Effectiveness of Care: Diabetes

Measure Title

Composite measure: Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year (hemoglobin A1c measurement, dilated eye examination, and foot examination).

Measure Source

Healthy People 2010.

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

Tables

2_1_1.1 Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year (hemoglobin A1c measurement, dilated eye examination, and foot examination), United States, 2002 and 2005.

2_1_1.2 Adults age 40 and over with diagnosed diabetes who received all three recommended services for diabetes in the calendar year (hemoglobin A1c measurement, dilated eye examination, and foot examination), United States, 2005, 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 over with diabetes who had a positive Diabetes Care Survey weight, who had at least one “No” response to one of the three exams, or who had a Yes response to all three exams. Other cases are considered missing values.

Numerator

U.S. civilian noninstitutionalized adults age 40 and over with diabetes who had a positive Diabetes Care Survey weight who had a Yes response to all three exams.

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 editions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

The method for defining the numerator and denominator for the eye exam component of this composite measure changed beginning with the 2008 edition of the reports; rates may not be comparable with those reported in earlier editions.

Missing values for the composite measure were excluded from the analysis.

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

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

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

This measure and its tables are also presented in other relevant sections of the National Healthcare Disparities Report.

Measure Title

Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c measurement in the calendar year.

Measure Source

Healthy People 2010.

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

National Tables

2_1_2.1 Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c measurement in the calendar year, United States, 2002 and 2005.

2_1_2.2 Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c measurement in the calendar year, United States, 2005, 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 over with diabetes who had a positive Diabetes Care Survey (DCS) weight and who answered the DCS question: During the survey year, “How many times did a doctor, nurse, or other health professional check for glycosylated hemoglobin or ‘hemoglobin A-one-C’?” Nonresponses and “Don't know” responses were excluded.

National Numerator

U.S. civilian noninstitutionalized adults age 40 and over with diabetes who had a positive Diabetes Care Survey (DCS) weight and who had a hemoglobin A1c test at least once in the preceding calendar year.

State Tables

2_1_2.3 Adults age 40 and over with diagnosed diabetes who received a hemoglobin A1c measurement in the calendar year, by State, 2001 and 2006.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Adults with diabetes who had a hemoglobin A1c test at least once in the survey year.

Comments

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

The national table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources appendix for more information on the DCS.

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 and 60 and over.

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

Measure Title

Adults age 40 and over with diagnosed diabetes who had their blood cholesterol checked in the last 2 years.

Measure Source

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

Tables

2_1_3.1 Adults age 40 and over with diagnosed diabetes who had their blood cholesterol checked in the last 2 years, United States, 2002 and 2005.

2_1_3.2 Adults age 40 and over with diagnosed diabetes who had their blood cholesterol checked in the last 2 years, United States, 2005, 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 over 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 over with diabetes whose answer to the question was “Within the past year” or “Within the past 2 years.”

Comments

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

This table reports data from the MEPS Preventive Care section. See the MEPS entry in the Data Sources section of this appendix for more information.

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 and 60 and over.

Measure Title

Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year.

Measure Source

Healthy People 2010.

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

National Tables

2_1_4.1 Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year, United States, 2002 and 2005.

2_1_4.2 Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year, United States, 2005, 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 over 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.”

National Numerator

U.S. civilian noninstitutionalized adults age 40 and over with diabetes who indicated they had at least one retinal eye examination in the preceding calendar year.

State Tables

2_1_4.3 Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year, by State, 2001 and 2006.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Adults with diabetes who had at least one retinal eye examination in the survey years.

Comments

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

The method for defining the numerator and denominator for this measure changed beginning with the 2008 edition of the reports; rates may not be comparable with those reported in earlier editions.

The national table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources appendix and http://meps.ahrq.gov/ for more information on the DCS and MEPS panels.

There is a slight difference between the text of the question asked in 2003 and later and the question asked in 2002 and earlier. In the earlier years, respondents were asked, “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.” In 2002 and earlier, respondents were asked, “Which of the following year(s) did you have an eye exam in which your pupils were dilated? This would have made you temporarily sensitive to bright light.”

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 and 60 and over.

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

Measure Title

Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year.

Measure Source

Healthy People 2010.

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

National Tables

2_1_5.1 Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year, United States, 2002 and 2005.

2_1_5.2 Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year, United States, 2005, 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 over with diabetes who answered the question: “During [the survey year], How many times did a health professional check your feet for any sores or irritations?” Nonresponses and “Don't know” responses were excluded.

National Numerator

U.S. civilian noninstitutionalized adults age 40 and over with diabetes who had a foot examination one or more times in the survey year.

State Tables

2_1_5.3 Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year, by State, 2001 and 2006.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Adults age 40 and over with diabetes.

State Numerator

Adults with diabetes who had a foot examination one or more times in the survey year.

Comments

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

The national table reports data from the MEPS Diabetes Care Survey (DCS). See the MEPS entry in the Data Sources appendix for more information on the DCS.

The criteria for selecting the diabetes population from MEPS have changed; reported rates may not be comparable with those found in prior editions.

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 and 60 and over.

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

Measure Title

Adults age 40 and over with diagnosed diabetes who received an influenza vaccination in the last 12 months.

Measure Source

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

National Tables

2_1_6.1 Adults age 40 and over with diagnosed diabetes who received a flu shot in the last 12 months, United States, 2002 and 2005.

2_1_6.2 Adults age 40 and over with diagnosed diabetes who received a flu shot in the last 12 months, United States, 2005, 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 over with diabetes who answered the question: “How long since you had a flu shot?” Nonresponses and “Don't know” responses were excluded.

National Numerator

U.S. civilian noninstitutionalized adults age 40 and over with diabetes who had an influenza vaccination in the past year.

State Tables

2_1_6.3 Noninstitutionalized high-risk adults ages 18-64 with diabetes who had a flu shot in the last 12 months, by State, 2001 and 2006.

State Data Source

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

High-risk adults ages 18-64 with diabetes.

State Numerator

High-risk adults ages 18-64 with diabetes who had an influenza immunization in the past year.

Comments

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

The national table reports data from the MEPS Preventive Care section. See the MEPS entry in the Data Sources section of this appendix for more information.

High-risk conditions include diabetes, heart disease, lung disease, kidney disease, liver disease and cancer. Here high-risk is defined as adults having diabetes; therefore definition for the State table differs slightly from the Healthy People 2010 definition for 14-29c in that it focuses exclusively on noninstitutionalized adults with diabetes.

The criteria for selecting the diabetes population from the MEPS survey have changed; reported rates may not be comparable with those found in prior editions of

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 2 age groups: 40-59, 60 and over.

Measure Title

Adults age 40 and over with diabetes whose condition was diagnosed.

Measure Source

Healthy People 2010.

Tables

2_1_7.1 Adults age 40 and over with diabetes whose condition was diagnosed, United States, 1999-2002 and 2003-2006.

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 over who have a fasting blood glucose level of 126 mg/dL.

Numerator

Subset of the 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.

Measure Title

Adults age 40 and over with diagnosed diabetes with HbA1c level <7.0% (optimal control).

Measure Source

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

Tables

2_2_1.1 Adults age 40 and over with diagnosed diabetes with HbA1c level less than 7.0% (optimal control), United States, 1988-1994 and 2003-2006.

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 40 and over with diabetes.

Numerator

Adults with diabetes who had hemoglobin A1c level less than 7.0% at examination.

Comments

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

Percentages are age adjusted using the 2000 standard population with two age groups: 40-59 and 60 and over.

Measure Title

Adults age 40 and over with diagnosed diabetes with total cholesterol <200 mg/dL.

Measure Source

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

Tables

2_2_2.1 Adults age 40 and over with diagnosed diabetes with total cholesterol less than 200 mg/dL, United States, 1988-1994 and 2003-2006.

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 40 and over with diabetes.

Numerator

Subset of the denominator with most recent total cholesterol <200 mg/dL.

Comments

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

Percentages are age adjusted using the 2000 standard population with two age groups: 40-59 and 60 and over.

Measure Title

Adults age 40 and over with diagnosed diabetes with blood pressure <140/80 mm Hg.

Measure Source

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

Tables

2_2_3.1 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, 1988-1994 and 2003-2006.

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 40 and over with diabetes.

Numerator

Adults with diabetes with blood pressure less than 140/80 mm/Hg at exam.

Comments

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

Percentages are age adjusted using the 2000 standard population with two age groups: 40-59 and 60 and over.

Measure Title

Hospital admissions for uncontrolled diabetes per 100,000 population age 18 and over.

Measure Source

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

National Tables

2_3_1.1 Admissions for uncontrolled diabetes without complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2000 and 2005.

2_3_1.2 Admissions for uncontrolled diabetes without complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, United States, 2005, by:

• Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

U.S. population age 18 and over by subcategories (age group, gender, region, median household income level, and urbanization).

National Numerator

Discharges age 18 and over with principal diagnosis of uncontrolled diabetes, without mention of short-term complications (ketoacidosis, hyperosmolarity, coma) or long-term complications (renal, eye, neurologic, circulatory, other unspecified). Excludes obstetric admissions and transfers from other institutions.

State Tables

2_3_1.3 Admissions for uncontrolled diabetes without complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Population age 18 and over, by State.

State Numerator

Same as national.

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.

Tables were created using version 3.1 of the AHRQ PQI software. This measure is referred to as PQI 14 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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

Although not all States participate in the HCUP database, the 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.

The SID 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, OK, RI, SC, TN, TX, VT, and WI.

Measure Title

Hospital admissions for short-term complications of diabetes per 100,000 population (ages 6-17, 18 and over).

Measure Source

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

AHRQ, Pediatric Quality Indicators (PDIs).

National Tables

2_3_2.1 Admissions for diabetes with short-term complications (excluding transfers from other institutions) per 100,000 population, ages 6-17, United States, 2000 and 2005.

2_3_2.2 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, 2000 and 2005.

2_3_2.3 Admissions for diabetes with short-term complications (excluding transfers from other institutions) per 100,000 population, ages 6-17, United States, 2005, by:

• Race/ethnicity.

2_3_2.4 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, 2005, by:

• Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

U.S. population ages 6-17 (for pediatric measure) or age 18 and over (for adult measure) by subcategories (age group, gender, region, median household income level, and urbanization).

National Numerator

Pediatric discharges ages 6-17 or adult discharges age 18 and over with a principal diagnosis of diabetes with short-term complications (ketoacidosis, hyperosmolarity, coma) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 250.10-250.13, 250.20-250.23, 250.30-250.33). Obstetric admissions and transfers from other institutions are excluded.

State Tables

2_3_2.5 Admissions for diabetes with short-term complications (excluding transfers from other institutions) per 100,000 population, ages 6-17, by State, 2000 and 2005.

2_3_2.6 Admissions for diabetes with short-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Population age 18 and over, by State.

State Numerator

Same as national.

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.

Table for the adult measure was created using version 3.1 of the AHRQ PQI software. This measure is referred to as PQI 1 in the software documentation. Table for the pediatric measure was created using version 3.1 of the AHRQ PDI software. This measure is referred to as PDI 15 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the 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.

The SID 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, OK, RI, SC, TN, TX, VT, and WI.

Measure Title

Hospital admissions for long-term complications of diabetes per 100,000 population age 18 and over.

Measure Source

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

National Tables

2_3_3.1 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, 2000 and 2005.

2_3_3.2 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, 2005, by:

• Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

U.S. population age 18 and over by subcategories (age group, gender, region, median household income level, and urbanization).

National Numerator

Hospital inpatient discharges age 18 and over with a principal diagnosis code for long-term complications (renal, eye, neurologic, or circulatory, or complications not otherwise specified) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93). Obstetric admissions and patients transferred from other institutions are excluded.

State Tables

2_3_3.3 Admissions for diabetes with long-term complications (excluding obstetric admissions and transfers from other institutions) per 100,000 population, age 18 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Population age 18 and over, by State.

State Numerator

Same as national.

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.

Tables were created using version 3.1 of the AHRQ PQI software. This measure is referred to as PQI 3 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the 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.

The SID 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, OK, RI, SC, TN, TX, VT, and WI.

Measure Title

Hospital admissions for lower extremity amputations per 1,000 population age 18 and over with diabetes.

Measure Source

Healthy People 2010.

Tables

2_3_4.1 Hospital admissions for lower extremity amputations per 1,000 population with diabetes, United States, 1998-2000 and 2004-2006.

2_3_4.2 Hospital admissions for lower extremity amputations per 1,000 population with diabetes, United States, 2004-2006, by:

• Race.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Hospital Discharge Survey and National Health Interview Survey (NHDS-NHIS).

Denominator

Number of U.S. civilian noninstitutionalized population who report that they have ever been diagnosed with diabetes, excluding women age 18 and over who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes).

Numerator

Number of hospital discharges among U.S. civilian population with diabetes (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) as any listed diagnosis and amputation of the lower extremity (ICD-9-CM code 84.1) as any listed procedure. Amputations due to trauma (ICD-9-CM codes 895-897) as any listed diagnosis are excluded.

Comments

Rate in the national table is age adjusted. The age groups used for age adjustment for estimates are different from those in some earlier versions of the National Healthcare Quality Report. Race classification changed in 2001. Data for 2001 and later years may not be comparable with data from previous years.

The numerator and denominator of this measure 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.

Adults are considered to have diabetes if they respond “Yes” to either of the two questions listed in the denominator section of Healthy People objective 5-3. Those who respond “Borderline” and women who report only gestational diabetes are excluded. Children are considered to have diabetes if the adult proxy respondent reports that they have ever been told by a doctor that the child has diabetes. See http://www.healthypeople.gov/document/html/tracking/od05.htm.

Data 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.

This measure is referred to as measure 5-10 in Healthy People 2010 documentation.

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