Morbidity and Mortality

• Lack of timeliness can result in emotional distress, physical harm, and higher treatment costs for patients.^2,3
• Stroke patients' mortality and long-term disability are largely influenced by the timeliness of therapy.^4,5
• Timely delivery of appropriate care can also help reduce mortality and morbidity for chronic conditions such as chronic kidney disease.⁶
• Timeliness in childhood immunizations helps maximize the protection from vaccine- preventable diseases while minimizing risks to the child and reducing the chance of disease outbreaks.⁷
• Timely antibiotic treatments are associated with improved clinical outcomes.⁸

Cost

• Early care for comorbid conditions has been shown to reduce hospitalization rates and costs for Medicare beneficiaries.⁹
• Some research suggests that, over the course of 30 years, the costs of treating diabetic complications can approach $50,000 per patient.¹⁰ Early care for complications in patients with diabetes can reduce overall costs of the disease.¹¹
• Timely outpatient care can reduce admissions for pediatric asthma, which in 2003 accounted for more than $1.25 billion in total hospitalization charges.^{12, 13}

Measures

This report focuses on three core report measures related to timeliness of primary, emergency, and hospital care:

• Getting care for illness or injury as soon as wanted
• Emergency department visits in which the patient left without being seen
• Time to initiation of thrombolytic therapy for heart attack patients

Getting Care for Illness or Injury As Soon As Wanted

A patient's primary care provider should be the point of first contact for most illnesses and injuries. The ability of patients to receive treatment for illness and injury in a timely fashion is a key element in a patient-focused health care system.

Figure 4.1. Adults age 18 and over who reported sometimes or never getting care for illness or injury as soon as wanted in the past year, by age group, 2000-2003

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000-2003.

Reference population: U.S. civilian noninstitutionalized population age 18 and over.

Figure 4.2. Parents who reported that their children sometimes or never got care for illness or injury as soon as wanted in the past year, 2001-2003

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2003.

Reference population: U.S. civilian noninstitutionalized population under age 18.

• From 2000 to 2003, the percentage of adults who reported that they sometimes or never got care for illness or injury as soon as wanted during the previous 12 months did not change significantly overall or for any age group (Figure 4.1).
• In all 4 data years, the proportion of adults who reported that they sometimes or never got care for illness or injury as soon as wanted was lower among those ages 45 to 64 and age 65 and older compared with those ages 18 to 44.
• Among children who had appointments reported for illness or injury during the previous 12 months, 9.1% sometimes or never got care as soon as wanted in 2003 (Figure 4.2). This rate did not change significantly between 2001 and 2003.
• From 2001 to 2003, there was no significant difference on this measure between the children ages 0-5 and children ages 6-17 (data not shown).

Emergency Department Visits in Which the Patient Left Without Being Seen

In 2001, patients visiting emergency departments in the United States spent an average of 3.2 hours waiting to be seen. This may be a result of the 20% increase in ED visit volumes over a 10-year period as the number of ED facilities decreased by 15%.¹⁴ Although there are many reasons that may lead a patient seeking care in a hospital emergency department to leave without being seen, long waits tend to exacerbate this problem.

Figure 4.3. Emergency department visits in which the patient left without being seen, 1997-1998, 1999-2000, 2001-2002, and 2003-2004

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 1997-1998, 1999-2000, 2001-2002, and 2003-2004.

Denominator: Visits to emergency departments of general and short-stay hospitals.

• From 1997-1998 to 2003-2004, the overall percentage of emergency department visits in which the patient left before being seen increased from 1.2% to 1.8% (Figure 4.3).

Time to Initiation of Thrombolytic Therapy for Heart Attack Patients

The capacity to treat hospital patients in a timely fashion is especially important for emergency situations such as heart attacks. For patients suffering from a heart attack, early interventions—such as percutaneous coronary stenting and thrombolytic therapy—may reduce heart muscle damage and save lives.¹⁵

Figure 4.4. Median time (minutes) from arrival of Medicare heart attack patients to initiation of thrombolytic therapy, 2000-2004

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2000-2004.

Denominator: Medicare beneficiaries meeting all of the following criteria: (1) principal diagnosis of acute myocardial infarction; (2) ST segment elevation or left bundle branch block on the electrocardiogram performed closest to hospital arrival; and (3) thrombolytic therapy during the hospital stay.

Note: This measure is assessed for patients with ST segment elevation or left bundle branch block on the electrocardiogram performed closest to the hospital arrival time.

• Among heart attack patients with Medicare, the median time from hospital arrival to the initiation of thrombolytic therapy was 49.8 minutes in 2004, compared with 43.0 minutes in 2000/2001, an increase of nearly 7 minutes (Figure 4.4).
• The median time to the initiation of therapy with thrombolytic agents remains well above the national target of 30 minutes.¹⁶