2018 National Healthcare Quality and Disparities Report ...

2018 National Healthcare Quality and Disparities Report

Measure Specifications

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857

October 2019 research/findings/nhqrdr/index.html

This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated. Suggested citation: 2018 National Healthcare Quality and Disparities Report Measure Specifications. Rockville, MD: Agency for Healthcare Research and Quality; October 2019.

Contents

Introduction ......................................................................................................................................1 Chapter 2. Access to Care ................................................................................................................2

2.1. Getting Appointments for Care ............................................................................................2 2.2. Waiting Time .......................................................................................................................3 2.3. Health Insurance...................................................................................................................9 2.4. Usual Source of Care .........................................................................................................13 2.5. Patient Perceptions of Need ...............................................................................................16 Chapter 3. Patient Safety................................................................................................................22 3.1. Healthcare Associated Infections .......................................................................................22 3.2. Surgical Care ......................................................................................................................25 3.3. Other Complications of Hospital Care ...............................................................................39 3.4. Complications of Medication .............................................................................................49 3.5. Birth-Related Complications..............................................................................................55 3.6. Inappropriate Treatment.....................................................................................................59 3.7. Supportive and Palliative Care...........................................................................................60 3.8. Home Health Communication............................................................................................64 Chapter 4. Person-Centered Care...................................................................................................68 4.1. Patient Experience of Care.................................................................................................68 4.2. Hospital Communication ...................................................................................................75 4.3. Home Health Communication............................................................................................75 4.4. Hospice Care ......................................................................................................................80 Chapter 5. Care Coordination ........................................................................................................87 5.1. Transitions of Care .............................................................................................................87 5.2. Medication Information .....................................................................................................88 5.3. Preventable Emergency Department Visits .......................................................................88 5.4. Preventable Hospitalizations............................................................................................123 5.5. Preventable Hospitalizations among Home Health and Nursing Home Patients ............131 5.6. Potentially Harmful Services Without Benefit ................................................................133 5.7. Supportive and Palliative Care.........................................................................................136 5.8. Potentially Avoidable Admissions...................................................................................139 Chapter 6. Effectiveness of Care .................................................................................................147 6.1. Cancer ..............................................................................................................................147

6.1.1. Breast Cancer ...........................................................................................................147 6.1.2. Cervical Cancer ........................................................................................................151 6.1.3. Colorectal Cancer .....................................................................................................153 6.1.4. Other Cancers ...........................................................................................................155 6.2. Cardiovascular Disease ....................................................................................................156 6.2.1. Prevention of Heart Disease .....................................................................................156 6.2.2. Treatment of Heart Attack........................................................................................157 6.2.4. Surgery for Heart and Vascular Disease ..................................................................163 6.2.5. Stroke .......................................................................................................................167

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6.3. Chronic Kidney Disease...................................................................................................170 6.3.1. Chronic Care of End Stage Renal Disease ...............................................................170

6.4. Diabetes............................................................................................................................174 6.4.1. Management of Diabetes..........................................................................................174 6.4.2. Control of Diabetes ..................................................................................................180 6.4.3. Hospitalization for Diabetes .....................................................................................182

6.5. HIV/AIDS ........................................................................................................................184 6.5.1. Management of HIV/AIDS ......................................................................................184

6.7. Mental Health & Substance Abuse ..................................................................................188 6.7.1. Treatment of Depression ..........................................................................................188 6.7.2. Treatment of Substance Abuse.................................................................................192

6.8. Musculoskeletal Disease ..................................................................................................202 6.9. Respiratory Diseases ........................................................................................................203

6.9.1. Treatment of Respiratory Infections ........................................................................203 6.9.3. Management of Asthma ...........................................................................................206 Chapter 7. Healthy Living............................................................................................................209 7.1. Maternal and Child Health ...............................................................................................209 7.2. Lifestyle Modification......................................................................................................213 7.3. Functional Status Preservation and Rehabilitation ..........................................................221 7.4. Supportive and Palliative Care.........................................................................................225 7.5. Clinical Preventive Services ............................................................................................232 7.5.1. Adult Preventive Care ..............................................................................................232 7.5.2. Childhood Immunization..........................................................................................245 7.5.3. Other Childhood Preventive Care ............................................................................256 7.5.3. Overall Preventive Care ...........................................................................................262 Chapter 8. Affordable Care..........................................................................................................266 8.1. Financial Burden of Health Care Cost .............................................................................267 8.2. Usual Source of Care .......................................................................................................267 Chapter 9. Priority Populations....................................................................................................271 9.1. Health Resources and Services Administration (HRSA) - Uniform Data System

(UDS) Measures...............................................................................................................271 9.1.1. Clinical Measures .....................................................................................................271 9.1.2. Clinical Visits ...........................................................................................................274 9.1.3. Electronic Health Records........................................................................................279 Chapter 15. Supplemental Measures............................................................................................281 15.1. Access to Care Measures ...............................................................................................281 15.1.1. Getting Appointments for Care ..............................................................................281 15.1.2. Workforce Diversity...............................................................................................284 15.1.3. Focus on the health Care Safety Net ......................................................................285 15.1.4. Patient Perceptions of Need ...................................................................................287 15.2. Person-Centered Care.....................................................................................................291 15.2.1. Patient Experience of Care .....................................................................................291

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15.3. Care Coordination ..........................................................................................................308 15.3.1. Medication Information..........................................................................................308 15.3.2. Preventable Emergency Department Visits............................................................308 15.3.3. Preventable Hospitalizations ..................................................................................309 15.3.4. Potentially Harmful Services Without Benefit.......................................................317 15.3.5. Electronic Health Records in Hospitals or in Physician Practices .........................318

15.4. Effectiveness of Care .....................................................................................................348 15.4.1. Hospitalizations for Diabetes .................................................................................348 15.4.2. HIV/AIDS ..............................................................................................................353 15.4.3. Mental Health & Substance Abuse ........................................................................355 15.4.4. Maternal & Child Health ........................................................................................359 15.4.5. Others .....................................................................................................................362

15.5. Lifestyle Modification....................................................................................................363 15.6. Affordable Care..............................................................................................................364

15.6.1. Financial Burden of Health Care Cost ...................................................................364 15.6.2. Cost of Hospitalization...........................................................................................366 Chapter 16. Special Analysis .......................................................................................................391 Chapter 17. Retired Measures......................................................................................................394

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Introduction

This document briefly describes the definitions of the 2018 National Healthcare Quality and Disparities Report measures which are posted on the NHQDR website . The descriptions for each measure include a measure title, a measure source, data source, data tables supporting the measure, definitions of numerator and denominator, as well as other comments. The measures are organized by the chapters followed by sections and subsections based on the NHQDR Measure List. The measure specification is also linked to each measure on the Data Query page on the website. This sources of this documentation are either based on the information from the source data system websites or from the QDR source data contributing agencies and organizations.

2018 National Healthcare Quality and Disparities Report Measure Specifications | 1

Chapter 2. Access to Care

2.1. Getting Appointments for Care

Measure ID: MEPS_16, 20101011

Measure Title: Adults who had an appointment for routine health care in the last 12 months who sometimes or never got an appointment for routine care as soon as wanted

Measure Source: Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS)

Table Description:

? Geographic Representation: National ? Years Available: National: 2002 to 2016 ? Population Subgroups: Activity limitations, age, education, employment status, ethnicity,

gender, family income, health insurance, perceived health status, language spoken at home, Medicaid/CHIP, race, residence location, and U.S. born

Data Source: AHRQ, CFACT, MEPS

Denominator: U.S. civilian noninstitutionalized population age 18 and over who made an appointment for regular or routine health care in the past 12 months and had a valid response to the question, "In the last 12 months, how often did you get an appointment for regular or routine health care as soon as you wanted?"

Numerator: Subset of the denominator who answered "Sometimes" or "Never"

Comments: National Table Descriptions report data from the MEPS Self-Administered Questionnaire (SAQ).

Measure ID: MEPS_17, 20101021

Measure Title: Children who had an appointment for routine health care in the last 12 months who sometimes or never got an appointment for routine care as soon as wanted

Measure Source: Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost (CFACT), Medical Expenditure Panel Survey (MEPS)

Table Description:

? Geographic Representation: National ? Years Available: National: 2002 to 2016 ? Population Subgroups: Age, gender, ethnicity, family income, health insurance, perceived

health status, language spoken at home, Medicaid/CHIP, race, residence location, children with special health care needs, and U.S. born

2 | 2018 National Healthcare Quality and Disparities Report Measure Specifications

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