National Healthcare Disparities Report - LDI Health Economist

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Patient Safety Figure 3.1. Adult surgery patients who received appropriate care, by gender and race/ethnicity, 2009 100 100 2009 Achievable Benchmark: 91% 2009 Achievable Benchmark: 91% 90 90 80 80 Chapter 3 Percent 70 Percent 70 60 60 50 Z 0 Male Female 50 Z 0 White Black Hispanic AI/AN Asian Key: AI/AN = American Indian/Alaska Native. Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2009. Denominator: Hospitalized patients having surgery. n In 2009, 87% of female surgery patients and 85% of male surgery patients received appropriate care (Figure 3.1). n More than 86% of White patients received appropriate surgical care. Nearly 86% of Black patients received appropriate surgical care, and 85% of Hispanic patients, 84% of Asian patients, and 82% of American Indian or Alaska Native (AI/AN) patients received appropriate surgical care. n The 2009 top 5 State achievable benchmark was 91%. ii Also, in the NHQR: n Eighty-seven percent of patients under age 65, 86% of patients ages 65-74, 85% of patients ages 75- 84, and 84% of patients age 85 and over received appropriate surgical care. Prevention: Appropriate Timing of Antibiotics Among Surgical Patients Wound infection following surgery is a common HAI. Hospitals can reduce the risk of surgical site infection by ensuring that patients get the right antibiotics at the right time on the day of their surgery. Surgery patients who get antibiotics within 1 hour before their operation are less likely to get wound infections than those who do not receive antibiotics within 1 hour before surgery. ii The top 5 States that contributed to the achievable benchmark are Delaware, Maine, Massachusetts, New Hampshire, and Vermont. 144 National Healthcare Disparities Report, 2011
Patient Safety Getting an antibiotic earlier than 1 hour before surgery or after surgery begins is not as effective. However, taking antibiotics for more than 24 hours after routine surgery is usually unnecessary and can increase the risk of side effects, such as antibiotic resistance and serious types of diarrhea. Among adult Medicare patients having surgery, the NHDR tracks receipt of antibiotics within 1 hour prior to surgical incision, discontinuation of antibiotics within 24 hours after end of surgery, and a composite of these two measures. Figure 3.2. Adult surgery patients who received appropriate timing of antibiotics: Overall composite, by race/ethnicity and gender, 2005-2009 100 White Hispanic AI/AN Black Asian 2008 Achievable Benchmark: 95% 100 Total Male Female 2008 Achievable Benchmark: 95% Chapter 3 90 90 80 80 Percent 70 Percent 70 60 60 50 Z 0 2005 2006 2007 2008 2009 50 Z 0 2005 2006 2007 2008 2009 Key: AI/AN = American Indian or Alaska Native. Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005-2009. Denominator: Hospitalized patients having surgery. Note: Populations not specifically noted as Hispanic are non-Hispanic. n The overall percentage of adult surgery patients who received appropriate timing of antibiotics improved from 2005 to 2009 (75% to 95%; Figure 3.2). Significant improvement was also seen among all racial, ethnic, and gender groups during this period. n From 2005 to 2009, Whites improved from 75% to 95%, Blacks improved from 75% to 94%, and Asians improved from 71% to 94%. The percentage of patients receiving appropriate timing of antibiotics increased from 70% to 94% for Hispanics and from 77% to 93% for AI/ANs. n The 2008 top 5 State achievable benchmark was 95%. iii At the current 5% annual rate of increase, this benchmark could be attained overall in less than 1 year. All ethnic, racial, and gender groups could also attain the achievable benchmark in less than 1 year. iii The top 5 States that contributed to the achievable benchmark are Hawaii, Maine, New Hampshire, South Dakota, and Vermont. National Healthcare Disparities Report, 2011 145
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