National Healthcare Disparities Report - LDI Health Economist

More documents

Recommendations

Info

Introduction and Methods Table 1.2. New measures in NHQR/NHDR, 2011 Chapter 1 Chapter Effectiveness Measures Chronic kidney disease • Nephrology care before kidney failure Diabetes • Kidney failure due to diabetes HIV and AIDS • People who had an HIV test outside of blood donation Maternal and child health • Adolescents who had a wellness checkup in the past 12 months • Adolescents given meningococcal vaccine • Adolescents screened for chlamydia Mental health and substance abuse • Emergency treatment for mental illness or substance abuse Musculoskeletal disease: • Arthritis education among adults with arthritis • Counseling about physical activity among adults with arthritis • Counseling about weight reduction among overweight adults with arthritis Patient Safety • Surgical Care Improvement Project (SCIP) composite iv • Central line-associated bloodstream infections in pediatric and neonatal intensive care units Health System Electronic Medical Records in Home Health and Hospice Agencies Infrastructure • Providers of home health or hospice care with electronic medical records (EMRs) that used selected EMR components: patient demographics, clinical notes, clinical decision support, and computerized physician order entry Retired Measures Since the first NHQR and NHDR, significant improvements in a number of measures of quality of care have occurred, with U.S. health care providers achieving overall performance levels exceeding 95%. The success of these measures limits their utility for tracking improvement over time. Because these measures cannot improve to a significant degree, including them in the measure set creates a ceiling effect that may distort quantification of rate of change over time. Each year, measures for which performance has reached 95% are retired. Data on retired measures will continue to be collected and these measures will be added back to the reports if their performance falls below 95%. iv Measures included in this composite are: (1) surgery patients who were given an antibiotic at the right time, (2) surgery patients who were given the right kind of antibiotic to help prevent infection, (3) surgery patients whose preventive antibiotics were stopped at the right time, (4) heart surgery patients whose blood sugar is kept under good control in the days right after surgery, (5) surgery patients needing hair removed from the surgical area before surgery who had hair removed using a safer method, (6) surgery patients whose doctors ordered treatments to prevent bloods clots after certain types of surgeries, (7) patients who got treatment at the right time to help prevent blood clots after certain types of surgery, and (8) surgery patients on beta blocker therapy prior to admission who received a beta blocker during the preoperative period. 40 National Healthcare Disparities Report, 2011
Introduction and Methods Measures may also be retired if a more suitable measure is identified. Suitability is determined on the basis of scientific testing, measure acceptance, and availability of valid and reliable data to construct the measure. Measures retired in 2011 include: n Receipt of angiotensin-converting enyzme (ACE) inhibitor for heart attack. n Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater). n Emergency department visits in which patients left without being seen. n Cholesterol test among people with diabetes. n Evaluation of left ventricular ejection fraction for heart failure. Composite Measures Policymakers and others have voiced support for composite measures of quality because they can be used to facilitate understanding of information from many different measures. A composite measure summarizes care represented by individual measures that are often related in some way, such as components of care for a particular disease or illness. Composite measures are composed of two or more measures that have been recommended or identified as a “best practice” in the treatment or prevention of complications associated with specific conditions. Chapter 1 Since measures used to construct composites represent various dimensions or processes of care, they provide a more complete understanding of the quality of the U.S. health care system. To ensure that actionable information is available, estimates of performance on the individual measures that make up a composite measure are available in an appendix to these reports. Decisions concerning the appropriateness of pooling data to generate a composite measure were discussed with data sources. Several of the composite measures included in the reports were developed, tested, and estimated by the data source or other public or private organizations for use in quality assessment, monitoring, and improvement activities. Composite measures in the NHQR and NHDR are created in several ways. The appropriateness model is sometimes referred to as the “all-or-none” approach because it is calculated based on the number of patients who received all of the services they needed. One example of this model is the diabetes composite, in which a patient who does not receive all four recommended services (two hemoglobin A1c (HbA1c) tests, a foot exam, an eye exam to detect diabetic retinopathy, and a flu shot) would not be counted as having received all recommended care. The opportunities model assumes that each patient needs and has the opportunity to receive one or more processes of care, but not all patients need the same care. Composite measures that use this model summarize the proportion of appropriate care that is delivered. The denominator for an opportunities model composite is the sum of opportunities to receive appropriate care across a panel of process measures. The numerator is the sum of the components of appropriate care that are actually delivered. The composite measure of recommended hospital care for pneumonia is an example of the use of the opportunities model. The total number of patients who receive treatments represented by individual components of the composite measure (e.g., blood culture collected before antibiotic treatment, initial National Healthcare Disparities Report, 2011 41
Page 1: NATIONAL HEALTHCARE DISPARITIES REP
Page 4 and 5: Acknowledgments The NHQR and NHDR a
Page 6 and 7: National Healthcare Disparities Rep
Page 8 and 9: Highlights New this year, the Highl
Page 10 and 11: Highlights n Disparities in quality
Page 12 and 13: Highlights n Quality is improving s
Page 14 and 15: Highlights Figure H.6. Number and p
Page 16 and 17: Highlights Table H.2. Quality measu
Page 18 and 19: Highlights n Disparities also chang
Page 20 and 21: Highlights Figure H.9. Income-relat
Page 22 and 23: Highlights Progress in Patient Safe
Page 24 and 25: Highlights available to the public
Page 26 and 27: Highlights Examples of Initiatives
Page 28 and 29: Highlights Provider: When referring
Page 30 and 31: Highlights State: The Ohio Plan To
Page 32 and 33: Highlights Figure H.15. Number and
Page 34 and 35: Highlights to have high health care
Page 36 and 37: Highlights n Data on disparities ar
Page 38 and 39: Highlights share experiences and di
Page 40 and 41: Highlights References Andrulis DP,
Page 42 and 43: Introduction and Methods With rapid
Page 44 and 45: Introduction and Methods a new sect
Page 48 and 49: Introduction and Methods antibiotic
Page 50 and 51: Introduction and Methods Progress o
Page 52 and 53: Introduction and Methods n Trends o
Page 54 and 55: Introduction and Methods Reporting
Page 56 and 57: Effectiveness of Care Cancer Import
Page 58 and 59: Effectiveness of Care Chapter 2 Can
Page 60 and 61: Effectiveness of Care Treatment: Re
Page 62 and 63: Effectiveness of Care Also, in the
Page 64 and 65: Effectiveness of Care Importance Ca
Page 68 and 69: Effectiveness of Care Chapter 2 Car
Page 72 and 73: Effectiveness of Care Chronic Kidne
Page 74 and 75: Effectiveness of Care Figure 2.13.
Page 76 and 77: Effectiveness of Care Diabetes Impo
Page 78 and 79: Effectiveness of Care Multivariate
Page 80 and 81: Effectiveness of Care Focus on Indi
Page 82 and 83: Effectiveness of Care HIV and AIDS
Page 84 and 85: Effectiveness of Care To normalize
Page 86 and 87: Effectiveness of Care HIV/AIDS core
Page 88 and 89: Effectiveness of Care Outcome: Deat
Page 90 and 91: Effectiveness of Care Findings NEW
Page 96 and 97:
Effectiveness of Care Prevention: W
Page 98 and 99:
Effectiveness of Care Mental Health
Page 100 and 101:
Effectiveness of Care Figure 2.31.
Page 102 and 103:
Page 104 and 105:
Effectiveness of Care NEW Musculosk
Page 106 and 107:
Effectiveness of Care n In all year
Page 108 and 109:
Effectiveness of Care NEW Managemen
Page 110 and 111:
Effectiveness of Care Findings Prev
Page 112 and 113:
Effectiveness of Care Also, in the
Page 114 and 115:
Effectiveness of Care Chapter 2 Res
Page 116 and 117:
Effectiveness of Care Lifestyle Mod
Page 118 and 119:
Effectiveness of Care n In 5 out of
Page 120 and 121:
Effectiveness of Care NEW Outcome:
Page 122 and 123:
Effectiveness of Care Chapter 2 Lif
Page 124 and 125:
Page 126 and 127:
Effectiveness of Care Functional St
Page 128 and 129:
Effectiveness of Care Chapter 2 Fun
Page 130 and 131:
Effectiveness of Care at admission
Page 132 and 133:
Effectiveness of Care Supportive an
Page 134 and 135:
Effectiveness of Care n The 2008 to
Page 136 and 137:
Effectiveness of Care Chapter 2 Sup
Page 138 and 139:
Page 140 and 141:
Effectiveness of Care References 20
Page 142 and 143:
Effectiveness of Care Centers for M
Page 144 and 145:
Effectiveness of Care Oral health i
Page 146 and 147:
140 National Healthcare Disparities
Page 148 and 149:
Patient Safety To Err Is Human does
Page 150 and 151:
Patient Safety Figure 3.1. Adult su
Page 152 and 153:
Patient Safety Also, in the NHQR: n
Page 154 and 155:
Patient Safety n From 2006-2007 to
Page 156 and 157:
Patient Safety n From 2004 to 2008,
Page 158 and 159:
Patient Safety Chapter 3 n From 200
Page 160 and 161:
Page 162 and 163:
Timeliness Findings Getting Care fo
Page 164 and 165:
Timeliness Chapter 4 n Not all pati
Page 166 and 167:
Timeliness Chapter 4 n Among heart
Page 168 and 169:
Page 170 and 171:
Patient Centeredness Chapter 5 Simi
Page 172 and 173:
Patient Centeredness Figure 5.1. Ad
Page 174 and 175:
Patient Centeredness Figure 5.3. Ch
Page 176 and 177:
Patient Centeredness Figure 5.5. Ad
Page 178 and 179:
Patient Centeredness Patient Langua
Page 180 and 181:
Patient Centeredness Information ab
Page 182 and 183:
Patient Centeredness Providers Aski
Page 184 and 185:
178 National Healthcare Quality Rep
Page 186 and 187:
Care Coordination Importance Chapte
Page 188 and 189:
Care Coordination n In 2009, Americ
Page 190 and 191:
Care Coordination Figure 6.3. Paren
Page 192 and 193:
Care Coordination Also, in the NHQR
Page 194 and 195:
Care Coordination Chapter 6 n Overa
Page 196 and 197:
Care Coordination Chapter 6 n Overa
Page 198 and 199:
Efficiency Findings Chapter 7 Inapp
Page 200 and 201:
Efficiency Figure 7.2. Potentially
Page 202 and 203:
Efficiency Comparisons with the 3 S
Page 204 and 205:
Efficiency Perforated Appendixes Pe
Page 206 and 207:
Efficiency Figure 7.8. Males age 75
Page 208 and 209:
Page 210 and 211:
Health System Infrastructure Eviden
Page 212 and 213:
Health System Infrastructure Figure
Page 214 and 215:
Health System Infrastructure Figure
Page 216 and 217:
Health System Infrastructure Occupa
Page 218 and 219:
Health System Infrastructure n From
Page 220 and 221:
Health System Infrastructure NEW Co
Page 222 and 223:
Health System Infrastructure Table
Page 224 and 225:
Health System Infrastructure Refere
Page 226 and 227:
Access to Health Care Findings Heal
Page 228 and 229:
Access to Health Care Figure 9.2. P
Page 230 and 231:
Page 232 and 233:
Access to Health Care Financial Bur
Page 234 and 235:
Access to Health Care Chapter 9 n O
Page 236 and 237:
Page 238 and 239:
Priority Populations Chapter 10 232
Page 240 and 241:
Priority Populations AHRQ’s Prior
Page 242 and 243:
Priority Populations Blacks or Afri
Page 244 and 245:
Priority Populations Hispanics or L
Page 246 and 247:
Priority Populations Geographic are
Page 248 and 249:
Priority Populations criminal justi
Page 250 and 251:
Priority Populations Postponement R
Page 252 and 253:
Priority Populations References Adl
Page 254 and 255:
Page 256:
U.S. Department of Health and Human
show all

National Healthcare Disparities Report - LDI Health Economist

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?