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<div><div><ul><li><a href="/research/findings/nhqrdr/nhdr11/index.html">Main Page</a></li><li><a href="/research/findings/nhqrdr/nhdr11/ackno.html">Acknowledgments</a></li><li><a href="/research/findings/nhqrdr/nhdr11/key.html">Highlights From the National Healthcare Quality and Disparities Report</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap1.html">Chapter 1. Introduction and Methods</a></li><li><a href="nhdr11/chap2.htm">Chapter 2. Effectiveness</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap3.html">Chapter 3. Patient Safety</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap4.html">Chapter 4. Timeliness</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap5.html">Chapter 5. Patient Centeredness</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap6.html">Chapter 6. Care Coordination</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap7.html">Chapter 7. Efficiency</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap8.html">Chapter 8. Health Systems Infrastructure</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap9.html">Chapter 9. Access to Health Care</a></li><li><a href="/research/findings/nhqrdr/nhdr11/chap10.html">Chapter 10. Priority Populations</a></li><li><strong>Appendixes</strong></li><li>Data Sources</li><li>Detailed Methods</li><li>Measure Specifications</li><li>Data Tables</li></ul></div></div>
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<h1>Chapter 7. Efficiency (Text Descriptions)</h1>
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<h2>National Healthcare Disparities Report, 2011</h2> <div id="basic-modal"><!-- start: Basic Modal -->
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<br /> <a id="fig71" name="fig71"></a> <h4 class="figcaption">Figure 7.1. Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year, by race/ethnicity and gender, 2002-2008</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Race / Ethnicity</th><th scope="col">2002</th><th scope="col">2003</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">White (percent)</td><td align="center">19.8</td><td align="center">19.0</td><td align="center">17.0</td><td align="center">17.6</td><td align="center">15.9</td><td align="center">15.8</td><td align="center">13.3</td></tr><tr><td scope="row">Black (percent)</td><td align="center">18.9</td><td align="center">17.6</td><td align="center">16.8</td><td align="center">18.9</td><td align="center">18.1</td><td align="center">14.7</td><td align="center">15.4</td></tr><tr><td scope="row">Hispanic (percent)</td><td align="center">18.1</td><td align="center">13.2</td><td align="center">13.8</td><td align="center">13.5</td><td align="center">13.5</td><td align="center">14.2</td><td align="center">14.4</td></tr></tbody></table><br /> <table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Gender</th><th scope="col">2002</th><th scope="col">2003</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">Male (percent)</td><td align="center">15.4</td><td align="center">13.4</td><td align="center">12.8</td><td align="center">14.3</td><td align="center">12.3</td><td align="center">11.8</td><td align="center">10.5</td></tr><tr><td scope="row">Female (percent)</td><td align="center">22.2</td><td align="center">22.3</td><td align="center">19.7</td><td align="center">20.2</td><td align="center">18.4</td><td align="center">18.1</td><td align="center">15.6</td></tr><tr><td scope="row">Total (percent)</td><td align="center">19.3</td><td align="center">18.5</td><td align="center">16.7</td><td align="center">17.7</td><td align="center">15.8</td><td align="center">15.4</td><td align="center">13.4</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2008.<br /><br /><strong>Denominator:</strong> Civilian noninstitutionalized population age 65 and over.<br /><br /><strong>Note:</strong> For this measure, lower rates are better. Prescription medications received include all prescribed medications initially purchased or otherwise obtained, as well as any refills. Whites and Blacks are non-Hispanic. Hispanic includes all races.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig71">Return to Document</a></p><a id="fig72" name="fig72"></a> <h4 class="figcaption">Figure 7.2. Potentially avoidable hospitalization rates, by race/ethnicity and area income, 2001-2008</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Race / Ethnicity</th><th scope="col">2001</th><th scope="col">2002</th><th scope="col">2003</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">White (rate per 100,000 pop.)</td><td align="center">1,433.3</td><td align="center">1,447.2</td><td align="center">1,380.6</td><td align="center">1,356.6</td><td align="center">1,384.6</td><td align="center">1,282.7</td><td align="center">1,277.8</td><td align="center">1,260.5</td></tr><tr><td scope="row">Black (rate per 100,000 pop.)</td><td align="center">3,286.0</td><td align="center">3,257.9</td><td align="center">2,847.3</td><td align="center">2,995.0</td><td align="center">2,753.1</td><td align="center">2,728.2</td><td align="center">2,763.8</td><td align="center">2,574.2</td></tr><tr><td scope="row">API (rate per 100,000 pop.)</td><td align="center">1,051.0</td><td align="center">1,072.5</td><td align="center">1,020.6</td><td align="center">1,071.7</td><td align="center">901.4</td><td align="center">788.0</td><td align="center">828.0</td><td align="center">810.9</td></tr><tr><td scope="row">Hispanic (rate per 100,000 pop.)</td><td align="center">1,711.7</td><td align="center">2,125.9</td><td align="center">2,205.7</td><td align="center">2,104.6</td><td align="center">1,907.5</td><td align="center">1,649.5</td><td align="center">1,612.3</td><td align="center">1,376.3</td></tr></tbody></table><br /> <table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Income Quartile</th><th scope="col">2001</th><th scope="col">2002</th><th scope="col">2003</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">1st Quartile (lowest)</td><td align="center">2107</td><td align="center">2141</td><td align="center">2211</td><td align="center">2084</td><td align="center">2090</td><td align="center">2073</td><td align="center">1988</td><td align="center">1946</td></tr><tr><td scope="row">2nd Quartile</td><td align="center">1738</td><td align="center">1802</td><td align="center">1693</td><td align="center">1619</td><td align="center">1598</td><td align="center">1551</td><td align="center">1503</td><td align="center">1487</td></tr><tr><td scope="row">3rd Quartile</td><td align="center">1403</td><td align="center">1507</td><td align="center">1406</td><td align="center">1338</td><td align="center">1376</td><td align="center">1288</td><td align="center">1272</td><td align="center">1248</td></tr><tr><td scope="row">4th Quartile (highest)</td><td align="center">1317</td><td align="center">1263</td><td align="center">1203</td><td align="center">1193</td><td align="center">1249</td><td align="center">1155</td><td align="center">1076</td><td align="center">1097</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases disparities analysis file, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version 4.1, 2001-2008.<br /><br /><strong>Denominator:</strong> Civilian noninstitutionalized adults age 18 and over.<br /><br /><strong>Note:</strong> For this measure, lower rates are better. Annual rates are adjusted for age and gender. White, Black, and Asian or Pacific Islander populations are non-Hispanic. Income quartiles are based on median income of ZIP Code of patient's residence.<br />2008 Achievable Benchmark: 818.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig72">Return to Document</a></p><a id="fig73" name="fig73"></a> <h4 class="figcaption">Figure 7.3. Excess number of potentially preventable hospitalizations, by race/ethnicity, 2008</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Potentially Preventable Hospitalizations</th><th scope="col">White</th><th scope="col">Black</th><th scope="col">Hispanic</th></tr><tr><td scope="row">Expected at Best Rate (hospitalizations)</td><td align="center">1,306,217</td><td align="center">217,766</td><td align="center">253,084</td></tr><tr><td scope="row">Excess (hospitalizations)</td><td align="center">706,545</td><td align="center">467,541</td><td align="center">172,733</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version 4.1, 2008.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig73">Return to Document</a></p><a id="fig74" name="fig74"></a> <h4 class="figcaption">Figure 7.4. Excess number of potentially preventable hospitalizations, by income, 2008</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Potentially Preventable Hospitalizations</th><th scope="col">First Quartile (lowest)</th><th scope="col">Second Quartile</th><th scope="col">Third Quartile</th><th scope="col">Fourth Quartile (highest)</th></tr><tr><td scope="row">Expected at Best Rate (hospitalizations)</td><td align="center">453,956.2</td><td align="center">496,224.2</td><td align="center">458,397.8</td><td align="center">471,579.4</td></tr><tr><td scope="row">Excess (hospitalizations)</td><td align="center">625,870.2</td><td align="center">405,711.2</td><td align="center">241,140.2</td><td align="center">160,779.8</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version 4.1, 2008.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig74">Return to Document</a></p><a id="fig75" name="fig75"></a> <h4 class="figcaption">Figure 7.5. Medicare home health patients with potentially avoidable hospitalizations within 30 days of start of care, by race/ethnicity, 2000-2010</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Race / Ethnicity</th><th scope="col">2000</th><th scope="col">2001</th><th scope="col">2002</th><th scope="col">2003</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th><th scope="col">2009</th><th scope="col">2010</th></tr><tr><td scope="row">White (hospitalizations)</td><td align="center">4.6</td><td align="center">4.6</td><td align="center">4.6</td><td align="center">4.5</td><td align="center">4.3</td><td align="center">4.1</td><td align="center">3.9</td><td align="center">3.9</td><td align="center">3.8</td><td align="center">3.7</td><td align="center">3.6</td></tr><tr><td scope="row">Black (hospitalizations)</td><td align="center">5.2</td><td align="center">5.4</td><td align="center">5.3</td><td align="center">5.1</td><td align="center">4.8</td><td align="center">4.6</td><td align="center">4.3</td><td align="center">4.3</td><td align="center">4.2</td><td align="center">4.0</td><td align="center">4.0</td></tr><tr><td scope="row">Other (hospitalizations)</td><td align="center">4.1</td><td align="center">4.0</td><td align="center">4.2</td><td align="center">4.0</td><td align="center">4.2</td><td align="center">3.7</td><td align="center">3.7</td><td align="center">3.4</td><td align="center">3.5</td><td align="center">3.4</td><td align="center">3.1</td></tr><tr><td scope="row">Asian (hospitalizations)</td><td align="center">2.9</td><td align="center">3.3</td><td align="center">3.1</td><td align="center">2.9</td><td align="center">2.9</td><td align="center">3.1</td><td align="center">3.1</td><td align="center">3.0</td><td align="center">2.9</td><td align="center">2.9</td><td align="center">2.8</td></tr><tr><td scope="row">Hispanic (hospitalizations)</td><td align="center">5.1</td><td align="center">4.8</td><td align="center">4.7</td><td align="center">4.4</td><td align="center">4.1</td><td align="center">4.0</td><td align="center">3.5</td><td align="center">3.3</td><td align="center">3.3</td><td align="center">3.1</td><td align="center">2.9</td></tr><tr><td scope="row">AI/AN (hospitalizations)</td><td align="center">5.0</td><td align="center">5.8</td><td align="center">5.0</td><td align="center">5.0</td><td align="center">5.2</td><td align="center">4.8</td><td align="center">4.8</td><td align="center">4.4</td><td align="center">4.3</td><td align="center">4.5</td><td align="center">3.3</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set linked with Medicare Part A claims (100%), 2000-2010.<br /><br /><strong>Denominator:</strong> Adult nonmaternity patients starting an episode of skilled home health care.<br /><br /><strong>Note:</strong> For this measure, lower rates are better. Rates standardized to the 2006 patient population according to Medicare enrollment category. Hispanics could include other races. All race categories could include Hispanics.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig75">Return to Document</a></p><a id="fig76" name="fig76"></a> <h4 class="figcaption">Figure 7.6. Perforated appendixes per 1,000 admissions for appendicitis, age 18 and over, by race/ethnicity and area income, 2004-2008</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Race / Ethnicity</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">White (rate per 1,000 admissions)</td><td align="center">287.8</td><td align="center">282.8</td><td align="center">271.3</td><td align="center">275.7</td></tr><tr><td scope="row">Black (rate per 1,000 admissions)</td><td align="center">308.7</td><td align="center">317.3</td><td align="center">302.1</td><td align="center">298.2</td></tr><tr><td scope="row">API (rate per 1,000 admissions)</td><td align="center">266.8</td><td align="center">270.3</td><td align="center">268.5</td><td align="center">261.9</td></tr><tr><td scope="row">Hispanic (rate per 1,000 admissions)</td><td align="center">291.8</td><td align="center">283.3</td><td align="center">276.2</td><td align="center">271.9</td></tr></tbody></table><br /> <table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Income Quartile</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">Highest Income Quartile (rate per 1,000 admissions)</td><td align="center">270.4</td><td align="center">265.9</td><td align="center">258.7</td><td align="center">254.3</td></tr><tr><td scope="row">Third Income Quartile (rate per 1,000 admissions)</td><td align="center">291.2</td><td align="center">284.4</td><td align="center">282.1</td><td align="center">276.8</td></tr><tr><td scope="row">Second Income Quartile (rate per 1,000 admissions)</td><td align="center">298.9</td><td align="center">294.2</td><td align="center">274.1</td><td align="center">288.3</td></tr><tr><td scope="row">Lowest Income Quartile (rate per 1,000 admissions)</td><td align="center">309.1</td><td align="center">308.9</td><td align="center">299.1</td><td align="center">301.2</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project State Inpatient Databases disparities analysis file, 2004, 2005, 2007, and 2008.<br /><br /><strong>Note:</strong> For this measure, lower rates are better. Data for 2006 were not available this year, because a new version of the PQI software was used to calculate rates and 2006 was not included in the calculation.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig76">Return to Document</a></p><a id="fig77" name="fig77"></a> <h4 class="figcaption">Figure 7.7. Perforated appendixes per 1,000 admissions for appendicitis, age 18 and over, in IHS, Tribal, and contract hospitals, by age and gender, 2004-2008</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Age</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">Total (rate per 1,000 admissions)</td><td align="center">310.6</td><td align="center">318.3</td><td align="center">286.0</td><td align="center">345.7</td><td align="center">283.7</td></tr><tr><td scope="row">18-44 (rate per 1,000 admissions)</td><td align="center">268.7</td><td align="center">254.8</td><td align="center">247.8</td><td align="center">275.4</td><td align="center">219.8</td></tr><tr><td scope="row">45-64 (rate per 1,000 admissions)</td><td align="center">415.9</td><td align="center">469.8</td><td align="center">356.2</td><td align="center">509.7</td><td align="center">387.9</td></tr><tr><td scope="row">65-69 (rate per 1,000 admissions)</td><td align="center">514.3</td><td align="center">428.6</td><td align="center">560.0</td><td align="center">583.3</td><td align="center">656.3</td></tr></tbody></table><br /> <table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Gender</th><th scope="col">2004</th><th scope="col">2005</th><th scope="col">2006</th><th scope="col">2007</th><th scope="col">2008</th></tr><tr><td scope="row">Male (rate per 1,000 admissions)</td><td align="center">309.1</td><td align="center">355.6</td><td align="center">315.0</td><td align="center">378.2</td><td align="center">333.3</td></tr><tr><td scope="row">Female (rate per 1,000 admissions)</td><td align="center">312.3</td><td align="center">277.2</td><td align="center">253.4</td><td align="center">309.1</td><td align="center">229.0</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Indian Health Service, National Patient Information Reporting System, National Data Warehouse, Workload and Population Data Mart, 2004-2008.<br /><br /><strong>Note:</strong> For this measure, lower rates are better.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig77">Return to Document</a></p><a id="fig78" name="fig78"></a> <h4 class="figcaption">Figure 7.8. Males age 75 and over who reported having a prostate-specific antigen test or a digital rectal exam within the last 12 months, by race and income, 2004-2010</h4><table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Race</th><th scope="col">2004</th><th scope="col">2006</th><th scope="col">2008</th><th scope="col">2010</th></tr><tr><td scope="row">White (percent)</td><td align="center">72.3</td><td align="center">73.9</td><td align="center">75.6</td><td align="center">74.8</td></tr><tr><td scope="row">Black (percent)</td><td align="center">59.8</td><td align="center">65.8</td><td align="center">63.9</td><td align="center">69.3</td></tr><tr><td scope="row">Asian (percent)</td><td align="center">-</td><td align="center">65.8</td><td align="center">43.4</td><td align="center">72.5</td></tr><tr><td scope="row">AI/AN (percent)</td><td align="center">-</td><td align="center">-</td><td align="center">62.7</td><td align="center">69.0</td></tr><tr><td scope="row">Other/missing (percent)</td><td align="center">58.2</td><td align="center">65.2</td><td align="center">65.9</td><td align="center">69.7</td></tr></tbody></table><br /> <table border="1" cellpadding="3" width="80%"><tbody><tr><th scope="col">Income</th><th scope="col">2004</th><th scope="col">2006</th><th scope="col">2008</th><th scope="col">2010</th></tr><tr><td scope="row">$50,000 or More (percent)</td><td align="center">80.3</td><td align="center">79.0</td><td align="center">82.1</td><td align="center">79.8</td></tr><tr><td scope="row">$35,000 to $49,999 (percent)</td><td align="center">73.1</td><td align="center">77.1</td><td align="center">78.1</td><td align="center">76.9</td></tr><tr><td scope="row">$15,000 to $34,999 (percent)</td><td align="center">69.3</td><td align="center">69.5</td><td align="center">71.7</td><td align="center">70.7</td></tr><tr><td scope="row">Less Than $15,000 (percent)</td><td align="center">63.0</td><td align="center">60.9</td><td align="center">56.2</td><td align="center">61.0</td></tr></tbody></table><p class="size2"><strong>Source:</strong> Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2004-2010.<br /><br /> <strong>Denominator:</strong> Adult males age 75 and over with no history of prostate cancer.<br /><br /><strong>Note:</strong> For this measure, lower rates are better. Data for 2004, 2006, and part of 2008 precede the U.S. Preventive Services Task Force recommendation against screening men age 75 and over. It should be noted that PSA tests and DREs are provided to this population for purposes unrelated to prostate cancer screening. Data to determine the purpose of these services was unavailable and all reported PSA tests and DREs are reflected in the data shown. Data for AI/ANs were statistically unreliable for 2004 and 2006.<br />2008 Achievable Benchmark: 62%<br /><br /><strong>Footnote:</strong> - = no data value available.</p><p class="size2"><a href="/research/findings/nhqrdr/nhdr11/chap7.html#fig78">Return to Document</a></p> </div>
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<div class="current-as-of">Page last reviewed October 2014</div>
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<span>Internet Citation: Chapter 7. Efficiency (Text Descriptions): National Healthcare Disparities Report, 2011.
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October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/nhqrdr/nhdr11/chap7txt.html</span>
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