Trends in Access
Graph 1: Access
No change overall: Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as needed, 2002-2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
No change overall: People who were unable to get or delayed in getting needed prescription medicines in the last 12 months, 2002-2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
No change overall: People with a usual primary care provider, 2002-2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
Trends in Quality
Graph 2: Person-Centered Care
Improving overall: National composite measure: Adults who had a doctor's office or clinic visit in the last 12 months whose health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them, 2002-2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
Improving overall: Adult hospital patients who sometimes or never had good communication about medications they received in the hospital, 2009-2015

Source: Centers for Medicare & Medicaid Services, Hospital Consumer Assessment of Healthcare Providers and Systems, 2009-2015.
Note: For this measure, lower rates are better. Good communication about medications means hospital staff explained clearly about effects and possible side effects of medications.
Graph 3: Patient Safety
Improving overall: Hospital admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, age 18 and over

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), 2008-2011; State Inpatient Databases (SID), 2012-2014, weighted to provide national estimates using the same methodology as the 2008-2011 NIS; and AHRQ Quality Indicators (QIs), version 4.4. For more information on the sampling approach and included States, see the HCUP Methods Series Report on methods applying AHRQ QIs to HCUP data for the 2015 QDR (www.hcup-us.ahrq.gov/reports/methods/methods.jsp).
Note: For this measure, lower rates are better.
Improving overall: Adult patients receiving hip joint replacement due to fracture with adverse events, age 18 and over, overall

Source: Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services, Medicare Patient Safety Monitoring System, 2009-2014.
Note: For this measure, lower rates are better.
Graph 4: Patient Safety
Improving overall: Hospital patients with an anticoagulant-related adverse drug event to low-molecular-weight heparin (LMWH) and factor Xa, age 18 and over, 2009-2014

Source: Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services, Medicare Patient Safety Monitoring System, 2009-2014.
Note: For this measure, lower rates are better.
Graph 5: Healthy Living
Improving overall: Adolescents ages 16-17 years who received 1 or more doses of meningococcal conjugate vaccine, 2008-2014

Source: Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Diseases and National Center for Health Statistics, National Immunization Survey—Teen, 2008-2014.
Graph 6: Healthy Living
Worsening overall: Women ages 21-65 who received a Pap smear in the last 3 years

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000-2013.
Note: Estimates are age adjusted to the 2000 U.S. standard population.
Worsening overall: Children ages 12-19 with obesity, 1999-2002 to 2011-2014

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 1999-2002 to 2011-2014.
Note: For this measure, lower rates are better.
Other Priority Areas
Effective Treatment is addressed in Graphs 15 and 16, under Geographic Differences. Care Coordination and Care Affordability are addressed under Trends in Disparities and under Geographic Differences.
Trends in Disparities
Graph 7: Person-Centered Care
Improving overall: National: Adults ages 18-64 who had a doctor's office or clinic visit in the last 12 months whose health providers sometimes or never showed respect for what they had to say, by insurance, 2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2014.
Note: For this measure, lower rates are better.
Large disparities: Hospice patients who received care consistent with their stated end-of-life wishes, by race, 2014

Source: National Hospice and Palliative Care Organization, Family Evaluation of Hospice Care Survey, 2014.
Graph 8: Patient Safety
Adults age 65 and over who received in the calendar year at least 1 of 33 potentially inappropriate prescription medications for older adults, by activity limitation, 2002-2014

| Year | Basic | Complex | Neither | Total |
|---|---|---|---|---|
| 2002 | 28.9 | 33.1 | 14.1 | 19.3 |
| 2003 | 26.5 | 26.7 | 14 | 18.5 |
| 2004 | 23.3 | 26.8 | 13 | 16.7 |
| 2005 | 23.9 | 26.9 | 14.5 | 17.7 |
| 2006 | 22.6 | 25.8 | 11.7 | 15.9 |
| 2007 | 23.3 | 24.3 | 11.5 | 15.5 |
| 2008 | 19.3 | 20 | 11.6 | 13.9 |
| 2009 | 18 | 19.4 | 11.3 | 13.4 |
| 2010 | 21.2 | 21.8 | 10.4 | 13.9 |
| 2011 | 19.7 | 20.3 | 10.3 | 12.9 |
| 2012 | 18.1 | 19.2 | 10 | 12.5 |
| 2013 | 17.1 | 23.2 | 8.7 | 11.4 |
| 2014 | 17.2 | 21.7 | 8.2 | 11.7 |
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
Large disparities: Adults age 65 and over who received in the calendar year at least 1 of 33 potentially inappropriate prescription medications for older adults, by activity limitation, 2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2014.
Note: For this measure, lower rates are better.
Graph 9: Care Coordination
Large disparities: Emergency department visits for asthma, per 100,000 population (including inpatient admissions), ages 2-17, by income, 2014

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2014.
Note: For this measure, lower rates are better.
Large disparities: Emergency department visits for asthma, per 100,000 population (including inpatient admissions), ages 18-39, by income, 2014

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2014.
Note: For this measure, lower rates are better.
Graph 10: Care Coordination
Emergency department visits for asthma, per 100,000 population (including inpatient admissions), ages 18-39, by income, 2008-2014

| Year | Poor | High Income |
|---|---|---|
| 2008 | 808.6 | 348.3 |
| 2009 | 881.3 | 343.3 |
| 2010 | 947.4 | 342.4 |
| 2011 | 839.5 | 341.2 |
| 2012 | 913 | 327.6 |
| 2013 | 969.6 | 338.8 |
| 2014 | 922.8 | 309.6 |
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2008-2014.
Note: For this measure, lower rates are better.
Emergency department visits for asthma, per 100,000 population (including inpatient admissions), ages 2-17, by income, 2008-2014

| Year | Poor | High Income |
|---|---|---|
| 2008 | 1195.6 | 553.1 |
| 2009 | 1411.8 | 604.7 |
| 2010 | 1339.9 | 524.6 |
| 2011 | 1254.5 | 621.2 |
| 2012 | 1500.3 | 587.5 |
| 2013 | 1500.3 | 587.5 |
| 2014 | 1514.8 | 548.7 |
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2008-2014.
Note: For this measure, lower rates are better.
Graph 11: Care Coordination
Emergency department visits with a principal diagnosis related to mental health only, by income, 2007-2014

| Year | Poor | High Income |
|---|---|---|
| 2007 | 1369 | 763 |
| 2008 | 1489 | 806 |
| 2009 | 1598 | 764 |
| 2010 | 1613 | 849 |
| 2011 | 1537 | 884 |
| 2012 | 1703 | 859 |
| 2013 | 1715 | 873 |
| 2014 | 1993 | 941 |
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2007-2014.
Note: For this measure, lower rates are better.
Large disparities: Emergency department visits with a principal diagnosis related to mental health only, by income, 2014

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2014.
Note: For this measure, lower rates are better.
Graph 12: Care Affordability
People unable to get or delayed in getting needed medical care who said it was due to financial or insurance reasons, by income, 2002-2014

| Year | Poor | Low Income | Middle Income | High Income |
|---|---|---|---|---|
| 2002 | 67.9 | 63.6 | 52.6 | 32.7 |
| 2003 | 71.5 | 64.8 | 52.1 | 35.4 |
| 2004 | 72.1 | 70.7 | 55.3 | 31 |
| 2005 | 72.6 | 70.2 | 56.7 | 30.8 |
| 2006 | 73.5 | 68.8 | 57.1 | 30.4 |
| 2007 | 72.3 | 63.5 | 53.3 | 32.2 |
| 2008 | 70.6 | 69.1 | 56.5 | 37.3 |
| 2009 | 69.4 | 70.6 | 62.6 | 39.3 |
| 2010 | 72.6 | 74.4 | 59.9 | 43.4 |
| 2011 | 66.7 | 71.1 | 61.5 | 32.5 |
| 2012 | 64.7 | 66.9 | 59.6 | 44.9 |
| 2013 | 70.3 | 62.7 | 55.7 | 43.8 |
| 2014 | 66.1 | 64.2 | 52.8 | 38.8 |
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
Large disparities: People unable to get or delayed in getting needed medical care who said it was due to financial or insurance reasons, by income, 2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2014.
Note: For this measure, lower rates are better.
Graph 13: Care Affordability
People unable to get or delayed in getting needed medical care who said it was due to financial or insurance reasons, by insurance, 2002-2014

| Year | Uninsured | Private Insurance |
|---|---|---|
| 2002 | 85.5 | 42.7 |
| 2003 | 91 | 41.1 |
| 2004 | 87.2 | 42.4 |
| 2005 | 89.1 | 43.5 |
| 2006 | 89.9 | 42.1 |
| 2007 | 85.4 | 40.5 |
| 2008 | 88.1 | 44.9 |
| 2009 | 88 | 47.6 |
| 2010 | 88.6 | 51.2 |
| 2011 | 89.4 | 44.1 |
| 2012 | 91.2 | 49.8 |
| 2013 | 89.6 | 44.4 |
| 2014 | 88.1 | 52.1 |
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2014.
Note: For this measure, lower rates are better.
Large disparities: People unable to get or delayed in getting needed medical care who said it was due to financial or insurance reasons, by insurance, 2014

Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2014.
Note: For this measure, lower rates are better.
Geographic Differences
Graph 14: Care Coordination
Large disparities: Emergency department visits with a principal diagnosis related to mental health only, per 100,000 population, by residence location, 2014

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2014.
Note: For this measure, lower rates are better.
Graph 15: Care Coordination
Emergency department visits with a principal diagnosis related to substance abuse only per 100,000 population, by residence location, 2007-2014
| Year | Large Central Metro | Large Fringe Metro | Medium Metro | Small Metro | Micropolitan | Noncore |
|---|---|---|---|---|---|---|
| 2007 | 477 | 448 | 443 | 405 | 370 | 355 |
| 2008 | 514 | 422 | 491 | 449 | 378 | 368 |
| 2009 | 599 | 431 | 494 | 443 | 385 | 392 |
| 2010 | 627 | 455 | 525 | 454 | 398 | 392 |
| 2011 | 657 | 474 | 593 | 463 | 419 | 385 |
| 2012 | 660 | 510 | 586 | 450 | 422 | 358 |
| 2013 | 746 | 518 | 596 | 461 | 441 | 354 |
| 2014 | 758 | 572 | 698 | 559 | 517 | 415 |
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, 2007-2014.
Note: For this measure, lower rates are better.
Emergency department visits with a principal diagnosis related to substance abuse only per 100,000 population, by residence location, 2014

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, State Inpatient Databases, 2014; and AHRQ Quality Indicators, modified version 4.1.
Note: For this measure, lower rates are better.
Graph 16: Effective Treatment
Large disparities: Hospital admissions for congestive heart failure, per 100,000 population, by residence location, 2014

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS), 2014 and AHRQ Quality Indicators, version 4.4.
Graph 17: Effective Treatment
People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months, 2010-2015

| Year | Large Central Metro | Large Fringe Metro | Medium Metro | Small Metro | Micropolitan | Noncore |
|---|---|---|---|---|---|---|
| 2010 | 18.4 | 17.6 | 19 | 16.5 | 21.3 | |
| 2011 | 20.5 | 19 | 22 | 17.5 | 22.4 | 22.3 |
| 2012 | 15.2 | 19.8 | 21.3 | 27.4 | 17.9 | |
| 2013 | 21.7 | 17.2 | 16.5 | 13.8 | 21.7 | |
| 2014 | 19.5 | 22.4 | 20.6 | 16.8 | 23.3 | 19.3 |
| 2015 | 16.1 | 15.5 | 24.2 | 19 | 14.5 | 26.8 |
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2010-2015.
Note: Data unavailable for 2010, 2012, 2013 for noncore.
People age 12 and over who needed treatment for illicit drug use and who received such treatment at a specialty facility in the last 12 months, 2015

Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015.
Graph 18: Care Affordability
National: People unable to get or delayed in getting needed prescription medicines who said it was due to financial or insurance reasons, 2014

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2014.



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