Chartbook on Effective Treatment

Rank of Leading Causes of Death by Age Group, 2013

Source: National Vital Statistics Report 2016 Feb 16;65(2). http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_02.pdf (4.9 MB).

• Consistent with the NQS priority "Promoting the most effective prevention and treatment of the leading causes of mortality," identified in the National Strategy for Quality Improvement in Health Care, the conditions tracked in this chartbook include the leading causes of death in the United States for which significant health care quality measurement activity exists.
• Some leading causes of death, such as accidents and homicide, cannot be tracked in this chartbook because related performance standards and quality measures are not well defined.
• Other leading causes of death cannot be tracked in this chartbook because robust national data sources are lacking.

Leading Chronic Conditions Causing Limitation of Activity, 2010

Source: National Heart, Lung, and Blood Institute. Morbidity & mortality: 2012 chartbook on cardiovascular, lung, and blood diseases. Bethesda, MD: National Institutes of Health; February 2012. www.nhlbi.nih.gov/files/docs/research/2012_ChartBook.pdf (3.8 MB).

• Musculoskeletal disease is not a leading cause of death, but it is included in this chartbook because it is a leading cause of functional limitation in the United States.

Most Costly Conditions, 2013

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Household Component Summary Tables. http://meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp.

• The conditions tracked in this chartbook are also prominent on the list of conditions with the highest health care expenses.

Trends in Quality Measures

Summary of trends: Number and percentage of all quality measures that are improving, not changing, or worsening through 2013, overall and by NQS priority

Key: n = number of measures.
Note: For the majority of measures, trend data are available from 2001 to 2013.

For each measure with at least four estimates over time, log-linear regression is used to calculate average annual percentage change and to assess statistical significance. Measures are aligned so that positive change indicates improved access to care.

• Improving = Rates of change are positive at 1% per year or greater and are statistically significant.
• No Change = Rate of change is less than 1% per year or is not statistically significant.
• Worsening = Rates of change are negative at -1% per year or greater and are statistically significant.
  • About 60% of Effective Treatment measures were improving, similar to the total.

Effective Treatment Measure Reintroduced in the 2015 QDR

• Measures that reach 95% are removed from the QDR.
• One Effective Treatment measure that was removed was reintroduced in 2015 because it fell under 95%:
  • Eligible HIV patients receiving prophylaxis for Pneumocystis pneumonia.

Effective Treatment Measures That Showed Worsening Quality

• Three Effective Treatment measures showed worsening over time, including two measures of management of chronic conditions (bold):
  • Suicide deaths per 100,000 population.
  • Adults age 40+ with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year.
  • People with current asthma who are now taking preventive medicine daily or almost daily.

Effective Treatment Measures With Elimination of Disparities

• One measure showed elimination of Black-White, Asian-White, and Hispanic-Non-Hispanic White disparities:
  • Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis.
• One measure showed elimination of a Hispanic-Non-Hispanic White disparity:
  • Admissions for diabetes with short-term complications per 100,000 population, age 18 and over.
• One measure showed elimination of income-related disparities:
  • People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler).
• Two measures showed elimination of rural-urban disparities:
  • Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year.
  • Admissions for uncontrolled diabetes without complications per 100,000 population, age 18 and over.

Effective Treatment Measures With Widening of Disparities

• One measure showed widening of American Indian/Alaska Native-White disparities:
  • New HIV cases per 100,000 population age 13 and over.
• Three measures showed widening of income-related disparities:
  • Admissions for diabetes with short-term complications per 100,000 population, age 18 and over.
  • Admissions for diabetes with long-term complications per 100,000 population, age 18 and over.
  • Hospital admissions for lower extremity amputations per 1,000 population age 18 and over with diabetes.
• Two measures showed widening of urban-rural disparities:
  • Deaths per 1,000 hospital admissions with acute myocardial infarction, age 18 and over.
  • Deaths per 1,000 hospital admissions with congestive heart failure, age 18 and over.
• Two measure showed widening of uninsured-privately insured disparities:
  • Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty, age 40 and over.
  • Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year.

Measures of Effective Treatment

• This chartbook tracks measures of Effective Treatment through 2013 and 2014, overall and for populations defined by age, race, ethnicity, income, education, insurance, and number of chronic conditions.
• Measures of Effective Treatment include:
  • Receipt of processes that reflect high-quality care.
  • Outcomes related in part to receipt of high-quality care.

Conditions Covered

• This chartbook is organized around eight conditions that are the leading causes of mortality and morbidity in the United States:
  • Cardiovascular disease.
  • Cancer.
  • Chronic kidney disease.
  • Diabetes.
  • HIV and AIDS.
  • Mental health and substance abuse.
  • Musculoskeletal diseases.
  • Respiratory diseases.

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