Acknowledgments The NHQR and NHDR are the products of collaboration among agencies across the Department of <strong>Health</strong> and Human Services (HHS). Many individuals guided and contributed to this report. Without their magnanimous support, this report would not have been possible. Specifically, we thank: Primary AHRQ Staff: Carolyn Clancy, William Munier, Katherine Crosson, Ernest Moy, Karen HoChaves, William Freeman, and Doreen Bonnett. HHS Interagency Workgroup for the NHQR/NHDR: Girma Alemu (HRSA), Hakan Aykan (ASPE), Rachel Ballard-Barbash (NCI), Magda Barini-Garcia (HRSA), Kirsten Beronio (ASPE), Douglas Boenning (ASPE), Julia Bryan (HRSA), Steven Clauser (NCI), Rachel Clement (HRSA), Martin Dannenfelser (ACF), Agnes Davidson (OPHS), Brenda Evelyn (FDA), Susan Fleck (CMS/NC), Edward Garcia (CMS), Miryam Gerdine (HRSA), Olinda Gonzalez (SAMHSA), Tanya Grandison (HRSA), Saadia Greenberg (AoA), Kirk Greenway (IHS), Lein Han (CMS), Linda Harlan (NCI), Rebecca Hines (CDC/NCHS), Edwin Huff (CMS/OA), Meghan Hufstader (ONC), Deloris Hunter (NIH), Memuna Ifedirah (CMS/OCSQ), Kenneth Johnson (OCR), Ruta Kadonoff (ASPE), Ruth Katz (ASPE), Richard Klein (CDC/NCHS), Lisa Koonin (CDC/NCHS), Helen Lamont (ASPE), Shari Ling (CMS/OCSQ), Leopold Luberecki (ASPE), Diane Makuc (CDC/NCHS), Richard McNaney (CMS), Diane Meier (ASPE), Nancy Miller (NIH), Carmen Moten (NIH/NIMH), Iran Naqvi (ORH), Leo Nolan (IHS), Cynthia Ogden (CDC/NCHS), Karen Oliver (NIH/NIMH), Lisa Patton (ASPE), Diane Pilkey (ASPE), Susan Polniaszek (ASPE), Suzanne Proctor-Hallquist (CDC/NCHS), Barry Portnoy (NIH/OD), Michael Rapp (CMS), Georgetta Robinson (CMS), William Rodriguez (FDA/OD), Rochelle Rollins (OMH), Asel Ryskulova (CDC/NCHS), Michael Schoenbaum (NIMH), Adelle Simmons (ASPE), Alan E. Simon (CDC/NCHS), Sunil Sinha (CMS), Jane Sisk (CDC/NCHS), Phillip Smith (IHS), Nancy Sonnenfeld (CDC/NCHS), Caroline Taplin (HHS-ASPE), Emmanuel Taylor (NCI), Wilma Tilson (ASPE), Karmen Todd (OCR), Benedict Truman (CDC), Sayeedha Uddin (CDC/NCHS), Nadarajen A. Vydelingum (NIH), Barbara Wells (NHLBI), Valerie Welsh (OPHS/OMH), Deborah Willis-Fillinger (HRSA), Lee Wilson (ASPE/OS), Susan Yanovski (NIH/NIDDK), and Pierre Yong (ASPE). AHRQ NHQR/NHDR Team: Roxanne Andrews (CDOM), Barbara Barton (SSS), Doreen Bonnett (OCKT), Jeffrey Brady (CQuIPS), Eva Chang (CQuIPS), Xiuhua Chen (SSS), Fran Chevarley (CFACT), Cecilia Rivera Casale (OEREP), Karen Ho Chaves (CQuIPS), Beth Collins Sharp (OEREP), Katherine Crosson (CQuIPS), Denise Dougherty (OEREP), William Freeman (CQuIPS), Erin Grace (CP3), Darryl Gray (CQuIPS), Padmini Jagadish (OEREP), Heather Johnson-Skrivanek (CP3), Ram Khadka (SSS), Shyam Misra (OEREP), Atlang Mompe (SSS), Ernest Moy (CQuIPS), William Munier (CQuIPS), Ryan Mutter (CDOM), Janet Pagán-Sutton (SSS), Amir Razi (SSS), Judy Sangl (CQuIPS), Nancy Wilson (IOD), and Marc Zodet (CFACT). HHS Data Experts: Barbara Altman (CDC/NCHS), Anjani Chandra (CDC/NCHS), Steven Cohen (AHRQ), James Colliver (SAMHSA), Paul Eggers (NIH), David Keer (ED/OSERS), William Mosher (CDC/NCHS), Cynthia Ogden (CDC/NCHS), Robin Remsburg (CDC/NCHS), Asel Ryskulova (CDC/NCHS), Alan E. Simon (CDC/NCHS), Jane Sisk (CDC/NCHS), and members of the Interagency Subcommittee on Disability Statistics. Other Data Experts: Dale Bratzler (Oklahoma QIO), Michael Halpern (NCDB, American Cancer Society), Allen Ma (Oklahoma QIO), Lauren Miller (Oklahoma QIO), Wato Nsa (Oklahoma QIO), Bryan Palis (American College of Surgeons), Florentina R. Salvail (Hawaii Department of <strong>Health</strong>), Allison Petrilla (NHCPO), Hardy Spoehr (Papa Ola Lokahi), Andrew Stewart (NCDB, American College of Surgeons), Jo Ann Tsark (Papa Ola Lokahi), and Claudia Wright (Oklahoma QIO). Other AHRQ Contributors: Cindy Brach, Karen Fleming-Michael, Christine Heidenrich, Biff LeVee, Corey Mackison, Gerri Michael-Dyer, Karen Migdail, Linwood Norman, Pamela Owens, Mamatha Pancholi, Larry Patton, Wendy Perry, Mary Rolston, Scott Rowe, Bruce Seeman, Randie Siegel, and Phyllis Zucker. Data Support Contractors: CHD-Fu, Social and Scientific Systems, Thomson Reuters <strong><strong>Health</strong>care</strong>, and Westat. <strong>National</strong> <strong><strong>Health</strong>care</strong> <strong>Disparities</strong> <strong>Report</strong>, 2011
Contents Chapter Page Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1. Introduction and Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2. Effectiveness of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Cardiovascular Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Maternal and Child <strong>Health</strong>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Mental <strong>Health</strong> and Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Musculoskeletal Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Respiratory Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Lifestyle Modification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Functional Status Preservation and Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Supportive and Palliative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 3. Patient Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 4. Timeliness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 5. Patient Centeredness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 6. Care Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 7. Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 8. <strong>Health</strong> System Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 9. Access to <strong>Health</strong> Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 10. Priority Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Appendixes: Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.ahrq.gov/qual/qrdr11/datasources/index.html Detailed Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.ahrq.gov/qual/qrdr11/methods/index.html Measure Specifications . . . . . . . . . . . . . . . . . . . . . . www.ahrq.gov/qual/qrdr11/measurespec/index.html Data Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.ahrq.gov/qual/qrdr11/index.html <strong>National</strong> <strong><strong>Health</strong>care</strong> <strong>Disparities</strong> <strong>Report</strong>, 2011
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