Measure Specifications Appendix

This appendix provides information about each database analyzed for the 2006 National Healthcare Quality Report, including source, data type, sample design, and primary content as well as information about how to generate each measure. Measures highlighted in the text of the full report as well as other measures examined but not discussed in the text are included; information about composite measures is also presented in this appendix.

Effectiveness of Care—Cancer
Screening for Breast Cancer
Percent of women (age 40 and over) who report they had a mammogram within the past 2 years
Rate of breast cancer incidence per 100,000 women age 40 and over diagnosed at advanced stage (regional, distant stage or local stage w/tumor greater than 2cm)
Screening for Cervical Cancer
Percent of women (age 18 and over) who report that they had a Pap smear within the past 3 years
Rate of cervical cancer incidence per 100,000 women age 20 and over diagnosed at advanced stage (all invasive tumors)
Screening for Colorectal Cancer
Percent of men and women (age 50 and over) who report they ever had a flexible sigmoidoscopy/colonoscopy
Percent of men and women (age 50 and over) who report they had a fecal occult blood test (FOBT) within the past 2 years
Rate of colorectal cancer incidence per 100,000 men and women age 50 and over diagnosed at advanced stage (tumors diagnosed at regional or distant stage)
Cancer Treatment
Cancer deaths per 100,000 persons per year for all cancers
Cancer deaths per 100,000 persons per year for most common cancers: prostate cancer
Cancer deaths per 100,000 persons per year for most common cancers: breast cancer
Cancer deaths per 100,000 persons per year for most common cancers: lung cancer
Cancer deaths per 100,000 persons per year for most common cancers: colorectal cancer
Deaths per 1,000 admissions with esophageal resection for cancer
Deaths per 1,000 admissions with pancreatic resection for cancer

Effectiveness of Care—Diabetes
Management of Diabetes
Composite measure: Adults with diabetes who had at least 1 hemoglobin A1c measurement, a retinal eye examination, and a foot examination in the past year
Percent of adults with diabetes who had a hemoglobin A1c measurement at least once in the past year
Percent of adults with diabetes who had a lipid profile in the past 2 years
Percent of adults with diabetes who had a retinal eye examination in the past year
Percent of adults with diabetes who had a foot examination in the past year
Percent of adults with diabetes who had an influenza immunization in the past year
Percent of adults with diagnosed diabetes with HbA1c level greater than 9.0% (poor control) and less than <7.0% (optimal)
Percent of adults with diagnosed diabetes with most recent LDL-C level less than 130mg/dL (minimally acceptable) or less than <100mg/dL (optimal)
Percent of adults with diagnosed diabetes with most recent blood pressure less than 140/90 mm/Hg
Hospital admissions for uncontrolled diabetes per 100,000 population
Hospital admissions for short-term complications of diabetes per 100,000 population
Hospital admissions for long-term complications of diabetes per 100,000 population
Hospital admissions for lower extremity amputations in patients with diabetes

Effectiveness of Care—End Stage Renal Disease
Management of End Stage Renal Disease
Percent of dialysis patients registered on the waiting list for transplantation
Percent of patients with treated chronic kidney failure who receive a transplant within 3 years of renal failure
Percent of hemodialysis patients with URR 65 percent or greater
Percent of patients with hematocrit 33 or greater or hemoglobin 11 or greater
Patient survival rate
Use of arteriovenous fistulas—new hemodialysis patients (aged 18 years and over)

Effectiveness of Care—Heart Disease
Screening for High Blood Pressure
Percent of people age 18 and over who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure is normal or high
Screening for High Cholesterol
Percent of adults 18 and over receiving cholesterol measurement within 5 years
Counseling on Risk Factors
Percent of smokers receiving advice to quit smoking
Treatment of AMI
Recommended hospital care received by Medicare patients with heart attack
Percent of AMI patients administered aspirin within 24 hours of admission
Percent of AMI patients with aspirin prescribed at discharge
Percent of AMI patients administered beta blocker within 24 hours of admission
Percent of AMI patients with beta blocker prescribed at discharge
Percent of AMI patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge
Percent of AMI patients given smoking cessation counseling while hospitalized
Median time in minutes to Thrombolysis. Time from arrival to initiation of a thrombolytic agent in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time
Median time to PTCA. Median time from arrival to percutaneous transluminal angioplasty (PTCA) in patients with ST segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time
Treatment of Acute Heart Failure
Recommended hospital care received by Medicare patients with heart failure
Percent of heart failure patients having evaluation of left ventricular ejection fraction
Percent of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitor at discharge
Management of Hypertension
Percent of people with hypertension who have blood pressure under control
Management of CHF
Hospital admissions for congestive heart failure (CHF)
Heart Disease Treatment
Pediatric heart surgery mortality rate (number of deaths per 1,000 heart surgeries in patients under age 18 years)
Abdominal aortic aneurysm (AAA) repair mortality rate (number of deaths per 1,000 AAA repairs)
Coronary artery bypass graft (CABG) mortality rate (number of deaths per 1,000 CABG procedures)
Percutaneous transluminal coronary angioplasty (PTCA) mortality rate (number of deaths per 1,000 PTCAs)
Acute myocardial infarction (AMI) mortality rate (number of deaths per 1,000 discharges for AMI)
Congestive heart failure (CHF) mortality rate (number of deaths per 1,000 discharges for CHF)

Effectiveness of Care—HIV and AIDS
AIDS Prevention
New AIDS cases per 100,000 population (age 13 or over)
Management of HIV/AIDS
HIV-infection deaths per 100,000 population
HIV patients with CD4 counts less than 200 who received pneumocystis jiroveci pneumonia (PCP) prophylaxis
HIV patients with CD4 counts less than 50 who received Mycobacterium avium complex (MAC) prophylaxis

Effectiveness of Care—Maternal and Child Health
Maternity Care
Percent of pregnant women receiving prenatal care in the first trimester
Percent of liveborn infants with low and very low birth weight (less than 2,500 grams, less than 1,500 grams)
Infant mortality per 1,000 live births
Maternal deaths per 100,000 live births
Immunization, Childhood
Percent of children 19-35 months who received all recommended vaccines
Immunization, Adolescent
Percent of adolescents (age 13-15) reported to have received 3 or more doses of hepatitis B vaccine
Percent of adolescents (age 13-15) reported to have received 2 or more doses of MMR vaccine
Percent of adolescents (age 13-15) reported to have received 1 or more doses of tetanus-diphtheria booster
Percent of adolescents (age 13-15) reported to have received 1 or more doses of varicella vaccine
Childhood Dental Care
Percent of children age 2-17 who report having a dental visit in the last year
Treatment of Pediatric Gastroenteritis
Hospital admissions for pediatric gastroenteritis per 100,000 population less than 18 years of age
Childhood preventive care
Percent of children under age 18 who had their height and weight measured by a doctor or other health provider
Percent of children age 2-17 for whom a doctor or other health provider gave advice about amount and kind of physical activity
Percent of children age 2-17 for whom a doctor or other health provider gave advice about eating healthy
Percent of children age 3-6 whose vision was checked by a doctor or other health provider
Percent of children under age 18 for whom a doctor or other health provider gave advice about how smoking in the house can be harmful
Percent of children under age 18 for whom a doctor or other health provider gave advice about using car safety restraints
Percent of children age 2-17 for whom a doctor or other health provider gave advice about using a helmet when riding a bicycle or motorcycle

Effectiveness of Care—Mental Health and Substance Abuse
Treatment of Depression
Percent of adults diagnosed with a new episode of depression who had optimal practitioner contacts for medication management during the acute treatment phase
Percent of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who received a continuous trial of medication treatment during the acute treatment phase
Percent of adults diagnosed with a new episode of depression and initiated on an antidepressant drug who remained on an antidepressant medication through the continuation phase of treatment
Deaths due to suicide per 100,000 population
Treatment of Serious Mental Illness
Adults with serious mental illness who received mental health treatment or counseling
Persons age 18 and older receiving mental health treatment and/or counseling for serious mental illness who experienced improvement
Treatment of Substance Abuse
People 12 and older who needed treatment at a specialty facility for illicit drug use and who received such treatment in the past year
People receiving illicit drug treatment who completed treatment

Effectiveness of Care—Respiratory Diseases
Immunization, Influenza
Percent of high-risk persons (e.g., COPD) age 18-64 who received an influenza vaccination in the past 12 months
Percent of persons age 65 and over who received an influenza vaccination in the past 12 months
Hospital admissions for immunization-preventable influenza per 100,000 population age 65 and over
Immunization, Pneumonia
Percent of high-risk persons (e.g., COPD) age 18-64 who ever received a pneumococcal vaccination
Percent of persons age 65 and over who ever received a pneumococcal vaccination
Treatment of Pneumonia
Recommended hospital care received by Medicare patients with pneumonia
Percent of patients with pneumonia who have blood cultures collected before antibiotics are administered
Percent of patients with pneumonia who receive the initial antibiotic dose within 4 hours of hospital arrival
Percent of patients with pneumonia who receive the initial antibiotic consistent with current recommendations
Percent of patients with pneumonia who receive influenza screening or vaccination
Percent of patients with pneumonia who receive pneumococcal screening or vaccination
Pneumonia mortality rate (number of deaths per 1,000 discharges for pneumonia)
Treatment of URI
Visit rates where antibiotics were prescribed for a diagnosis of common cold per 10,000 population
Management of Asthma
Percent of people with persistent asthma who are prescribed medications acceptable as primary therapy for long-term control of asthma (inhaled corticosteroids)
Hospital admissions for pediatric asthma under age 18
Hospital admissions for asthma age 18 and over
Hospital admissions for asthma age 65 and over
Treatment of TB
Percent of TB patients who complete a curative course of TB treatment within 12 months of initiation of treatment

Effectiveness of Care—Nursing Home and Home Health Care
Nursing Facility Care
Chronic care: Percent of residents whose need for help with daily activities has increased
Chronic care: Percent of residents who have moderate to severe pain
Chronic care: Percent of residents who were physically restrained
Chronic care: Percent residents who spent most of their time in bed or in a chair
Chronic care: Percent of residents whose ability to move about in and around their room got worse
Chronic care: Percent of residents with a urinary tract infection
Chronic care: Percent of residents who have become more depressed or anxious
Chronic care: Percent of high-risk residents who have pressure sores
Chronic care: Percent of low-risk residents who have pressure sores
Chronic care: Percent of low-risk residents who lose control of their bowels or bladder
Chronic care: Percent of residents who have/had a catheter inserted and left in their bladder
Post acute care: Percent of short-stay residents who had moderate to severe pain
Post acute care: Percent of short-stay residents with delirium
Post acute care: Percent of short-stay residents with pressure sores
Percent of residents who lose too much weight
Home Health Care
Improvement in upper body dressing
Improvement in management of oral medications
Improvement in bathing
Stabilization in bathing
Improvement in transferring
Improvement in ambulation/locomotion
Improvement in toileting
Improvement in pain interfering with activity
Improvement in dyspnea
Improvement in urinary incontinence
Improvement in confusion frequency
Acute care hospitalization

Effectiveness of Care—Patient Safety
Complications of Care
Birth trauma—injury to neonate
Death in low mortality DRGs
Failure to rescue
Transfusion reactions (discharge-based) and transfusion reactions (area-based)
Foreign body accidentally left in body during procedure (discharge-based) and foreign body accidentally left in body during procedure (area-based)
Central line-associated bloodstream infection in intensive care unit patients
Central line-associated bloodstream infection in infants weighing 1,000 grams or less at birth in intensive care
Complications of anesthesia
Decubitus ulcers
Iatrogenic pneumothorax (discharge-based) and iatrogenic pneumothorax (area-based)
Selected infections due to medical care (discharge-based) and selected infections due to medical care (area-based)
Postoperative hip fractures
Postoperative hemorrhage or hematoma
Postoperative physiologic and metabolic derangements
Postoperative respiratory failure
Postoperative pulmonary embolism or deep venous thrombosis
Postoperative sepsis
Accidental puncture or laceration during procedures (discharge-based) and accidental puncture or laceration during procedures (area-based)
Reclosure of postoperative disruption of abdominal wall (discharge-based) and reclosure of postoperative disruption of abdominal wall (area-based)
Obstetric trauma—vaginal with instrument
Obstetric trauma—vaginal without instrument
Obstetric trauma—Cesarean delivery
Intensive care unit patients—catheter-associated urinary tract infection
Intensive care unit patients—ventilator-associated pneumonia
Infants weighing 1,000g or less at birth in intensive care—ventilator-associated pneumonia
Postoperative venous thromboembolic events
Postoperative pneumonia events
Mechanical adverse events associated with central vascular catheters (CVCs)
Insertion-site infections associated with central vascular catheters (CVCs)
Blood stream infections (BSIs) associated with central vascular catheters (CVCs)
Postoperative urinary tract infections (UTIs)
Ventilator associated pneumonia (VAP) events
Hospital-acquired blood stream infections (BSIs)
Adverse events associated with hip joint replacement due to degenerative conditions
Adverse events associated with hip joint replacement due to fracture
Adverse events associated with hip joint replacement due to fracture or degenerative conditions
Adverse events associated with knee joint replacement
Prescribing Medications
Percent of community-dwelling elderly who had at least 1 prescription (from a list of 11 medications and from a list of 33 medications) that is potentially inappropriate for the elderly
Percent of persons who report that their usual source of care (USC) asks about prescription medications and treatments from other providers

Effectiveness of Care—Timeliness
Basic Access
Percent of persons who report that they have a usual source of medical care, by place of care
Percent of families who experienced difficulty in obtaining care, by reason
Getting Appointments for Care
Among adults age 18 and over who reported making an appointment for routine health care in the last 12 months, percent distribution of how often they got an appointment as soon as wanted
Among children under age 18 who had appointments reported for routine health care in the last 12 months, percent distribution of how often they got an appointment as soon as wanted
Among adults age 18 and over who reported making an appointment for an illness or injury in the last 12 months, percent distribution of how often they got an appointment as soon as wanted
Among children under age 18 who had appointments reported for an illness or injury in the last 12 months, percent distribution of how often they got an appointment as soon as wanted
Waiting Time
Emergency Department visits: Percent ED visits where patient was admitted to the hospital or transferred to other facility whose ED visit was greater than or equal to 6 hours
Emergency Department visits: Percent of ED visits where patients left before being seen

Effectiveness of Care—Patient Centeredness
Patient Experience of Care
Composite measure: people's experiences with how well their doctors communicate
Composite measure: percentage of parents of health plan members who reported how often their children's doctors or other health providers communicated well
Among adults age 18 and over who reported going to a doctor's office or clinic in the last 12 months, percent distribution of how often their health providers listened carefully to them
Among children under age 18 who had a doctor's office or clinic visit reported in the last 12 months, percent distribution of how often their health providers listened carefully to their parents
Among adults age 18 and over who reported going to a doctor's office or clinic in the last 12 months, percent distribution of how often their health providers explained things clearly
Among children under age 18 who had a doctor's office or clinic visit in the last 12 months, percent distribution of how often their health providers explained things clearly
Among adults age 18 and over who reported going to a doctor's office or clinic in the last 12 months, percent distribution of how often their health providers showed respect for what they had to say
Among children under age 18 who had a doctor's office or clinic visit in the last 12 months, percent distribution of how often their health providers showed respect for what their parents had to say
Among adults age 18 and over who reported going to a doctor's office or clinic in the last 12 months, percent distribution of how often their health providers spent enough time with them
Among children under age 18 who had a doctor's office or clinic visit in the last 12 months, percent distribution of how often their health providers spent enough time with them and their parents

Effectiveness of Care—Overall Measures
Among adults age 18 and over who reported going to a doctor's office or clinic in the last 12 months, percent giving a best rating for health care received
Among children under age 18 who had a doctor's office or clinic visit in the last 12 months, percent of parents giving a best rating for health care received

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