National Healthcare Disparities Report, 2013
Chapter 4: Text Descriptions
Figure 4.1. Distribution of hospital acquired conditions, based on national rates per 1,000 adult hospital discharges, by race/ethnicity, 2010
| Hospital Acquired Condition | White Patients | Black Patients |
|---|---|---|
| Adverse Drug Events | 47.4 | 63.4 |
| Catheter-Associated Urinary Tract Infections | 11.6 | 12.3 |
| Central Line-Associated Bloodstream Infections | 0.4 | 1.6 |
| Falls | 8.0 | 7.8 |
| Obstetric Adverse Events | 2.1 | 1.1 |
| Pressure Ulcer | 43.3 | 30.2 |
| Surgical Site Infection | 3.0 | 2.9 |
| Ventilator-Associated Pneumonia | 1.1 | 1.4 |
| Venous Thromboembolism | 0.5 | 0.7 |
| All Other HACs | 26.1 | 26.7 |
Source: Agency for Healthcare Research and Quality, Medicare Patient Safety Monitoring System, 2010; Center for Disease Control and Prevention, National Healthcare Security Network, 2009-2011; and Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases and AHRQ Quality Indicators, version 4.1, 2011.
Note: Data are for patients 18 years of age and over. Estimates are rounded to the nearest tenth.
Figure 4.2. Postoperative sepsis per 1,000 adult discharges with an elective operating room procedure, by race/ethnicity and insurance, 2008-2010
| Year | White | Black | API | Hispanic | Private | Medicare | Medicaid | Other | Uninsured |
|---|---|---|---|---|---|---|---|---|---|
| 2008 | 14.8 | 19.6 | 14.7 | 16.9 | 13.8 | 14.9 | 19.3 | 13.1 | 9.1 |
| 2009 | 15.6 | 18.9 | 19.0 | 17.7 | 14.1 | 15.8 | 18.7 | 13.6 | 13.0 |
| 2010 | 15.0 | 18.8 | 19.4 | 17.1 | 13.9 | 15.7 | 20.3 | 13.7 | 15.1 |
Key: API = Asian and Pacific Islander.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version 4.1, State Inpatient Databases disparities analysis files, 2008-2010.
Denominator: All elective hospital surgical discharges, age 18 and over, with length of stay of 4 or more days, excluding patients admitted for infection, patients with cancer or immunocompromised states, patients with obstetric conditions, and admissions specifically for sepsis.
Note: For this measure, lower rates are better. White, Black, and API are non-Hispanic. Hispanic includes all races. Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group clusters.
2008 Achievable Benchmark: 8.7
Figure 4.3. Adult surgery patients with postoperative catheter-associated urinary tract infection, by race/ethnicity, 2009-2011
| Year | White | Black | Asian | Hispanic |
|---|---|---|---|---|
| 2009 | 2.9% | 4.2% | NA% | NA |
| 2010 | 3.4% | 4.0% | 5.0% | 5.1% |
| 2011 | 2.9% | 3.8% | 4.3% | 4.0% |
Source: Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services, Medicare Patient Safety Monitoring System, 2009-2011.
Denominator: Selected discharges of hospitalized patients age 18 and over having major surgery and meeting specific criteria for each measure.
Note: For this measure, lower rates are better. White, Black, and Asian are non-Hispanic. Hispanic includes all races. Data for Asians and Hispanics in 2009 did not meet criteria for statistical reliability.
Figure 4.4. Rate per 1,000 central line days of central line-associated bloodstream infections in major teaching hospitals and non-major teaching hospitals, 2006-2011
| Year | Medical Major Teaching | Medical All Others | Medical/Surgical Major Teaching | Medical/Surgical All Others |
|---|---|---|---|---|
| 2006-2008 | 2.6 | 1.9 | 2.1 | 1.5 |
| 2009 | 2.2 | 1.6 | 1.7 | 1.3 |
| 2010 | 1.8 | 1.3 | 1.4 | 1.1 |
| 2011 | 1.2 | 1.1 | 1.4 | 0.9 |
Source: Centers for Disease Control and Prevention, National Healthcare Safety Network annual reports, 2008-2011.
Denominator: Number of central-line days.
Note: For this measure, lower rates are better. Major teaching hospitals are hospitals that are an important part of a teaching program at a medical school.
Figure 4.5. Composite: Mechanical adverse events associated with central venous catheter placement among adults, by race and sex, 2009-2011
| Year | White | Black | Male | Female |
|---|---|---|---|---|
| 2009 | 3.2% | 8.5% | 3.7% | 4.1% |
| 2010 | 3.1% | 4.5% | 3.2% | 3.4% |
| 2011 | 3.8% | 3.8% | 3.9% | 4.0% |
Source: Agency for Healthcare Research and Quality, Medicare Patient Safety Monitoring System, 2009-2011
Denominator: Selected discharges of hospitalized patients age 18 and over with central venous catheter placement.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Mechanical adverse events include allergic reaction to the catheter, tamponade, perforation, pneumothorax, hematoma, shearing off of the catheter, air embolism, misplaced catheter, thrombosis or embolism, knotting of the pulmonary artery catheter, and certain other events.
Figure 4.6. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by race/ethnicity and area income, 2004-2010
| Year | White | Black | API | Hispanic | Q1 (Lowest) | Q2 | Q3 | Q4 (Highest) |
|---|---|---|---|---|---|---|---|---|
| 2004 | 33.2% | 15.6% | 46.2% | 23.5% | 22.8% | 28.3% | 32.2% | 36.2% |
| 2005 | 31.0% | 14.6% | 48.4% | 23.3% | 22.3% | 27.5% | 30.0% | 35.2% |
| 2006 | 28.4% | 13.3% | 45.3% | 20.8% | 19.9% | 23.6% | 27.6% | 32.5% |
| 2007 | 26.8% | 13.5% | 41.8% | 19.3% | 19.1% | 22.1% | 25.1% | 29.7% |
| 2008 | 25.9% | 13.3% | 40.7% | 18.4% | 19.8% | 22.8% | 24.5% | 28.4% |
| 2009 | 25.4% | 13.2% | 40.0% | 16.5% | 18.1% | 20.6% | 24.1% | 26.1% |
| 2010 | 24.9% | 12.2% | 40.4% | 16.2% | 17.4% | 21.7% | 24.2% | 29.1% |
Key: API = Asian or Pacific Islander; Q1 represents the lowest income quartile and Q4 represents the higher income quartile based on the median income of a patient's ZIP code of residence.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version 4.1, 2004-2010.
Denominator: All patients hospitalized for vaginal delivery without indication of instrument assistance.
Note: For this measure, lower rates are better. Rates are adjusted by age. White, Black, and API are non-Hispanic; Hispanic includes all races.
2008 Achievable Benchmark: 17.8%
Figure 4.7. Nursing home residents experiencing various adverse events, by race/ethnicity, 2011
| Adverse Event | White | Black | Asian | NHOPI | AI/AN | Hispanic | >1 Race |
|---|---|---|---|---|---|---|---|
| Pressure Ulcers - Short Stay | 1.8% | 2.4% | 1.6% | 1.6% | 2.1% | 1.6% | 1.6% |
| Restraints - Long Stay | 2.4% | 2.1% | 3.3% | 4.1% | 2.2% | 3.2% | 3.2% |
| UTI - Long Stay | 8.6% | 6.1% | 5.9% | 7.0% | 6.7% | 7.2% | 8.0% |
Source: Centers for Medicare & Medicaid Service, Minimum Data Set 3.0, 2011.
Denominator: For pressure ulcers, the denominator was short-stay residents, who are defined as residents whose cumulative stay was less than or equal to 100 days. For restraints and urinary tract infections, the denominator was long-stay residents, who are defined as residents whose cumulative stay was greater than 100 days.
Note: For these measures, lower rates are better. Measures were calculated as follows: Pressure ulcers: Percentage of short-stay residents for whom a look-back scan indicates one or more new or worsening stage II-IV pressure ulcers. Restraints: Percentage of long-stay residents who are physically restrained on a daily basis. UTI: Percentage of long-stay residents with a urinary tract infection within the 30 days prior to assessment.
Figure 4.8. Home health patients with improvement in their surgical site wounds, by race and ethnicity, 2010-2011
| Race / Ethnicity | 2010 | 2011 |
|---|---|---|
| White | 86.0% | 88.2% |
| Black | 85.6% | 87.2% |
| Asian | 86.3% | 88.0% |
| NHOPI | 83.4% | 89.1% |
| AI/AN | 84.2% | 87.1% |
| >1 Race | 84.6% | 86.2% |
| Hispanic | 85.8% | 86.9% |
| White | 86.0% | 88.2% |
| Black | 85.6% | 87.2% |
| Other | 85.5% | 88.0% |
Key: AI/AN = American Indian or Alaska Native. NHOPI = Native Hawaiian or Other Pacific Islander.
Source: Centers for Medicare & Medicaid Services, Outcome Assessment Information Set, 2010-2011
Denominator: Number of home health episodes during the measurement period in which the patient had a surgical wound and the episode ended with the patient discharged from home health care.
Note: For ethnicity, White, Black, and Other are non-Hispanic. Hispanic includes all races.
Figure 4.9. Home health patients with improvements in their ability to take medications orally, by race and ethnicity, 2010-2011
| Race / Ethnicity | 2010 | 2011 |
|---|---|---|
| White | 46.9% | 48.4% |
| Black | 48.4% | 49.3% |
| Asian | 44.9% | 45.1% |
| NHOPI | 44.0% | 47.0% |
| AI/AN | 45.2% | 46.6% |
| >1 Race | 46.1% | 48.5% |
| Hispanic | 37.4% | 36.8% |
| White | 46.9% | 48.4% |
| Black | 48.4% | 49.3% |
| Other | 44.9% | 45.5% |
Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander.
Source: Centers for Medicare & Medicaid Services, Outcome Assessment Information Set, 2010-2011
Denominator: Number of home health episodes of care in which a patient was unable to take oral medications independently at the start of the episode that ended during the measurement period.
Note: For ethnicity, White, Black, and Other are non-Hispanic. Hispanic includes all races.
Figure 4.10. Improvement in the ability of home health patients to take medications orally, by ethnicity and State, 2011
| No significant difference between rates of Hispanics and non-Hispanic Whites | Non-Hispanic Whites have significantly worse rates than Hispanics | Hispanics have significantly worse rates than non-hispanic Whites | States have fewer than 20 cases in the denominator for Hispanic cases |
|---|---|---|---|
| Alaska | South Carolina | Florida | Montana |
| Alabama | Washington | North Carolina | North Dakota |
| Arkansas | -- | Nevada | South Dakota |
| Arizona | -- | Texas | Vermont |
| California, Colorado, Connecticut, District of Columbia, Delaware, Georgia, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachussets, Maryland, Maine, Minnesota, Missouri, Mississippi, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Virginia, Wisconsin, West Virginia, Wyoming |
-- | -- | -- |
Figure 4.11. Ambulatory care visits due to adverse effects of medical care per 1,000 people, by race and geographic area, 2006-2009
| Year | White | Black | MSA | Non-MSA |
|---|---|---|---|---|
| 2006-2007 | 37.0 | 29.8 | 36.1 | 27.4 |
| 2007-2008 | 43.0 | 42.2 | 44.1 | 28.8 |
| 2008-2009 | 33.6 | 42.1 | 33.2 | 33.4 |
Key: MSA = metropolitan statistical area.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2006-2009.
Denominator: U.S. Census Bureau estimated civilian noninstitutionalized population as of July 1 of each data year.
Note: For this measure, lower rates are better. Ambulatory care includes visits to office-based physicians, hospital outpatient departments, and hospital emergency departments.
Figure 4.12. Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year, by race/ethnicity and family income, 2002-2010
| Year | White | Black | Hispanic | Poor | Low Income | Middle Income | High Income |
|---|---|---|---|---|---|---|---|
| 2002 | 19.8% | 18.9% | 18.1% | 23.0% | 22.1% | 18.8% | 16.2% |
| 2003 | 19.0% | 17.6% | 13.2% | 18.5% | 18.6% | 19.7% | 17.1% |
| 2004 | 17.0% | 16.8% | 13.8% | 18.5% | 18.8% | 16.5% | 14.5% |
| 2005 | 17.6% | 18.9% | 13.5% | 19.4% | 19.6% | 16.7% | 16.4% |
| 2006 | 15.9% | 18.1% | 13.5% | 16.3% | 16.2% | 16.3% | 14.9% |
| 2007 | 15.8% | 14.7% | 14.2% | 17.0% | 15.8% | 18.5% | 12.2% |
| 2008 | 13.3% | 15.4% | 14.4% | 15.6% | 14.4% | 14.0% | 11.5% |
| 2009 | 13.2% | 15.7% | 11.7% | 15.4% | 14.9% | 14.3% | 10.9% |
| 2010 | 14.7% | 10.4% | 11.8% | 16.5% | 14.9% | 13.8% | 12.5% |
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2010.
Denominator: Civilian noninstitutionalized population age 65 and over.
Note: For this measure, lower rates are better. Prescription medications received include all prescribed medications initially purchased or otherwise obtained, as well as any refills. Whites and Blacks are non-Hispanic. Hispanic includes all races.
Figure 4.13. Median hospital 30-day risk standardized readmission rate, by proportion of African American and Medicaid patients, 2008-2010
| Low | High | |
|---|---|---|
| African American patients | ||
| AMI | 19.2% | 20.4% |
| Heart Failure | 24.4% | 25.8% |
| Pneumonia | 17.9% | 19.1% |
| Medicaid patients | ||
| AMI | 19.5% | 20.2% |
| Heart Failure | 24.5% | 25.2% |
| Pneumonia | 17.9% | 18.7% |
Key: AMI = acute myocardial infarction.
Source: Hospital Compare Chartbook, 2012.
Denominator: Expected number of readmissions for each disease type given the hospital's case mix.
Note: For this measure, lower rates are better. For a hospital's proportion of patients who are African American, low is defined as 0% for all three measures. High is defined as ≥22% for AMI, ≥23% for heart failure, and ≥22% for pneumonia. For the proportion of the hospital's patients who are insured by Medicaid, low is defined ≤8% for AMI, ≤7% for heart failure, and ≤6% for pneumonia. High is defined as ≥30% for AMI, ≥29% for heart failure, and ≥29% for pneumonia.
Figure 4.14. Pennsylvania patient safety reports by event type and age, 2012
| Event Type | 65+ | 18-64 | 1-17 | <1 Year |
|---|---|---|---|---|
| Errors Related to Procedure / Treatment / Test | 20,557 | 25,964 | 2,455 | 2,416 |
| Medication Errors | 18,497 | 18,814 | 3,623 | 1,924 |
| Falls | 18,877 | 16,321 | 864,208 | NA |
Source: Pennsylvania Patient Safety Reporting System, 2012.
Note: Only hospital and ambulatory surgical facility data are presented.
Figure 4.15. Pennsylvania patient safety reports by harm and age, 2012
| Harm level | Unsafe Conditions (No Harm) | Near Miss (No Harm) | Patient Event With No Harm | Death and Other Patient Event With Harm |
|---|---|---|---|---|
| <1 | 1,024 | 1,323 | 6,049 | 133 |
| 1-17 | 1,199 | 2,910 | 7,100 | 412 |
| 18-64 | 15,165 | 12,503 | 75,582 | 3,924 |
| 65+ | 13,455 | 10,998 | 79,754 | 3,570 |
Source: Pennsylvania Patient Safety Reporting System, 2012.
Note: Only hospital and ambulatory surgical facility data are presented.
Figure 4.16. Average percent positive response for teamwork across units and handoffs and transitions, by hospital teaching status, 2012
| Nonteaching | Teaching | |
|---|---|---|
| Teamwork Across Units | 60% | 55% |
| Handoffs and Transitions | 47% | 42% |
Source: Agency for Healthcare Research and Quality, Hospital Survey on Patient Safety Culture, 2012.
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