Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty (PTCA), age 40 and over
Prevention of Heart Disease
Measure Title
Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high.
Measure Source
Healthy People 2020.
National Tables
2_2_1_1.1 Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high, United States, 1998, 2003, and 2008
2_2_1_1.2a-c Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high, United States, 2008, 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. adult population age 18 and over.
National Numerator
Subset of the denominator who had their blood pressure measured in the last 2 years and can state whether their blood pressure was normal or high.
Comments
This measure is referred to as measure HDS-4 in Healthy People 2020 documentation. Estimates are age adjusted to the 2000 U.S. standard population. Age data and health insurance data for the population age 65 and over are unadjusted.
Prevention of Heart Disease
Measure Title
Adults with controlled hypertension.
Measure Source
Healthy People 2020.
National Table
2_2_1_2.1 Adults with hypertension whose blood pressure is under control, United States, 1999-2010
National Data Source
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).
National Denominator
U.S. civilian noninstitutionalized population age 18 and over with high blood pressure/hypertension, excluding pregnant women.
National Numerator
Subset of denominator whose mean systolic blood pressure is less than 140 mm Hg and mean diastolic blood pressure is less than 90 mm Hg.
Comments
Controlled hypertension is defined as having an average blood pressure reading of <140/90 mm/Hg.
Percentages are age adjusted to the 2000 U.S. standard population, except where indicated, using three age groups: 18-39, 40-59, and 60 and over. This measure is referred to as measure HDS-12 in Healthy People 2020 documentation.
Prevention of Heart Disease
Measure Title
Adults who received a blood cholesterol measurement in the last 5 years.
Measure Source
Healthy People 2020.
National Tables
2_2_1_3.1_1 Adults who received a blood cholesterol measurement in the last 5 years, United States, 1998, 2003, and 2008
2_2_1_3.1_2a-c Adults who received a blood cholesterol measurement in the last 5 years, United States, 2008, 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. adult population age 18 and over.
National Numerator
Subset of the denominator who have had their cholesterol checked within the previous 5 years.
State Table
2_2_1_3.1_3 Adults age 18 and over who had their blood cholesterol checked within the last 5 years, by State, United States, 2001-2007 and 2009
State Data Source
CDC, Behavioral Risk Factor Surveillance System (BRFSS).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Data are age adjusted to the 2000 U.S. standard population. Age-adjusted rates are weighted sums of age-specific rates. This measure is referred to as measure HDS-6 in Healthy People 2020 documentation.
Treatment of Heart Attack
Measure Title
Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI).
Measure Source
Agency for Healthcare Research and Quality (AHRQ), Centers for Delivery Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Inpatient Quality Indicators (IQIs).
National Tables
2_2_2_1.1 Deaths per 1,000 hospital admissions with acute myocardial infarction, age 18 and over, United States, 2000, 2004-2009.
2_2_2_1.2 Deaths per 1,000 hospital admissions with acute myocardial infarction, age 18 and over, by race/ethnicity, United States, 2009
2_2_2_1.4 Deaths per 1,000 hospital admissions with acute myocardial infarction, age 18 and over, by income, United States, 2000-2009
National Data Source
AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.
National Denominator
All hospital inpatient discharges among people age 18 and over with a principal diagnosis of AMI. Excluded from the denominator are obstetric admissions and patients transferring to another short-term hospital or missing a discharge disposition.
National Numerator
Subset of the denominator who died.
State Table
2_2_2_1.3 Deaths per 1,000 hospital admissions with acute myocardial infarction, age 18 and over, by State, United States, 2000, 2004, 2007-2009
State Data Source
AHRQ, CDOM, HCUP, State Inpatient Databases (SID).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Rates are adjusted by age, major diagnostic category (MDC), all patient refined-diagnosis related group (APR-DRG) risk of mortality score, and transfers to the hospital. When reporting is by age, the adjustment is by MDC, APR-DRG risk of mortality score, and transfers to the hospital. The AHRQ IQI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).
Although not all States participate in the HCUP database, 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.
SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.
The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.
Treatment of Heart Failure
Measure Title
Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) at discharge.
Measure Source
Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organization Program (QIO).
National Tables
2_2_3_1.1 Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, United States, 2005-2010
National Data Source
CMS, QIO.
National Denominator
Discharged hospital patients age 18 and over with a principal diagnosis of acute myocardial infarction (AMI) and documented left ventricular ejection fraction, without contraindications for ACE inhibitors or ARB, excluding patients transferred to another acute care or Federal hospital, patients who died, patients who left against medical advice, patients discharged to hospice, and patients with certain conditions or contraindications pertaining to the medications described in the measure.
National Numerator
Subset of the denominator prescribed an ACE inhibitor or ARB at hospital discharge with no documentation of ACE inhibitor allergy or ARB allergy, moderate or severe aortic stenosis, or other reasons documented by a physician, nurse practitioner, or physician assistant for not prescribing an ACE inhibitor or ARB at discharge.
State Table
2_2_3_1.2 Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed ACE inhibitor or ARB at discharge, by State, United States, 2005-2010
State Data Source
CMS, QIO.
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Estimates for 2009 do not include data from the U.S. territories (Guam, Puerto Rico, and Virgin Islands); estimates for other years do not include data from Guam and the U.S. Virgin Islands.
Further information on this and other heart disease measures is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/index.html
Treatment of Heart Failure
Measure Title
Hospital admissions for congestive heart failure (CHF) per 100,000 population.
Measure Source
Healthy People 2020.
Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Prevention Quality Indicators (PQIs).
National Tables
2_2_3_2.1_1 Admissions for congestive heart failure, per 100,000 population, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008
2_2_3_2.1_4 Admissions for congestive heart failure per 100,000 population, age 18 and over, by income, United States, 2000-2008
National Data Source
AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.
National Denominator
U.S. population in metropolitan area or county, age 18 years and over.
National Numerator
Subset of the denominator with a principal diagnosis of CHF, excluding maternal discharges, transfers from other institutions, and cases with cardiac procedure codes.
State Table
2_2_3_2.1_3 Admissions for congestive heart failure per 100,000 population, age 18 and over, by State, United States, 2000, 2004, 2007-2009
State Data Source
AHRQ, CDOM, HCUP, State Inpatient Databases (SID).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Rates are adjusted by age and gender using the total U.S. resident 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 HDS-24 in Healthy People 2020 documentation. The age range has been modified from the original specification.
Although not all States participate in the HCUP database, 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.
SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.
The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.
Treatment of Heart Failure
Measure Title
Deaths per 1,000 adult hospital admissions with congestive heart failure (CHF).
Measure Source
Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Inpatient Quality Indicators (IQIs).
National Tables
2_2_3_3.1 Deaths per 1,000 hospital admissions with congestive heart failure, age 18 and over, United States, 2000, 2004-2009
2_2_3_3.2 Deaths per 1,000 hospital admissions with congestive heart failure, age 18 and over, by race/ethnicity, United States, 2009
2_2_3_3.4 Deaths per 1,000 hospital admissions with congestive heart failure, age 18 and over, by income, United States, 2000-2009
National Data Source
AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.
National Denominator
All discharges among people age 18 and over with principal diagnosis code of CHF, excluding transfers to another short-term hospital, obstetric admissions, and cases with a missing discharge disposition.
National Numerator
Subset of the denominator who died.
State Table
2_2_3_3.3 Deaths per 1,000 hospital admissions with congestive heart failure, age 18 and over, by State, United States, 2000, 2004, 2007-2009
State Data Source
AHRQ, CDOM, HCUP, State Inpatient Databases (SID).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Rates are adjusted by age, gender, age-gender interactions, major diagnostic category (MDC), all patient refined-diagnosis related group (APR-DRG) risk of mortality score, and transfers to the hospital. When reporting is by age, the adjustment is by gender, MDC, APR-DRG risk of mortality score, and transfers to the hospital; when reporting is by gender, the adjustment is by age, MDC, APR-DRG risk of mortality score, and transfers to the hospital. The AHRQ IQI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).
Although not all States participate in the HCUP database, 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.
SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.
The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.
Surgery for Heart and Vascular Disease
Measure Title
Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair.
Measure Source
Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Inpatient Quality Indicators (IQIs).
National Tables
2_2_4_1.1 Deaths per 1,000 hospital admissions with abdominal aortic aneurysm repair, age 18 and over, United States, 2000, 2004-2009
2_2_4_1.2 Deaths per 1,000 hospital admissions with abdominal aortic aneurysm repair, age 18 and over, by race/ethnicity, United States, 2009
2_2_4_1.4 Deaths per 1,000 hospital admissions with abdominal aortic aneurysm repair, age 18 and over, by income, United States, 2000-2009
National Data Source
AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.
National Denominator
Discharges age 18 years and over with an AAA repair code in any procedure field and a diagnosis of AAA in any field, excluding obstetric admissions, transfers to another short-term hospital, and cases with a missing discharge disposition.
National Numerator
Subset of the denominator who died.
State Table
2_2_4_1.3 Deaths per 1,000 hospital admissions with abdominal aortic aneurysm repair, age 18 and over, by State, United States, 2000, 2004, 2007-2009
State Data Source
AHRQ, CDOM, HCUP, State Inpatient Databases (SID).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Rates are adjusted by age, gender, age-gender interactions, major diagnostic category (MDC), and all patient refined-diagnosis related group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender, MDC, and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age, MDC, and APR-DRG risk of mortality score. The AHRQ IQI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).
Although not all States participate in the HCUP database, 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.
SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.
The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.
Surgery for Heart and Vascular Disease
Measure Title
Deaths per 1,000 hospital admissions with coronary artery bypass graft surgery (CABG), age 40 and over.
Measure Source
Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Inpatient Quality Indicators (IQIs).
National Tables
2_2_4_2.1 Deaths per 1,000 hospital admissions with coronary artery bypass graft, age 40 and over, United States, 2000, 2004-2009
2_2_4_2.2 Deaths per 1,000 hospital admissions with coronary artery bypass graft, age 40 and over, by race/ethnicity, United States, 2009
2_2_4_2.4 Deaths per 1,000 hospital admissions with coronary artery bypass graft, age 40 and over, by income, United States, 2000-2009
National Data Source
AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.
National Denominator
Hospital inpatient discharges, age 40 and over, with a CABG in any procedure field, excluding obstetric admissions and transfers to another hospital.
National Numerator
Subset of the denominator who died.
State Table
2_2_4_2.3 Deaths per 1,000 hospital admissions with coronary artery bypass graft, age 40 and over, by State, United States, 2000, 2004, 2007-2009
State Data Source
AHRQ, CDOM, HCUP, State Inpatient Databases (SID).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Rates are adjusted by age, gender, age-gender interactions, major diagnostic category (MDC), and all patient refined-diagnosis related group (APR-DRG) risk of mortality score. When reporting is by age, the adjustment is by gender, MDC, and APR-DRG risk of mortality score; when reporting is by gender, the adjustment is by age, MDC, and APR-DRG risk of mortality score. The AHRQ IQI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).
Although not all States participate in the HCUP database, 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.
SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.
The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.
Surgery for Heart and Vascular Disease
Measure Title
Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty (PTCA), age 40 and over.
Measure Source
Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Inpatient Quality Indicators (IQIs).
National Tables
2_2_4_3.1 Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty, age 40 and over, United States, 2000, 2004-2009
2_2_4_3.2 Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty, age 40 and over, by race/ethnicity, United States, 2009
2_2_4_3.4 Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty, age 40 and over, by income, United States, 2000-2009
National Data Source
AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.
National Denominator
Hospital inpatient discharges, age 40 and over, with PTCA in any procedure field, excluding obstetric admissions, transfers to another hospital, and cases with a missing discharge disposition.
National Numerator
Subset of the denominator who died.
State Table
2_2_4_3.3 Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty, age 40 and over, by State, United States, 2000, 2004, 2007-2009
State Data Source
AHRQ, CDOM, HCUP, State Inpatient Databases (SID).
State Denominator
Same as national.
State Numerator
Same as national.
Comments
Rates are adjusted by age, gender, age-gender interactions, major diagnostic category (MDC), all patient refined-diagnosis related group (APR-DRG) risk of mortality score, and transfers to the hospital. When reporting is by age, the adjustment is by gender, MDC, APR-DRG risk of mortality score, and transfers to the hospital; when reporting is by gender, the adjustment is by age, MDC, APR-DRG risk of mortality score, and transfers to the hospital. The AHRQ IQI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).
Although not all States participate in the HCUP database, 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.
SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient’s race.
The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.
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