National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Also, in the NHQR: n From 1998 to 2008, adults ages 45-64 and age 65 and over were more likely to have a blood cholesterol measurement than adults ages 18-44. Among adults under age 65, those who had public insurance or who were uninsured were less likely to have a blood cholesterol measurement than those with private health insurance. Chapter 2 Cardiovascular Disease NEW Outcome: Inpatient Deaths Following Heart Attack Heart attack, or acute myocardial infarction, is a common life-threatening condition that requires rapid recognition and efficient treatment in a hospital to reduce the risk of serious heart damage and death. Measuring processes of heart attack care can provide information about whether a patient received specific needed services, but these processes make up a very small proportion of all the care that a heart attack patient needs. Measuring outcomes of heart attack care, such as mortality, can provide a more global assessment of all the care a patient receives and usually is the aspect of quality that matters most to patients. Significant improvements in process measures of quality of care for heart attack have occurred in recent years. All process measures tracked in past reports have attained overall performance levels exceeding 95% and have been retired. Therefore, the 2011 NHQR and NHDR focus on outcome measures. Survival following admission for heart attack reflects multiple patient factors, such as a patient’s comorbidities, as well as health care system factors, such as the possible need to transfer patients to other hospitals for services. It also may partly reflect receipt of appropriate health services. Previous reports used AHRQ Quality Indicators version 3.1 to generate death rates for heart attack. The 2011 reports use a modified version 4.1 of the software. While the effects of version change are extremely small, these estimates should not be compared with estimates in previous reports. 60 National Healthcare Disparities Report, 2011
Effectiveness of Care Figure 2.7. Inpatient deaths per 1,000 adult hospital admissions with heart attack, by race/ethnicity and area income, 2001-2008 120 White Black Hispanic API 120 Q1 (Lowest) Q2 Q3 Q4 (Highest) 100 100 Deaths per 1,000 Admissions 80 60 40 20 0 2008 Achievable Benchmark: 47 2001 2002 2003 2004 2005 2006 2007 2008 Key: API = Asian or Pacific Islander; Q1 represents the lowest income quartile and Q4 represents the highest income quartile based on the median income of a patient’s ZIP Code of residence. Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, State Inpatient Databases disparities analysis file, and AHRQ Quality Indicators modified version 4.1, 2001-2008. Denominator: Adults age 18 and over admitted to a non-Federal community hospital in the United States with acute myocardial infarction as principal discharge diagnosis. Note: For this measure, lower rates are better. Rates are adjusted by age and all payer refined-diagnosis related group scoring of risk of mortality. White, Black, and API groups are non-Hispanic; Hispanic includes all races. Deaths per 1,000 Admissions 80 60 40 20 0 2008 Achievable Benchmark: 47 2001 2002 2003 2004 2005 2006 2007 2008 Chapter 2 Cardiovascular Disease n From 2001 to 2008, the overall inpatient mortality rate for hospital admissions with heart attack decreased significantly (data not shown) and for each racial/ethnic and area income group (Figure 2.7). n In all years, Blacks had lower inpatient mortality rates than Whites. n In all years, residents of the two lowest income quartiles had higher inpatient mortality rates than residents of the highest income quartile. n The 2008 top 3 State achievable benchmark for inpatient heart attack mortality was 47 per 1,000 admissions. ix At current rates of improvement, all racial/ethnic and area income groups would attain the benchmark within the next 4 years. Also, in the NHQR: n In all years, patients ages 45-64 and 65 and over had higher rates of inpatient heart attack deaths than patients ages 18-44. Residents of small metropolitan, micropolitan, and noncore (rural) areas had higher rates of inpatient heart attack mortality than residents of large fringe metropolitan areas. ix The top 3 States that contributed to the achievable benchmark are Arizona, Michigan, and Ohio. National Healthcare Disparities Report, 2011 61
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U.S. Department of Health and Human
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