NationalPrivate Insurance Quality Measures Compared to Achievable Benchmarks

The NHQR quality measures specific to Private Insurance are compared to achievable benchmarks, which are derived from the top-performing States. Better performance of a State can mean higher or lower values of a measure, depending on the desired outcome. For example, low values are desirable for measures such as infant mortality, whereas high values are desirable for measures such as preventative screening. The categories of achievement have been standardized across the measure definitions so that:

 
Far away from benchmark - the value for a measure has not achieved 50% of the benchmark.
 
Close to benchmark - the value for a measure is between 50% and 90% of a benchmark (i.e., worse than the benchmark but has achieved at least half of the benchmark but not as much as 90% of a benchmark).
 
Achieved benchmark or better - the the value for a measure is no worse than 90% of the benchmark value, the measure has achieved the benchmark. This category also includes the case in which the measure’s value is equal to or better than the benchmark.
Measures That Achieved Benchmark or Better
Measure Population Estimate Benchmark Distance to Benchmark
Women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy) Private 96.5 96.8 0%
Women ages 21-65 who received a Pap smear in the last 3 years Any private 85.5 86.9 2%
Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined Private 92.5 95.9 4%
Women ages 50-74 who received a mammogram in the last 2 years Any private 76.8 85.2 10%
Measures That Are Close to Benchmark
Measure Population Estimate Benchmark Distance to Benchmark
Deaths per 1,000 adult hospital admissions with acute myocardial infarction (AMI) Any private 40.6 35.5 14%
Deaths per 1,000 hospital admissions with coronary artery bypass surgery, adults age 40 and over Any private 15.8 13.6 16%
Sepsis diagnoses per 1,000 elective-surgery admissions of length 4 or more days, adults Any private 12.5 10.4 20%
Deaths per 1,000 hospital admissions with percutaneous transluminal coronary angioplasty (PTCA), adults age 40 and over Any private 15.0 11.4 32%
Obstetric trauma per 1,000 instrument-assisted deliveries Any private 138.0 94.3 46%
Birth trauma - injury to neonate per 1,000 selected live births Any private 1.90 1.29 47%
Measures That Are Far From Benchmark
Measure Population Estimate Benchmark Distance to Benchmark
Obstetric trauma per 1,000 vaginal deliveries without instrument assistance Any private 23.1 14.1 63%
Deaths per 1,000 adult hospital admissions with pneumonia Any private 21.2 12.8 66%
Deaths per 1,000 adult hospital admissions with congestive heart failure Any private 21.3 11.5 85%
Hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions, adults Any private 0.77 0.26 196%
Measures With No Available Benchmark Information
Measure Population Estimate Benchmark Distance to Benchmark
People who were unable to get or delayed in getting needed medical care in the last 12 months Any private 3.50
People who were unable to get or delayed in getting needed dental care in the last 12 months Any private 4.30
Hospital admissions for perforated appendix per 1,000 admissions with appendicitis, adults Any private 398.5
Adults age 40 and over with diagnosed diabetes who had their feet checked for sores or irritation in the calendar year Any private 66.2
People who were unable to get or delayed in getting needed prescription medicines in the last 12 months Any private 2.70
Adults age 40 and over with diagnosed diabetes who received at least two hemoglobin A1c measurements in the calendar year Any private 79.2
Adults age 40 and over with diagnosed diabetes who received a dilated eye examination in the calendar year Any private 63.0
People with a usual source of care, excluding hospital emergency rooms, who has office hours at night or on weekends Any private 45.7
People with a usual source of care who is somewhat to very difficulty to contact during regular business hours over the telephone Any private 13.4
Adults who had a doctor's office or clinic visit in the last 12 months whose health providers sometimes or never explained things in a way they could understand Any private 4.40
Adults 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 Any private 5.30
Adults age 40 and over with diagnosed diabetes who received a flu vaccination in the calendar year Any private 59.5
Adults who needed to see a specialist in the last 12 months who sometimes or never found it easy to see a specialist Any private 16.3
Children who needed to see a specialist in the last 12 months who sometimes or never found it easy to see a specialist Any private 15.9
Adults who had a doctor's office or clinic visit in the last 12 months whose health providers sometimes or never listened carefully to them Any private 6.60
Hospital admissions for perforated appendix per 1,000 admissions with appendicitis, children Any private 443.0
Adults who had a doctor's office or clinic visit in the last 12 months and needed care, tests, or treatment who sometimes or never found it easy to get the care, tests, or treatment Any private 6.90
Children who had a doctor's office or clinic visit in the last 12 months and needed care, tests, or treatment who sometimes or never found it easy to get the care, tests, or treatment Any private 3.10
Rating of health care 0-6 on a scale from 0 to 10 (best grade) by adults who had a doctor's office or clinic visit in the last 12 months Any private 10.2
Adults with limited English proficiency and usual source of care (USC) and the USC had language assistance Any private 88.6
Adults who had a doctor's office or clinic visit in the last 12 months whose health providers sometimes or never spent enough time with them Any private 9.10
Hospital admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, adults age 18 and over or obstetric admissions Any private 0.67
Postoperative physiologic and metabolic derangements per 1,000 elective surgical hospital discharges, adults Any private 1.51
Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical hospital discharges, adults Any private 2.02
Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges, adults Any private 8.42
Adults with limited English proficiency who had a usual source of care Any private 67.7
People with a usual source of care who sometimes or never asked person to help make decisions when there was a choice between treatments Any private 13.9
Postoperative respiratory failure per 1,000 elective surgical hospital discharges, adults Any private 4.91
Postoperative hip fracture per 1,000 surgical admissions who were not susceptible to falling, adults Any private 0.06
Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions of length 2 or more days, adults Any private 1.01
Adults with chronic joint symptoms who have ever seen a doctor or other health professional for joint symptoms Any private 69.8
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 Any private 12.0
Adults who had any appointments for routine health care in the last 12 months who sometimes or never got an appointment for routine care as soon as needed Any private 14.8
Accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, adults Any private 2.28
Accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, children Any private 0.50
Deaths per 1,000 adult hospital admissions with abdominal aortic aneurysm (AAA) repair Any private 23.2
Children who had any appointments for routine health care in the last 12 months who sometimes or never got an appointment for routine care as soon as needed Any private 4.10
Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, adults ages 18-89 or obstetric admissions Any private 103.4
People under age 65 with any private health insurance Total 65.7
Adults age 65 and over with any private health insurance Total 48.2
Deaths per 1,000 hospital admissions with expected low-mortality Any private 0.25
People with a usual source of care who usually asks about prescription medications and treatments from other doctors Any private 82.4
People with a specific source of ongoing care Any private 90.4
People with a usual primary care provider Any private 76.7
People in fair or poor health with a specific source of ongoing care Any private 91.5
Adult current smokers with a checkup in the last 12 months who received advice to quit smoking Any private 62.1
Adult smokers who attempt to quit in the past year Any private 57.8
Exclusive breastfeeding through 3 months Any private 55.4
Adults who ever smoked and quitted recently Any private 9.20
Children ages 6 months to 17 years who received influenza vaccination Any private 54.4
Children ages 2-19 with obesity Private 14.2
Adults with obesity who ever received advice from a health professional to exercise more Any private 63.4
Adults with obesity who do not now spend half an hour or more in moderate or vigorous physical activity at least five times a week Any private 53.3
Children ages 2-17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have Any private 48.7
Children ages 3-5 who ever had their vision checked by a health provider Any private 69.1
Adults with obesity who ever received advice from a health professional about eating fewer high-fat or high-cholesterol foods Any private 49.7
Children ages 2-17 for whom a health provider gave advice within the past 2 years about eating healthy Any private 64.8
Children who had their height and weight measured by a health provider within the past 2 years Any private 95.2
Children ages 2-17 who had a dental visit in the calendar year Any private 60.6
Children ages 2-17 who had a preventive dental service in the calendar year Any private 51.6
Adults who received a blood pressure measurement in the last 2 years and can state whether their blood pressure was normal or high Any private 93.9
Children 41-80 lbs for whom a health provider gave advice within the past 2 years about using a booster seat when riding in the car Any private 39.7
Children for whom a health provider gave advice within the past 2 years about how smoking in the house can be bad for a child Any private 39.2
Children 0-40 lbs for whom a health provider gave advice within the past 2 years about using a child safety seat while riding in the car Any private 64.2
Children ages 0-17 with wellness checkup in the past 12 months Any private 86.1
Adults who received a blood cholesterol measurement in the last 5 years Any private 86.6
Children over 80 lbs for whom a health provider gave advice within the past 2 years about using lap or shoulder belts when riding in a car Any private 33.8
Adults ages 18-64 at high risk (e.g., COPD) who received an influenza vaccination in the last 12 months Any private 49.3
Children ages 2-17 for whom a health provider gave advice within the past 2 years about using a helmet when riding a bicycle or motorcycle Any private 38.5
Adults ages 18 and over who received influenza vaccination Any private 41.8
People under age 65 whose family's health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income Private ESI 16.7
Adults ages 18-64 at high risk (e.g., COPD) who ever received pneumococcal vaccination Any private 22.6
People without a usual source of care who indicated a financial or insurance reason for not having a source of care Any private 6.80
People unable to get or delayed in getting needed medical care due to financial or insurance reasons Any private 44.2
People unable to get or delayed in getting needed prescription medicines due to financial or insurance reasons Any private 56.8
Adults who had a preventive dental service in the calendar year Any private 46.4
People unable to get or delayed in getting needed dental care due to financial or insurance reasons Any private 65.6
People with current asthma who are now taking preventive medicine daily or almost daily (either oral or inhaler) Any private 20.4
Adults with a dental visit in the calendar year Any private 39.2