Effectiveness of Care: Diabetes

Measure Title

Composite measure: Adults age 40 and over with diabetes who had all three recommended services for diabetes in the past year (at least one hemoglobin A1c measurement, a retinal eye examination, and a foot examination).

Measure Source

Healthy People 2010.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

National Tables

19a Adults age 40 and over with diabetes who had a hemoglobin A1c test, a retinal eye examination, and a foot examination in the past year, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

National Data Source

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

National Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question and had valid, non-missing responses to all three questions.

National Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes whose answers indicated they had at least one hemoglobin A1c test, a retinal eye examination, and a foot examination in the study period.

State Tables

19b Diabetes patients age 40 and over who ever had hemoglobin A1c measurement, retinal eye examination, and foot examination within the past year, California, 2005, by

• Race.
• Ethnicity.
• Family income.
• Asian ethnicity.

State Data Source

University of California, Los Angeles (UCLA), California Health Interview Survey (CHIS).

State Denominator

California civilian population age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question and had valid, non-missing responses to all three questions, excluding people residing in group quarters..

State Numerator

Adults age 40 and older with diabetes whose answers indicated they had at least one hemoglobin A1c test, a retinal eye examination, and a foot examination in the study period.

Comments

The criteria for selecting the diabetes population from the MEPS survey and the methodology for calculating the diabetes composite measure have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Disparities Report.

Nonresponses and "Don't know" responses to the DCS question were excluded from the analysis.

National estimates are age adjusted to the 2000 standard population with two age groups: 40-59, 60 and over.

See entries for each of the three components of the composite measure for further details about the individual survey questions.

This measure and its tables are also presented in other relevant sections of the report.

The measures that comprise this composite measure are referred to as measures 5-12, 5-13, and 5-14 in Healthy People 2010 documentation.

Measure Title

Adults with diabetes who had a hemoglobin A1c measurement at least once in the past year.

Measure Source

Healthy People 2010.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

20 Adults age 40 and over with diabetes who had a hemoglobin A1c measurement in past year, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question: "During the year, how many times did a doctor, nurse, or other health professional check for glycosylated hemoglobin or ‘hemoglobin A-one-C’?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had a hemoglobin A1c test at least once in the study year.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Disparities Report.

Nonresponses and "Don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 standard population with two age groups: 40-59, 60 and over.

This measure is referred to as measure 5-12 in Healthy People 2010 documentation.

Measure Title

Adults with diabetes who had a lipid profile in the past 2 years.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

21 Adults age 40 and over with diabetes who had a lipid profile in past 2 years, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the question: "About how long has it been since you had your blood cholesterol checked by a doctor or other health professional?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered "Within the past year" or "Within the past 2 years" to the question.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Disparities Report.

Nonresponses and "Don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 standard population with two age groups: 40-59, 60 and over.

Measure Title

Adults with diabetes who had a retinal eye examination in the past year.

Measure Source

Healthy People 2010.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

22 Adults age 40 and over with diabetes who had a retinal eye examination in past year, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question: "When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to light."

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had at least one retinal eye examination in the study year or early following year (depending on panel).

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Disparities Report.

Nonresponses and "Don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 standard population with two age groups: 40-59, 60 and over.

This measure is referred to as measure 5-13 in Healthy People 2010 documentation.

Measure Title

Adults with diabetes who had a foot examination in the past year.

Measure Source

Healthy People 2010.

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

23 Adults age 40 and over with diabetes who had a foot examination in past year, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the Diabetes Care Survey (DCS) question: "During the year, how many times did a health professional check your feet for any sores or irritations?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had a foot examination one or more times in the study year.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Disparities Report.

Nonresponses and "Don't know" responses to the DCS question were excluded from the analysis.

Estimates are age adjusted to the 2000 standard population with two age groups: 40-59, 60 and over.

This measure is referred to as measure 5-14 in Healthy People 2010 documentation.

Measure Title

Adults with diabetes who had an influenza immunization in the past year.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Tables

24 Adults age 40 and over with diabetes who had an influenza immunization in past year, United States, 2004, by

• Race.
• Ethnicity.
• Family income.
• Education.

Data Source

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

Denominator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who answered the question: "How long since your last flu shot?"

Numerator

U.S. civilian noninstitutionalized adults age 40 and older with diabetes who indicated they had an influenza immunization within the study year.

Comments

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable with those found in prior years' editions of the National Healthcare Disparities Report.

Nonresponses and "Don't know" responses to the Diabetes Care Survey (DCS) question were excluded from the analysis.

Estimates are age adjusted to the 2000 standard population with two age groups: 40-59, 60 and over.

Measure Title

Hospital admissions for uncontrolled diabetes per 100,000 population.

Measure Source

Healthy People 2010. Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQI).

Table

25 Admissions for uncontrolled diabetes without complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Adult U.S. population age 18 and older by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Adult non-maternal discharges age 18 and over with principal diagnosis of uncontrolled diabetes, without mention of a short-term (ketoacidosis, hyperosmolarity, coma) or long-term complication (renal, eye, neurological, circulatory, other unspecified). Transfers from other institutions are excluded.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

Tables were created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 14 in the AHRQ Prevention Quality Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

This measure is referred to as measure 1-9c in Healthy People 2010 documentation.

Measure Title

Hospital admissions for short-term complications of diabetes per 100,000 population.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQI).

Tables

26a Admissions for diabetes with short-term complications (excluding transfers from other institutions) per 100,000 population, ages 6-17, United States, 2004, by

• Race/ethnicity.

26b Admissions for diabetes with short-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Adult U.S. population age 18 and older by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Adult discharges age 18 and over with a principal diagnosis of diabetes with short-term complications (ketoacidosis, hyperosmolarity, coma), ICD-9-CM code 250.10-250.13, 250.20-250.23, 250.30-250.33). Excluded obstetric admissions and transfers from other institutions.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 1 in the AHRQ Prevention Quality Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Hospital admissions for long-term complications of diabetes per 100,000 population.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQI).

Table

27 Admissions for diabetes with long-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Adult U.S. population age 18 and older by subcategory (i.e., race, age group, gender, median household income level, urbanization, and region).

Numerator

Adult non-maternal discharges age 18 and over with a diagnosis of diabetes and any diagnosis indicating long-term complications including retinopathy; microvascular disease (including coronary heart disease, cerebrovascular disease, and peripheral vascular disease, leading to amputation); sensory neuropathy; and impaired renal function. Transfers from other institutions are excluded.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 3, of the AHRQ Prevention Quality Indicators software. This measure is referred to as indicator 3 in the AHRQ Prevention Quality Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Hospital admissions for lower extremity amputations in patients with diabetes per 100,000 population.

Measure Source

Healthy People 2010.

Agency for Healthcare Research and Quality (AHRQ), Prevention Quality Indicators (PQI).

Table

28a Hospital admissions for lower extremity amputations in patients with diabetes per 1,000 population, United States, 2003-2005, by

• Race.

28b Admissions for lower extremity amputations among patients with diabetes (excluding trauma, obstetric admissions, and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2004, by

• Ethnicity.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Hospital Discharge Survey (NHDS) for Table 28a numerator.

CDC, NCHS, National Health Interview Survey (NHIS) for Table 28a denominator.

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP) for Table 28b.

Denominator

Number of persons in the NHIS population who reported that they have ever been diagnosed with diabetes (for Table 28a).

Population in Metro area or county age 18 years and older (for Table 28b).

Numerator

Number of hospital discharges among U.S. civilian persons with diabetes (ICD-9-CM code 250) as any listed diagnosis and amputation of the lower limb (ICD-9-CM procedure code 84.1) as any listed procedure (for Table 28a).

All non-maternal discharges age 18 years and older with ICD-9-CM procedure code for lower extremity amputation in any field and diagnosis code of diabetes in any field (for Table 28b).

Comments

Table 28a refers to measure 5-10 in Healthy People 2010 documentation. Table 28b was created using version 3.0 of the AHRQ Prevention Quality Indicators software; the measure is referred to as indicator 16 in the AHRQ PQI documentation. Rates reported in Table 28a are not comparable to rates reported in Table 28b due to differences in data source, measure methodology, and denominator scope.

The numerator and denominator of Table 28a refer to slightly different populations. The numerator includes the U.S. civilian population; the denominator includes only the U.S. civilian noninstitutionalized population.

Amputations due to causes other than diabetes are not included.

For Table 28a, adults are considered to have diabetes if they respond "Yes" to either of two questions listed in the denominator section of the survey. Those who respond "Borderline" and women who report only gestational diabetes are excluded. For Table 28b, adults are considered to have diabetes if a diagnosis of diabetes is present on the discharge record.

Data in Table 28a are age adjusted to the 2000 standard population using the age groups under 65 years, 65-74, and 75 years and over. Age-adjusted rates are weighted sums of age-specific rates. Data in Table 28b are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Table 28b uses the disparities analysis file. This file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

Measure Title

Percent of adults with diagnosed diabetes with HbA1c level greater than 9.0% (poor control) and less than 7.0% (optimal).

Measure Source

This measure is a combined measure developed expressly for the purpose of reporting both minimal and optimal levels of quality.

Table

30 Percent of adults age 40 and over with diagnosed diabetes whose hemoglobin A1c level was less than 7.0% (optimal control), United States, 1999-2004

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).

Denominator

Adults, age 18 or older, with diagnosed diabetes.

Numerator

Adults with diabetes who had hemoglobin A1c level greater than 9.0% or less than 7.0%, respectively, at examination.

Comments

Rates are age adjusted using the 2000 standard population.

Measure Title

Percent of adults with diagnosed diabetes with most recent LDL-C level less than 200 mg/dL (minimally acceptable) or less than 100 mg/dL (optimal).

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Table

31 Percent of adults age 40 and over with diagnosed diabetes whose total cholesterol was less than 200 mg/dL, United States, 1999-2004

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).

Denominator

Adults, age 18 or older, with diabetes.

Numerator

Subset of the denominator with most recent low-density lipoprotein-cholesterol level less than 200 mg/dL or less than100 mg/dL, respectively, at examination.

Comments

Rates are age adjusted using the 2000 standard population.

Measure Title

Percent of adults with diagnosed diabetes with most recent blood pressure <140/80/Hg.

Measure Source

National Alliance for Diabetes Quality Improvement, National Quality Forum, 2002.

Table

32 Percent of adults age 40 and over with diagnosed diabetes with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 80 mm Hg based on average of 3 measurements, United States, 1999-2004

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).

Denominator

Adults, age 18 or older, with diabetes.

Numerator

Subset of the denominator most recent blood pressure measurement <140/80/Hg.

Comments

Rates are age adjusted using the 2000 standard population.

Measure Title

Percent of adults age 40 and over with diabetes whose condition is diagnosed.

Measure Source

Healthy People 2010.

Table

33 Percent of adults age 40 and over with diabetes whose condition is diagnosed, United States, 1999-2004

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health and Nutrition Examination Survey (NHANES).

Denominator

Number of adults aged 40 years and older who have a fasting blood glucose level of 126 mg/dl.

Numerator

Subset of denominator who report that they have ever been diagnosed with diabetes.

Comments

This measure is referred to as measure 5-4 in Healthy People 2010 documentation. The age range has been modified from the original specification.