附录E: AHRQ National Healthcare Quality and Disparities Report Measures
Access
Health Insurance
Adults 18–64 who were uninsured at the time of interview
People without health insurance coverage at the time of interview, by age
Adults 18–64 who were uninsured at the time of interview, by race/ethnicity
Adults 18–64 without health insurance at the time of interview, by region
Adults 18–64 with private health insurance coverage, by age
Service
People with a place to go for medical care, by age and sex
Age-/sex-adjusted percentage of people with a place to go for medical care, by race/ethnicity
People who were unable to get or delayed getting needed medical care, dental care, or prescription medicines in the last 12 months, by insurance (under age 65) and age
People who were unable to get or delayed getting needed medical care, dental care, or prescription medicines in the last 12 months, by perceived health status and ethnicity
Timeliness
Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by insurance (ages 18–64) and ethnicity
Children who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by preferred language and ethnicity
Infrastructure
Physicians and surgeons per 100,000 population, by race and ethnicity
Primary care medical residents per 100,000 population, by sex and race/ethnicity
Characteristics of HRSA-supported health center population versus US population
Medicaid and uninsured discharges in US short-term acute hospitals, by facility characteristics
Affordability
Access Problems due to Healthcare Costs
People under age 65 whose family’s health insurance premiums and out-of-pocket medical expenses were more than 10% of total family income
People without a usual source of care who indicate a financial or insurance reason for not having a source of care
People unable to get or delayed getting needed medical care, dental care, or prescription medicines who indicate a financial or insurance reason for the problem
Inefficiency
Ruptured appendix per 1000 adult admissions with appendicitis
Men age 40+ who had a screening prostate-specific antigen test in the past year
Supplemental
Per capita national health expenditures
Care Coordination
Transitions
Hospitalized adult patients with heart failure who were given complete written discharge instructions
Median hospital 30-day risk standardized readmission rate or certain conditions
Median hospital 30-day risk standardized readmission rate
Potentially Avoidable ER Visits
ER visits with a principal diagnosis related to mental health, alcohol, or substance abuse ED visits with a principal diagnosis of dental conditions
ER visits for asthma, ages 18–39
ER visits for asthma, ages 2–17
Integration of Medical Information
People under age 65 with a usual source of care whose health provider usually asks about prescription medications and treatments from other doctors
Hospitals with electronic exchange of patient medication history with hospitals outside their system
Hospitals with electronic exchange of patient medication history with ambulatory providers outside their system
Electronic Health Record
Patients who reported that it was very important for them to get their own medical information electronically
Patients who reported that it was very important that doctors and other health providers be able to share their medical information with other providers electronically
Hospitals with fully implemented electronic medical record system
Hospitals with computerized systems that allow for electronic clinical documentation
Hospitals with computerized systems that allow for results viewing
Hospitals with computerized systems that allow for decision support
Hospitals with computerized systems that allow for computerized provider order entry
Effective Treatment
Cardiovascular Disease
Adults with hypertension whose blood pressure is under control
Hospital patients with heart attack given fibrinolytic medication within 30 minutes of arrival
Inpatient deaths per 1000 adult hospital admissions with heart attack
Adult admissions for congestive heart failure per 100,000 population Total national costs of hospitalizations for congestive heart failure
Cancer
Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined
Age-adjusted colorectal cancer deaths per 100,000 population
Chronic Kidney Disease
Nephrology care before kidney failure
Registration for transplantation
Hemodialysis death rate
Diabetes
Receipt of four recommended diabetes services
People with current diabetes who have a written diabetes management plan Outcome:
Adults age 40+ with diagnosed diabetes with hemoglobin A1c and blood pressure under control
Hospital admissions for uncontrolled diabetes
New cases of end-stage renal disease due to diabetes
HIV and AIDS
New AIDS cases
Adult HIV patients who had at least two outpatient visits during the year
Adult HIV patients with a viral load less than 200 copies/mL
HIV infection deaths
HIV patients in Ryan White–funded care who were virally suppressed (HIV RNA <200 copies/mL)
HIV patients in Ryan White–funded care who were retained in care (at least two ambulatory visit dates 90 days apart)
Mental Health and Substance Abuse
Treatment for depression
Suicide deaths
Treatment for illicit drug use or alcohol problem
Completion of substance abuse treatment
Emergency department visits with a principal diagnosis related to mental health, alcohol or substance abuse, by age and income
Musculoskeletal Disease
Adults with chronic joint symptoms who have ever seen a doctor or health professional for joint symptoms
Respiratory Disease
Completion of tuberculosis therapy
Daily asthma medication
Written asthma management plans
Emergency department visits for asthma
Healthy Living
Maternal and Child Healthcare
Access
Periods without insurance
Effectiveness
Prenatal care
Receipt of recommended immunizations by young children
Children’s vision screening
Well-child visits in the last year
Receipt of meningococcal vaccine by adolescents
Receipt of human papillomavirus (HPV) vaccination by adolescents Person-centered care
Children who had a doctor’s office or clinic visit in the last 12 months who reported poor communication with health providers
Patient Safety
Birth trauma—injury to neonates
Care Coordination
Children and adolescents whose health provider usually asks about prescription medications and treatments from other doctors
Emergency department (ED) visits with a principal diagnosis related to mental health, alcohol, or substance abuse ED visits for asthma
Lifestyle Modification
Adult current smokers with a checkup in the last 12 months who received advice to quit smoking
Adults with obesity who ever received advice from a health professional to exercise more
Adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week
Children 2–17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have
Adults with obesity who ever received advice from a health professional about eating fewer high-fat or high-cholesterol foods
Children 2–17 for whom a health provider gave advice within the past 2 years about healthy eating
Clinical Preventive Services
Women 21–65 who received a Pap smear in the last 3 years
Invasive cervical cancer incidence per 100,000 women age 20+
Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high
Immunization
Adults 65+ who ever received pneumococcal vaccination
Hospital patients who received
– Pneumococcal immunization
– Influenza immunization
Long-stay nursing home residents who were assessed and appropriately given
– Pneumococcal immunization
– Influenza immunization
Rehabilitation
Improvement in mobility among home healthcare patients
Nursing home residents needing more help with daily activities
Improvement in management of oral medications
Supportive and Palliative Care
Relief of suffering:
Improvement in shortness of breath among home healthcare patients
Nursing home residents with moderate to severe pain
Nursing home residents who lose too much weight
Help with emotional and spiritual needs
Worsening depression or anxiety in nursing home residents High-quality palliative care:
Home healthcare patients with hospital admission
Home healthcare patients with urgent, unplanned medical care
Nursing home residents receiving antipsychotic medication
Hispanic Healthcare
Breast Cancer
Women 50–74 who received a mammogram in the last 2 years
Breast cancer diagnosed at advanced stage per 100,000 women age 40+
Women with clinical Stage I–IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy at the time of surgery
Women under 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis
Breast cancer deaths per 100,000 female population per year
Colorectal Cancer
Men and women 50–75 who report that they had a blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or colonoscopy in the past 10 years
Colorectal cancer diagnosed at advanced stage per 100,000 men and women age 50+
Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined
Colorectal cancer deaths per 100,000 population per year
Other Cancer
All cancer deaths per 100,000 population per year
Women 21–65 who received a Pap smear in the last 3 years
Invasive cervical cancer incidence per 100,000 women age 20+
Men age 75+ without prostate cancer who had a PSA test or digital rectal exam for prostate cancer screening within the past year
Lung cancer deaths per 100,000 population per year
Cardiovascular Care
Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high
Adult admissions for hypertension
Adult admissions for angina without cardiac procedure
Adult admissions for congestive heart failure
Hospital patients with heart failure and left ventricular systolic dysfunction who were prescribed angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge
Hospital patients with heart attack given percutaneous coronary intervention within 90 minutes of arrival
Hospital patients with heart attack given fibrinolytic medication within 30 minutes of arrival
Deaths per 1000 hospital admissions with acute myocardial infarction, age 18+
Deaths per 1000 hospital admissions with congestive heart failure, age 18+
Deaths per 1000 hospital admissions with abdominal aortic aneurysm repair, age 18+
Deaths per 1000 hospital admissions with coronary artery bypass graft, age 40+
Deaths per 1000 hospital admissions with percutaneous transluminal coronary angioplasty, age 40+
Substance Abuse
People age 12+ who received any illicit drug or alcohol abuse treatment in the last 12 months
People age 12+ who needed treatment for illicit drug use or an alcohol problem and who received such treatment at a specialty facility in the last 12 months
People age 12+ treated for substance abuse who completed treatment course
Diabetes
Adults age 40+ with diabetes whose condition was diagnosed
Adults age 40+ with diagnosed diabetes who received all four recommended services for diabetes in the calendar year
Adults age 40+ with diagnosed diabetes with hemoglobin A1c under control
Adults age 40+ with diagnosed diabetes with blood pressure under control
Mental Health
Adults who received mental health treatment or counseling in the last 12 months
Adults with a major depressive episode in the last 12 months who received treatment
Children 12–17 with a major depressive episode in the last 12 months who received treatment Suicide deaths per 100,000 population
Infant Mortality and Maternity Care
Live-born infants with low birth weight (less than 2500 g)
Live-born infants with very low birth weight (less than 1500 g)
Infant mortality per 1000 live births
Maternal deaths per 100,000 live births
Birth trauma—injury to newborn per 1000 live births
Obstetric trauma per 1000 vaginal deliveries without instrument assistance Obstetric trauma per 1000 instrument-assisted vaginal deliveries
Patient Safety
Healthcare-Associated Infections
Postoperative sepsis per 1000 adult discharges with an elective operating room procedure
Standardized infection ratios for central line-associated bloodstream infections and surgical site infections
Bloodstream infections per 1000 central-line days in neonatal intensive care units
Bloodstream infections per 1000 central-line days in adult intensive care units
Procedure-Related Events
Unadjusted mortality rate 30 days postoperation for colorectal surgeries among US hospitals participating in the American College of Surgeons–National Surgical Quality Improvement Program
Percentage of adult patients receiving hip joint replacement because of fracture or degenerative conditions who experienced adverse events
Percentage of adults with mechanical adverse events associated with central venous catheter placement
Nursing Home Setting
Nursing home residents experiencing urinary tract infections
Nursing home residents experiencing use of restraints
Pooled mean rate of healthcare-associated infections per 1000 resident days in Pennsylvania nursing homes
Home Health Setting
Home health patients with improvement in surgical wounds
Home health patients with improvements in their ability to take medications orally
Ambulatory Setting
Adults with a probable missed stroke in the emergency department
Adults age 65+ who received potentially inappropriate prescription medications during the calendar year
Culture
Average percent positive responses on the AHRQ Hospital Survey on Patient Safety Culture
Average percent positive responses on the AHRQ Medical Office Survey on Patient Safety Culture
Average percent positive responses for patient safety culture composite among participants in the National Center for Patient Safety High Reliability Team training
Percent change from baseline in observed annual mortality rate per 1000 procedures, by medical team training status of Veterans Health Administration facility
Organizations
Distribution of Patient Safety Organizations by category of event reports collected
Reduction in surgical site infections among Vascular Quality Initiative Centers that expanded from sporadic to routine chlorhexidine use
Person- and Family-Centered Care
Communications—Doctor’s Office
Adults who had a doctor’s office or clinic visit in the last 12 months who reported poor communication with health providers, by insurance, 18–64 and 65+
Adults who had a doctor’s office or clinic visit in the last 12 months who reported poor communication with health providers, by ethnicity and education
Children who had a doctor’s office or clinic visit in the last 12 months whose parents reported poor communication with health providers, by ethnicity and language spoken at home
Communications—Hospital
Adult hospital patients who reported poor communication with nurses and doctors, by age
Adult hospital patients who did not receive good communication about discharge information, by race
Communications—Home Health
Provider–patient communication among adults receiving home healthcare, by language spoken at home
Provider–patient communication among adults receiving home healthcare, by race/ethnicity
Engagement in Decision Making
Adults with a usual source of care whose health providers sometimes or never asked for the patient’s help to make treatment decisions, by insurance and education
People with a usual source of care whose health providers sometimes or never asked for the patient’s help to make treatment decisions, by number of chronic conditions and ethnicity
End of Life
Hospice patients who received care consistent with their stated end-of-life wishes, by age and ethnicity
Hospice patients who received the right amount of help for feelings of anxiety or sadness, by ethnicity and race
Hospice patients who received the right amount of medicine for pain, by sex and race
Rural Healthcare
Access to Healthcare
Patient Safety
Person- and Family-Centered Care
Communication and Care Coordination
Prevention and Treatment of Leading Causes of Morbidity and Mortality
Healthy Living
Affordability
Women’s Healthcare
Access to Healthcare
Patient Safety
Person- and Family-Centered Care
Communication and Care Coordination
Prevention and Treatment of Leading Causes of Morbidity and Mortality
Healthy Living Affordability Sources:
2014 National Healthcare Quality & Disparities Report Chartbooks. Content last reviewed October 2015. Rockville, MD: Agency for Healthcare Research and Quality. www.ahrq.gov /research/findings/nhqrdr/2014chartbooks/index.html
2014 National Healthcare Quality & Disparities Report Data Query Tool. Nhqrnet.ahrq.gov / inhqrdr/data/query
2014 National Healthcare Quality and Disparities Report chartbook on access to health care. Rockville, MD: Agency for Healthcare Research and Quality; April 2015. AHRQ Pub. No. 15-0007-1-EF.
2014 National Healthcare Quality and Disparities Report chartbook on care affordability. Rockville, MD: Agency for Healthcare Research and Quality; June 2015. AHRQ Pub. No. 15-0007-6-EF.
2014 National Healthcare Quality and Disparities Report chartbook on care coordination. Rockville, MD: Agency for Healthcare Research and Quality; May 2015. AHRQ Pub. No. 15-0007-5-EF.
2014 National Healthcare Quality and Disparities Report chartbook on effective treatment. Rockville, MD: Agency for Healthcare Research and Quality; July 2015. AHRQ Pub. No. 15-0007-8-EF.
2014 National Healthcare Quality and Disparities Report chartbook on health care for Hispanics. Rockville, MD: Agency for Healthcare Research and Quality; September 2015. AHRQ Pub. No. 15-0007-11-EF.
2014 National Healthcare Quality and Disparities Report chartbook on healthy living. Rockville, MD: Agency for Healthcare Research and Quality; June 2015. AHRQ Pub. No. 15-0007-7-EF.
2014 National Healthcare Quality and Disparities Report chartbook on patient safety. Rockville, MD: Agency for Healthcare Research and Quality; April 2015. AHRQ Pub. No. 15-0007-2-EF.
2014 National Healthcare Quality and Disparities Report chartbook on person- and familycentered care. Rockville, MD: Agency for Healthcare Research and Quality; May 2015. AHRQ Pub. No. 15-0007-4-EF.
2014 National Healthcare Quality and Disparities Report chartbook on rural health care. Rockville, MD: Agency for Healthcare Research and Quality; August 2015. AHRQ Pub. No. 15-0007-9-EF.
2014 National Healthcare Quality and Disparities Report chartbook on women’s health care. Rockville, MD: Agency for Healthcare Research and Quality; September 2015. AHRQ Pub. No. 15-0007-10-EF.
2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy. Rockville, MD: Agency for Healthcare Research and Quality.
AHRQ; April 2016. AHRQ Pub. No. 16-0015.