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<h1>2012 National Healthcare Quality and Disparities Reports </h1>
<h3>Efficiency</h3>
<div class="body_field">
<a id="efficiency" name="efficiency"></a> <h3>Measure Title</h3><p><a href="#it"><strong>Inappropriate Treatment</strong></a><br /><a href="#it1">Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year (11 medications)</a><br /><a href="#it2">Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year (33 medications)</a></p><p><strong><a href="#pev">Preventable Emergency Department Visits</a></strong><br /><a href="#pev1">Potentially avoidable emergency department encounters for asthma</a></p><p><a href="#pot1"><strong>Potentially Avoidable Hospitalizations</strong></a><br /><a href="#potmt1">Potentially avoidable hospitalizations for all conditions</a><br /><a href="#potmt2">Potentially avoidable hospitalizations for acute conditions</a><br /><a href="#potmt3">Potentially avoidable hospitalizations for chronic conditions</a><br /><a href="#potmt4">Potentially avoidable hospitalizations and emergency department encounters for congestive heart failure (CHF)</a><br /><a href="#potmt5">Perforated appendixes per 1,000 admissions with appendicitis</a><br /><br /><a href="#potem1"><strong>Potentially Harmful Services Without Benefit</strong></a><br /><a href="#potemtm1">Visits with antibiotics prescribed for a diagnosis of common cold per 10,000 population</a><br /><a href="#potemtm2">Males age 75 and over who reported having a prostate-specific antigen (PSA) test or a digital rectal exam within the last 12 months</a><br />&#160;</p><hr /><p><a id="it" name="it"></a><a id="it1" name="it1">&#160;</a></p><h2>Inappropriate Treatment</h2><h3>Measure Title</h3><p>Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year (11 medications).</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).</p><h3>National Tables</h3><p>7_1_1_1.1 Adults age 65 and over with at least 1 prescription from 11 medications that should be avoided in older adults, United States, 2002-2009</p><p>7_1_1_1.2a-d Adults age 65 and over with at least 1 prescription from 11 medications that should be avoided in older adults, United States, 2009, by:</p><ol type="a"><li>Race.</li><li>Ethnicity.</li><li>Family income.</li><li>Education.</li></ol><h3>National Data Source</h3><p>AHRQ, CFACT, MEPS.</p><h3>National Denominator</h3><p>U.S. population age 65 and over.</p><h3>National Numerator</h3><p>Subset of the denominator who received at least 1 of the 11 medications that are potentially inappropriate for older adults.</p><h3>Comments</h3><p>Prescription medications received includes all prescribed medications initially purchased or otherwise obtained during the calendar year, as well as any refills.</p><p>For additional information concerning the potentially inappropriate medications, refer to Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from 1996 Medical Expenditure Panel Survey. <em>JAMA</em> 2001;286(22):2823-29.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="it2" name="it2">&#160;</a></p><h2>Inappropriate Treatment</h2><h3>Measure Title</h3><p>Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year (33 medications).</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).</p><h3>National Tables</h3><p>7_1_1_2.1 Adults age 65 and over with at least 1 prescription from 33 medications that are potentially inappropriate, United States, 2002-2009</p><p>7_1_1_2.2a-d Adults age 65 and over with at least 1 prescription from 33 medications that are potentially inappropriate, United States, 2009, by:</p><ol type="a"><li>Race.</li><li>Ethnicity.</li><li>Family income.</li><li>Education.</li></ol><h3>National Data Source</h3><p>AHRQ, CFACT, MEPS.</p><h3>National Denominator</h3><p>U.S. population age 65 and over.</p><h3>National Numerator</h3><p>People age 65 and over who received 1 or more of the 33 potentially inappropriate medications.</p><h3>Comments</h3><p>Prescription medications received includes all prescribed medications initially purchased or otherwise obtained during the calendar year, as well as any refills.</p><p>For additional information concerning the potentially inappropriate medications, refer to Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from 1996 Medical Expenditure Panel Survey. <em>JAMA</em> 2001;286(22):2823-29.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="pev" name="pev">&#160;</a> <a id="pev1" name="pev1">&#160;</a></p><h2>Preventable Emergency Department Visits</h2><h3>Measure Title</h3><p>Potentially avoidable emergency department encounters for asthma.</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Emergency Department Sample (NEDS).</p><h3>National Tables</h3><p>7_2_1_4.1 Emergency department visits for asthma per 100,000 population (including inpatient admissions), age 18 and over, United States, 2009</p><p>7_2_1_5.2_1 Emergency department visits for asthma per 100,000 population (including inpatient admissions), ages 2-17, United States, 2009</p><h3>National Data Source</h3><p>AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample, and AHRQ Quality Indicators, modified version 4.1.</p><h3>National Denominator</h3><p>U.S. civilian population ages 2-17 or age 18 and over, as appropriate.</p><h3>National Numerator</h3><p>Subset of the denominator with an emergency department asthma visit.</p><h3>Comments</h3><p>Consistent with the AHRQ Quality Indicators software, asthma must be the principal diagnosis and the following cases are excluded: admissions with cystic fibrosis or anomalies of the respiratory system, transfers from other institutions, and obstetric admissions.</p><p>Rates are adjusted by age and gender using the total U.S. population for 2000 as the U.S. standard population; when reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.</p><p>Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="pot1" name="pot1">&#160;</a> <a id="potmt1" name="potmt1">&#160;</a></p><h2>Potentially Avoidable Hospitalizations</h2><h3>Measure Title</h3><p>Potentially avoidable hospitalizations for all conditions.</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Prevention Quality Indicators (PQIs).</p><h3>National Tables</h3><p>7_3_1_2.1_1 Potentially avoidable hospitalizations per 100,000 population for all conditions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008</p><p>7_3_1_2.1_4 Potentially avoidable hospitalizations per 100,000 population for all conditions, age 18 and over, by income, United States, 2000-2008</p><h3>National Data Source</h3><p>AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.</p><h3>National Denominator</h3><p>U.S. population age 18 and over.</p><h3>National Numerator</h3><p>Subset of the denominator who qualified for any individual PQI numerator: 1, 3, 7, 8, and 10-16 (see Comments).</p><p>PQI components of the composites include:</p><ul><li>PQI 1: Diabetes, short-term complications.</li><li>PQI 3: Diabetes, long-term complications.</li><li>PQI 5: Chronic obstructive pulmonary disease.</li><li>PQI 7: Hypertension.</li><li>PQI 8: Congestive heart failure.</li><li>PQI 10: Dehydration.</li><li>PQI 11:Bacterial pneumonia.</li><li>PQI 12: Urinary tract infections.</li><li>PQI 13: Angina without procedure.</li><li>PQI 14: Uncontrolled diabetes.</li><li>PQI 15: Asthma in younger adults.</li><li>PQI 16: Lower extremity amputations among patients with diabetes.</li></ul><h3>State Table</h3><p>7_3_1_2.1_3 Potentially avoidable hospitalizations per 100,000 population for all conditions, age 18 and over, by State, 2000, 2004, 2005, 2007, and 2008</p><h3>State Data Source</h3><p>AHRQ, CDOM, HCUP, State Inpatient Databases (SID).</p><h3>State Denominator</h3><p>Same as national.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>Based on the 11 AHRQ PQIs for angina, asthma, bacterial pneumonia, congestive heart failure, dehydration, diabetes, hypertension, and urinary tract infection. For consistency of longitudinal reporting, the modified overall composite does not include AHRQ PQI 5 for chronic obstructive pulmonary disease because it is affected by International Classification of Diseases, Ninth Revision coding changes.</p><p>Rates are adjusted by age and gender using the total 2000 U.S. standard population.</p><p>Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.</p><p>SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient&#39;s race.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="potmt2" name="potmt2">&#160;</a></p><h2>Potentially Avoidable Hospitalizations</h2><h3>Measure Title</h3><p>Potentially avoidable hospitalizations for acute conditions.</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Prevention Quality Indicators (PQIs).</p><h3>National Tables</h3><p>7_3_1_2.2_1 Potentially avoidable hospitalizations per 100,000 population for acute conditions, age 18 and over, United States, 2000, 2004, 2005, 2007, and 2008</p><p>7_3_1_2.2_4 Potentially avoidable hospitalizations per 100,000 population for acute conditions, age 18 and over, by income, United States, 2000-2008</p><h3>National Data Source</h3><p>AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.</p><h3>National Denominator</h3><p>U.S. civilian population age 18 and over.</p><h3>National Numerator</h3><p>Subset of the denominator who qualified for any individual PQI numerator considered acute: 10, 11, and 12 (see Comments).</p><h3>State Table</h3><p>7_3_1_2.2_3 Potentially avoidable hospitalizations per 100,000 population for acute conditions, age 18 and over, by State, 2000, 2004, 2007-2009</p><h3>State Data Source</h3><p>AHRQ, CDOM, HCUP, State Inpatient Databases (SID).</p><h3>State Denominator</h3><p>Same as national.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>Based on the three AHRQ PQIs for dehydration, bacterial pneumonia, and urinary tract infection.</p><p>Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.</p><p>SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient&#39;s race.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="potmt3" name="potmt3">&#160;</a></p><h2>Potentially Avoidable Hospitalizations</h2><h3>Measure Title</h3><p>Potentially avoidable hospitalizations for chronic conditions.</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Prevention Quality Indicators (PQIs).</p><h3>National Table</h3><p>7_3_1_2.3_1 Potentially avoidable hospitalizations per 100,000 population for chronic conditions, age 18 and over, United States, 2004, 2005, 2007, and 2008</p><p>7_3_1_2.3_4 Potentially avoidable hospitalizations per 100,000 population for chronic conditions, age 18 and over, by income, United States, 2000-2008</p><h3>National Data Source</h3><p>AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.</p><h3>National Denominator</h3><p>U.S. civilian population age 18 and over.</p><h3>National Numerator</h3><p>Subset of the denominator who qualified for any individual PQI numerator considered chronic: 1, 3, 7, 8, and 13-16 (see Comments).</p><h3>State Table</h3><p>7_3_1_2.3_3 Potentially avoidable hospitalizations per 100,000 population for chronic conditions, age 18 and over, by State, United States, 2000, 2004, 2007-2009</p><h3>State Data Source</h3><p>AHRQ, CDOM, HCUP, State Inpatient Databases (SID).</p><h3>State Denominator</h3><p>Same as national.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>Based on the eight AHRQ PQIs for angina, asthma, congestive heart failure, diabetes, and hypertension. For consistency of longitudinal reporting, the modified overall composite does not include AHRQ PQI 5 for chronic obstructive pulmonary disease because it is affected by International Classification of Diseases, Ninth Revision coding changes.</p><p>Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.</p><p>SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient&#39;s race.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="potmt4" name="potmt4">&#160;</a></p><h2>Potentially Avoidable Hospitalizations</h2><h3>Measure Title</h3><p>Potentially avoidable hospitalizations and emergency department encounters for congestive heart failure (CHF).</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Prevention Quality Indicators (PQIs).</p><h3>National Table</h3><p>7_4_1_3.1 Emergency department visits for congestive heart failure per 100,000 population (including inpatient admissions), age 18 and over, United States, 2008-2009</p><h3>National Data Source</h3><p>AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS).</p><h3>National Denominator</h3><p>U.S. civilian population age 18 and over.</p><h3>National Numerator</h3><p>Subset of the denominator who were admitted to a hospital or visited an emergency department for CHF.</p><h3>Comments</h3><p>Consistent with the AHRQ PQI software, CHF must be the principal diagnosis and the following are excluded: admissions with cardiac procedures and transfers from other institutions.</p><p>Rates are adjusted by age and gender using the total 2000 U.S. standard population; when reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.</p><p>Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="potmt5" name="potmt5">&#160;</a></p><h2>Potentially Avoidable Hospitalizations</h2><h3>Measure Title</h3><p>Perforated appendixes per 1,000 admissions with appendicitis.</p><h3>Measure Source</h3><p>Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Prevention Quality Indicators (PQIs).</p><h3>National Tables</h3><p>7_5_1_1.1_1 Admissions with perforated appendix per 1,000 admissions with appendicitis, age 18 and over, United States, 2000, 2004-2009</p><p>7_5_1_1.1_2 Admissions with perforated appendix per 1,000 admissions with appendicitis, age 18 and over, by race/ethnicity, United States, 2008</p><p>7_5_1_1.1_4 Perforated appendixes per 1,000 admissions with appendicitis, age 18 and over, by income, United States, 2000-2009</p><p>7_5_1_1.2_1 Perforated appendixes per 1,000 admissions with appendicitis, age 18 and over, in Indian Health Service, Tribal, and contract hospitals and community hospitals, United States, 2003-2010</p><p>7_5_1_2.1 Admissions with perforated appendix per 1,000 admissions with appendicitis, ages 1-17, United States, 2000, 2004-2009</p><p>7_5_1_2.2 Admissions with perforated appendix per 1,000 admissions with appendicitis, ages 1-17, by race/ethnicity, United States, 2009</p><p>7_5_1_2.4 Perforated appendixes per 1,000 admissions with appendicitis, ages 1-17, by income, United States, 2000-2009</p><h3>National Data Source</h3><p>AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1; State Inpatient Databases (SID), disparities analysis file.</p><h3>National Denominator</h3><p>Nonmaternal discharges with principal or secondary diagnosis of appendicitis, excluding transfers from other institutions.</p><h3>National Numerator</h3><p>Subset of the denominator with principal or secondary diagnosis code for perforation or abscess of appendix.</p><h3>State Tables</h3><p>7_5_1_1.1_3 Admissions with perforated appendix per 1,000 admissions with appendicitis, age 18 and over, by State, United States, 2000, 2004, 2007-2009</p><p>7_5_1_2.3 Admissions with perforated appendix per 1,000 admissions with appendicitis, ages 1-17, by State, United States, 2000, 2004, 2007-2009</p><h3>State Data Source</h3><p>AHRQ, CDOM, HCUP, SID.</p><h3>State Denominator</h3><p>Same as national.</p><h3>State Numerator</h3><p>Same as national.</p><h3>Comments</h3><p>Consistent with the AHRQ PQI software, transfers from other institutions are excluded.</p><p>Rates are adjusted by age and gender using U.S. hospitalizations for 2000 as the U.S. standard population; when reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.</p><p>Although not all States participate in the HCUP database, NIS is weighted to give national estimates using weights based on all U.S. community, nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.</p><p>SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient&#39;s race.</p><p>The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><p><a id="potem1" name="potem1">&#160;</a><a id="potemtm1" name="potemtm1">&#160;</a></p><h2>Potentially Harmful Services Without Benefit</h2><h3>Measure Title</h3><p>Visits with antibiotics prescribed for a diagnosis of common cold per 10,000 population.</p><h3>Measure Source</h3><p>Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).</p><h3>National Tables</h3><p>7_5_1_3.1 Doctor&#39;s office, emergency department, and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold, per 10,000 population, United States, 2005-2009</p><p>7_5_1_3.3 Doctor&#39;s office, emergency department, and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold, per 10,000 population, by race, United States, 2008-2009</p><h3>National Data Source</h3><p>CDC, NCHS, NAMCS, NHAMCS.</p><h3>National Denominator</h3><p>U.S. civilian noninstitutionalized population.</p><h3>National Numerator</h3><p>Subset of the denominator with a sole diagnosis of common cold for which antibiotics were prescribed or continued.</p><h3>Comments</h3><p>Population is U.S. Census Bureau estimated civilian noninstitutionalized population on July 1 of the 2 data years. Ambulatory medical care visits include visits to office-based physicians, hospital outpatient departments, and emergency departments.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><hr /><a id="potemtm2" name="potemtm2"></a> <h2>Potentially Harmful Services Without Benefit</h2><h3>Measure Title</h3><p>Males age 75 and over who reported having a prostate-specific antigen (PSA) test or a digital rectal exam within the last 12 months.</p><h3>Measure Source</h3><p>Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS).</p><h3>National Table</h3><p>7_5_1_4.1 Men age 75 and over without prostate cancer who had a prostate-specific antigen test or a digital rectal exam for prostate cancer screening within the past year, United States, 2004, 2006, 2008, and 2010</p><h3>National Data Source</h3><p>CDC, BRFSS.</p><h3>National Denominator</h3><p>Adult males age 75 and over without history of prostate cancer.</p><h3>National Numerator</h3><p>Subset of the denominator who had a PSA test or a digital rectal exam within the past year.</p><p class="size2"><a href="#efficiency">Top of Page</a></p><p class="size2"><a href="/research/findings/nhqrdr/nhqrdr12/measurespec/index.html">Return to Contents</a><br /><a href="/research/findings/nhqrdr/nhqrdr12/measurespec/facilitators_and_barriers.html">Proceed to Next Section</a></p></div>
<div class="current-as-of">Page last reviewed June 2013</div>
<div class="citation">
<span>Internet Citation: 2012 National Healthcare Quality and Disparities Reports : Efficiency.
June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/nhqrdr/nhqrdr12/measurespec/efficiency.html</span>
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