Timeliness

Measure Title

Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

National Tables

11_1_1.1 Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2005.

11_1_1.2 Adults who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2002.

11_1_1.3 Adults who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.
• Education.

11_1_1.4 Adults who had an appointment for routine health care in the last 12 months who usually got appointments for routine care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.
• Education.

11_1_1.5 Adults who had an appointment for routine health care in the last 12 months who sometimes or never got appointments for routine care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.
• Education.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Adults age 18 and over who made an appointment for regular or routine health care in the last 12 months and answered the question, “In the last 12 months, how often did you get an appointment for regular or routine health care as soon as you wanted?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in three categories according to their answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

11_1_1.6 Adults who had an appointment for routine health care in the last 6 months who always got appointments for routine care as soon as wanted, Medicaid, by State, 2007.

11_1_1.7 Adults who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, Medicare managed care, by State, 2007.

11_1_1.8 Adults who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, Medicare fee for service, by State, 2007.

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

Respondents who answered “Yes” to the question, “In the last 6 months did you make any appointments with a doctor or other health care provider for regular or routine health care?” for Medicaid.

Respondents who answered “Yes” to the question, “In the last 12 months did you make any appointments with a doctor or other health care provider for regular or routine health care?” for Medicare managed care and Medicare fee for service.

State Numerator

Subset of the denominator population who answered “Always” to the question, “In the last 6 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?” for Medicaid.

Subset of the denominator population who answered “Always” to the question, “In the last 12 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?” for Medicare managed care and Medicare fee for service.

Comments

National tables report data from the MEPS Self-Administered Questionnaire (SAQ). See the MEPS entry in the Data Sources appendix for more information on the SAQ.

Measure Title

Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

National Tables

11_1_2.1 Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2005.

11_1_2.2 Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted, United States, 2002.

11_1_2.3 Children who had an appointment for routine health care in the last 12 months who always got appointments for routine care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.

11_1_2.4 Children who had an appointment for routine health care in the last 12 months who usually got appointments for routine care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.

11_1_2.5 Children who had an appointment for routine health care in the last 12 months who sometimes or never got appointments for routine care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Children who had an appointment for regular or routine health care in the last 12 months and with a valid answer to the question, “In the last 12 months, how often did [the person] get an appointment for regular or routine health care as soon as you wanted?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in three categories according to their parent or guardian's answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

11_1_2.6 Children who had an appointment for routine health care in the last 6 months who always got appointments for routine care as soon as wanted, Medicaid, by State, 2007.

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

Children with Medicaid benefits who had appointments with a doctor or other health care provider for regular or routine health care in the last 6 months.

State Numerator

Subset of the denominator population with their parent or guardian's answer of “Always” to the question, “In the last 6 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?”

Comments

The national table reports data from the MEPS Child Health section. See the MEPS entry in the Data Sources appendix for more information.

Measure Title

Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

National Tables

11_1_3.1 Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2005.

11_1_3.2 Adults who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2002.

11_1_3.3 Adults who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.
• Education.

11_1_3.4 Adults who needed care right away for an illness, injury, or condition in the last 12 months who usually got care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.
• Education.

11_1_3.5 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 wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.
• Education.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Adults age 18 and over who had an illness or injury that needed care right away from a doctor's office, clinic, or emergency room in the last 12 months and also answered the question, “In the last 12 months, when you needed care right away for an illness or injury, how often did you get care as soon as you wanted?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in three categories according to their answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

11_1_3.6 Adults who needed care right away for an illness, injury, or condition in the last 6 months who always got care as soon as wanted, Medicaid, by State, 2007.

11_1_3.7 Adults who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, Medicare managed care, by State, 2007.

11_1_3.8 Adults who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, Medicare fee for service, by State, 2007.

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

Adults who reported having an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office in the last 6 months for Medicaid.

Adults who reported having an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office in the last 12 months for Medicare managed care and Medicare fee for service.

State Numerator

Subset of the denominator who answered “Always” to the question, “In the last 6 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?” for Medicaid.

Subset of the denominator who answered “Always” to the question, “In the last 12 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?” for Medicare managed care and Medicare fee for service.

Comments

National tables report data from the MEPS Self-Administered Questionnaire (SAQ). See the MEPS entry in the Data Sources appendix for more information on the SAQ.

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

Measure Title

Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access, and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

National Tables

11_1_4.1 Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2005.

11_1_4.2 Children who needed care right away for an illness, injury, or condition in the last 12 months who got care as soon as wanted, United States, 2002.

11_1_4.3 Children who needed care right away for an illness, injury, or condition in the last 12 months who always got care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.

11_1_4.4 Children who needed care right away for an illness, injury, or condition in the last 12 months who usually got care as soon as wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.

11_1_4.5 Children 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 wanted, United States, 2005, by:

• Race.
• Ethnicity.
• Family income.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Children under age 18 who had an illness or injury that needed care right away from a doctor's office, clinic, or emergency room in the last 12 months, with a valid answer to the question, “In the last 12 months, when [the person] needed care right away for an illness or injury, how often did [person] get care as soon as you wanted?” Nonresponses and “Don't know” responses were excluded.

National Numerator

Subset of the denominator population in three categories according to their parents or guardians' answer to the above question: “Always,” “Usually,” “Sometimes,” or “Never.”

State Tables

11_1_4.6 Children who needed care right away for an illness, injury, or condition in the last 6 months who always got care as soon as wanted, Medicaid, by State, 2007.

State Data Source

AHRQ, Center for Quality Improvement and Patient Safety (CQuIPS), National CAHPS Benchmarking Database (NCBD).

State Denominator

Children with Medicaid benefits who had an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office in the last 6 months.

State Numerator

Subset of the denominator with their parent or guardian's answer of “Always” to the question, “In the last 6 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?”

Comments

The national table reports data from the MEPS Child Health section. See the MEPS entry in the Data Sources appendix for more information.

Measure Title

Emergency department (ED) visits lasting 6 or more hours and resulting in admission to the hospital or transfer to another facility, per 1,000 ED visits.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

11_2_1.1 Emergency department (ED) visits in which patient was admitted to the hospital or transferred to another facility whose ED visit was 6 hours or more, United States, 2000-2001 and 2005-2006.

11_2_1.2 Emergency department (ED) visits in which patient was admitted to the hospital or transferred to another facility whose ED visit was 6 hours or more, United States, 2005-2006, by:

• Race.

Data Source

CDC, NCHS, National Hospital Ambulatory Medical Care Survey (NHAMCS).

Denominator

ED visits in which patient was later admitted to the hospital or intensive care unit/cardiac care unit or transferred to other facility.

Numerator

Subset of the denominator with those who stayed in emergent/urgent care for 6 hours or more.

Comments

The wording of the survey question used for this measure differed slightly between 2004 and 2005.

Measure Title

Emergency department (ED) visits where patients left without being seen.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

11_2_2.1 Emergency department visits where patients left without being seen, United States, 1997-1998 and 2005-2006.

11_2_2.2 Emergency department visits where patients left without being seen, United States, 2005-2006, by:

• Race.

Data Source

CDC, NCHS, National Hospital Ambulatory Medical Care Survey (NHAMCS).

Denominator

Visits to the emergency and outpatient departments of noninstitutional general and short-stay hospitals, exclusive of Federal, military, and Veterans Affairs hospitals located in the 50 States and the District of Columbia.

Numerator

Subset of the denominator with a visit disposition of “left before being seen” on the NHAMCS Emergency Department Patient Record Form.

Comments

The wording of the survey question used for this measure differed slightly between 2004 and 2005.

Measure Title

Median time in minutes from arrival to initiation of a thrombolytic agent in patients with ST segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

11_2_3.1 Median time in minutes from arrival to initiation of a thrombolytic agent in heart attack patients with ST segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG), United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Not applicable.

National Numerator

Not applicable.

State Tables

11_2_3.2 Median time in minutes from arrival to initiation of a thrombolytic agent in heart attack patients with ST segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG), by State, 2005 and 2006.

11_2_3.3 Hospital patients with heart attack who were given fibrinolytic medication within 30 minutes of arrival, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Not applicable for Table 11_2_3.2.

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented thrombolytic therapy during the hospital stay for Table 11_2_3.3.

State Numerator

Not applicable for Table 11_2_3.2.

Subset of the denominator with thrombolytic therapy within 30 minutes of arrival for Table 11_2_3.3.

Comments

Effective October 2003, CMS revised this measure. Rates may not be comparable with earlier versions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

Median time is in minutes from arrival to initiation of a thrombolytic agent in patients with ST segment elevation or LBBB on the electrocardiogram ECG performed closest to hospital arrival time.

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18 and patients transferred from another acute care hospital, including another emergency department. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State HC tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

For QIO tables, the estimate for the Total row is based on State-level estimates whereas the estimates for the demographic categories are based on patient/episode-level data.

Measure Title

Median time in minutes from arrival to percutaneous transluminal coronary angioplasty (PTCA) in patients with ST segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

National Tables

11_2_4.1 Median time in minutes from arrival to percutaneous transluminal coronary angioplasty (PTCA) in heart attack patients with ST segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG), United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Not applicable.

National Numerator

Not applicable.

State Tables

11_2_4.2 Median time in minutes from arrival to percutaneous transluminal coronary angioplasty (PTCA) in heart attack patients with ST segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG), by State, 2005 and 2006.

11_2_4.3 Hospital patients with heart attack who were given percutaneous coronary intervention (PCI) within 90 minutes of arrival, by State, 2004 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Not applicable for Table 11_2_4.2.

Discharged hospital patients with a principal diagnosis of acute myocardial infarction (AMI) and documented PTCA or stent placement during the hospital stay for Table 11_2_4.3.

State Numerator

Not applicable for Table 11_2_4.2.

Subset of the denominator given PCI (angioplasty or stent placement) within 90 minutes of arrival for Table 11_2_4.3.

Comments

The 2005 and 2006 estimates are within 120 minutes of arrival.

Effective October 2003, CMS revised this measure. Rates may not be comparable with earlier versions of the National Healthcare Quality Report and the National Healthcare Disparities Report.

Median time is time in minutes from arrival to PTCA in patients with ST segment elevation or LBBB on the ECG performed closest to hospital arrival time.

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for AMI include 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, and 410.91. The measure specifies exclusion of patients under age 18 and patients transferred from other acute care hospitals, including other emergency departments, and patients administered thrombolytic agents. Further information on this and other heart disease measures is available at http://www.cms.hhs.gov/HospitalQualityInits/.

For State HC tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

For QIO tables, the estimate for the Total row is based on State-level estimates whereas the estimates for the demographic categories are based on patient/episode-level data.

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