National Healthcare Disparities Report - LDI Health Economist

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Patient Safety n From 2004 to 2008, the rate of postoperative respiratory failure was significantly lower for Whites than for Blacks and Hispanics (Figure 3.6). n During this same period, the rate of postoperative respiratory failure decreased for Blacks and Hispanics. Also, in the NHQR: n From 2004 to 2008, the rate of postoperative respiratory failure for patients ages 18-44 remained significantly lower than for all other age groups. Preventable and Premature Mortality Rates Chapter 3 Outcome: Deaths Following Complications of Care Many complications that arise during hospital stays cannot be prevented. However, rapid identification and aggressive treatment of complications may prevent these complications from leading to death. The indicator “deaths following complications of care,” also called “failure to rescue,” tracks deaths among patients whose hospitalizations are complicated by pneumonia, thromboembolic events, sepsis, acute renal failure, gastrointestinal bleeding or acute ulcer, shock, or cardiac arrest (AHRQ, 2003). Figure 3.7. Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue), ages 18-89, by race/ethnicity and area income, 2004-2008 180 160 White Black Asian Hispanic 180 160 First Quartile (Lowest) Second Quartile Third Quartile Fourth Quartile (Highest) 140 140 Rate Rate 120 120 100 100 80 Z 80 Z 0 2004 2005 2006 2007 2008 0 2004 2005 2006 2007 2008 Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases disparities analysis file, 2007, and AHRQ Quality Indicators, modified version 4.1. Denominator: Patients ages 18-89 years from U.S. community hospitals whose hospitalizations are complicated by pneumonia, thromboembolic events, sepsis, acute renal failure, gastrointestinal bleeding or acute ulcer, shock, or cardiac arrest. Note: For this measure, lower rates are better. Whites, Blacks, and Asians are non-Hispanic. Rates are adjusted by age, gender, comorbidities, and diagnosis-related group clusters. 150 National Healthcare Disparities Report, 2011
Patient Safety n From 2004 to 2008, the rate of deaths following complications of care declined from 138 to 122 per 1,000 admissions of adults ages 18-89 (data not shown). A significant decrease was also seen among all income groups during the same period (Figure 3.7). n During this period, there were no statistically significant changes in the gap between the failure to rescue rate of high-income patients and patients of other income groups. Also, in the NHQR: n From 2004 to 2008, the rate of death following complications of care was significantly lower for patients ages 18-44 than for patients ages 45-64 and 65-89. During this same period, females had a significantly lower rate than males of death following complications. Outcome: Inpatient Pneumonia Deaths Measuring quality of care is a key component in improving care. One measure of quality is the 30-day hospital mortality rate for conditions such as pneumonia. National 30-day mortality rates due to pneumonia are not currently available for reporting, so the in-hospital mortality rates per 1,000 hospital admissions with pneumonia are reported here. About two-thirds of patients who die within 30 days of hospital admission die in the hospital, and the correlation between hospital-level inpatient and 30-day mortality is high (Rosenthal, et al., 2000). Chapter 3 Figure 3.8. Deaths per 1,000 hospital admissions with pneumonia as principal diagnosis, age 18 and over, by race/ethnicity and area income, 2004-2008 75 60 White Black API Hispanic 75 60 First Quartile (Lowest) Second Quartile Third Quartile Fourth Quartile (Highest) 45 45 Rate Rate 30 30 2007 Achievable Benchmark: 28 2007 Achievable Benchmark: 28 15 15 0 2004 2005 2006 2007 2008 0 2004 2005 2006 2007 2008 Key: API = Asian or Pacific Islander. Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases disparities analysis file, 2007, and AHRQ Quality Indicators, modified version 4.1. Denominator: All discharges age 18 and over with principal diagnosis code of pneumonia, excluding patients transferred to another short-term hospital and obstetric and neonatal admissions. Note: For this measure, lower rates are better. Whites, Blacks, and APIs are non-Hispanic. Rates are adjusted by age, gender, agegender interactions, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers into the hospital. When reporting is by age, the adjustment is by gender, comorbidities, MDC, DRG, and transfers into the hospital. National Healthcare Disparities Report, 2011 151
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U.S. Department of Health and Human
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