National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Findings Prevention: Pneumococcal Vaccination Vaccination is a cost-effective strategy for reducing illness, death, and disparities associated with pneumonia and influenza. Figure 2.39. Adults age 65 and over who reported ever receiving pneumococcal vaccination, by race and ethnicity, 2000-2009 Chapter 2 Respiratory Diseases Percent 75 White Black Asian 2008 Achievable Benchmark: 67% 65 55 45 Percent 75 65 55 45 Non-Hispanic White Hispanic 2008 Achievable Benchmark: 67% 35 35 25 Z 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000-2009. Denominator: Civilian noninstitutionalized population age 65 and over. Note: Age adjusted to the 2000 U.S. standard population. Benchmark is derived from the Behavioral Risk Factor Surveillance System; see Chapter 1, Introduction and Methods, for details. n Overall, the percentage of adults age 65 and over who reported ever having pneumococcal vaccination increased from 53% in 2000 to 61% in 2009 (data not shown). Increases were observed among all racial and ethnic groups between 2000 and 2009 (Figure 2.39). n In all years, Blacks and Asians were less likely than Whites, and Hispanics were less likely than non- Hispanic Whites to have pneumococcal vaccination. n The 2008 top 5 State achievable benchmark was 67%. xxi At the current annual rate of increase, this benchmark could be attained overall in about 8 years. Whites could attain the achievable benchmark in about 6 years, while Blacks, Asians, and Hispanics would not attain the benchmark for 16, 19, and 30 years, respectively. 25 Z 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 xxi The top 5 States contributing to the achievable benchmark are Colorado, Delaware, Maine, New Hampshire, and Oklahoma. 104 National Healthcare Disparities Report, 2011
Effectiveness of Care Also, in the NHQR: n In all years, adults with Medicare only were less likely than adults with Medicare and private supplemental health insurance to have pneumococcal vaccination. Poor adults were less likely than high-income adults to have pneumococcal vaccination. Treatment: Receipt of Recommended Care for Pneumonia CMS tracks a set of measures for quality of pneumonia care for hospitalized patients from the CMS Quality Improvement Organization Program. This set of measures has been adopted by the Hospital Quality Alliance. Recommended care for patients with pneumonia includes receipt of (1) initial antibiotics within 6 hours of hospital arrival, (2) antibiotics consistent with current recommendations, (3) blood culture before antibiotics are administered, (4) influenza vaccination status assessment or provision, and (5) pneumococcal vaccination status assessment or provision. An opportunities model composite of these five measures is presented here. Figure 2.40. Hospital patients with pneumonia who received recommended hospital care, by race/ethnicity, 2007-2009. 100 Total White Black Hispanic Asian AI/AN 95 2008 Achievable Benchmark: 94% Chapter 2 Respiratory Diseases Percent 90 85 80 75 Z 0 2007 2008 2009 Key: AI/AN = American Indian or Alaska Native. Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2007-2009. Denominator: Patients hospitalized with a principal discharge diagnosis of pneumonia or a principal discharge diagnosis of either septicemia or respiratory failure and secondary diagnosis of pneumonia. Note: White, Black, AI/AN, and Asian groups are non-Hispanic; Hispanic includes all races. Recommended care includes initial antibiotics within 6 hours of hospital arrival, antibiotics consistent with current recommendations, blood culture before antibiotics are administered, influenza vaccination status assessment or provision, and pneumococcal vaccination status assessment or provision. n In 2009, 93% of hospital patients with pneumonia received recommended hospital care (Figure 2.40). n In all years, the percentage of patients with pneumonia who received recommended hospital care was significantly lower for Blacks, Asians, AI/ANs, and Hispanics compared with Whites. n In 2008, the top 5 State achievable benchmark was 94%. xxii By 2009, all racial/ethnic groups were close to the benchmark except AI/ANs. xxii The top 5 States contributing to the achievable benchmark are Iowa, Maine, New Hampshire, New Jersey, and Vermont. National Healthcare Disparities Report, 2011 105
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