Cardiovascular Disease (CVD) in Texas A Surveillance Report December 2008 Health Promotion Unit...

Cardiovascular Disease (CVD) in TexasA Surveillance Report

December 2008

Health Promotion UnitTexas Department of State Health Services

Burden of CVD

Leading cause of death in Texas and in the United States

32% of all deaths in Texas in 2005 1,441,000 Texas adults reported that

they have had heart disease or stroke in 2007

PROGRAM STRATEGIES

Surveillance, Data and Outcome Management

Health Education and Outreach Clinical Prevention and Treatment

Services Community Policy and Environmental

Changes

The Burden of CVD: Measures

Measure Data Source Years Available

Prevalence of Disease and Behavioral Risk Factors

Behavioral Risk Factor Surveillance Data (BRFSS)

1999-2007

Youth Surveys (YRBS) 2001, 2005, 2007

Mortality Mortality Data (Death) 1999-2005

EMS for CVD and Stroke Texas EMS/Trauma Registry Data 2003/2004

Financial Burden Hospital Discharge Data 2001-2006

Medicaid Data 2003-2007

Medical Condition Control Health Plan Employer Data and Information Set (HEDIS)

2001-2007

Prevalence

Prevalence

The number of existing cases of a disease or health condition in a population at some designated time

How common a disease is in a population An indication of the extent of a health

problem

Prevalence

)%given time aat population

ill persons ofNumber ( Prevalence

Prevalence measures the frequency of disease at a given point in time. The measure is defined as follows:

(Usually expressed as a % of the population at a given time)

Behavioral Risk Factor Surveillance System (BRFSS)

Population-based, random-digit dialed telephone survey sponsored by DSHS in partnership with CDC

Conducted annually by all 50 states, 3 territories, and the District of Columbia

Randomly selected Texans 18 years or older are asked questions about their health and life style habits

More than 550 Texans are surveyed per month.

Prevalence Questions for CVD

CVD--Respondents 18 years and older who report that they have been diagnosed as having had a Heart Attack, Myocardial Infarction, Angina, Coronary Heart Disease, or Stroke.

Heart Disease--Respondents 18 years and older who report that they have been diagnosed as having had a Heart Attack, Myocardial Infarction, Angina, or Coronary Heart Disease.

Stroke--Respondents 18 years and older who report that they have been diagnosed as having had a Stroke.

Prevalence of Cardiovascular Disease (CVD), Texas 1999-2007

Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2007

8.3%8.3%8.5%8.7%7.9% 7.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

1999 2001 2003 2005 2006 2007Pre

vale

nce

(P

erce

nt

wit

h 9

5% C

I)

Prevalence of CVDby Demographic, Texas, 2007

Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2007

8.1% 8.3% 8.6% 8.0%9.4% 8.6%

6.4%

2.4% 2.7%

10.8%

25.3%

13.2%

9.0%7.8%

5.6%

12.5%

7.7%

4.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Pre

va

len

ce

(p

erc

en

t w

ith

95

% C

I)

Prevalence of CVDby Public Health Service Region, 2007


Prevalence of Heart Disease Texas 1999-2007


6.6% 6.1%

7.5%6.6% 6.6% 6.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

1999 2001 2003 2005 2006 2007Pre

vale

nce

( Per

cent

with

95%

CI)

Prevalence of Heart Disease by Demographic, Texas, 2007


7.3%6.1%

7.8%5.7% 5.2%

1.8%

8.7%

20.4%

10.5%

7.1% 6.4%4.6%

9.7%

6.4%4.3%

6.7%6.5%

2.2%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Pre

vale

nce

(P

erce

nt

wit

h 9

5% C

I)

Prevalence of Heart Disease by Public Health Service Region, 2007


Prevalence of Stroke, Texas 1999-2007


2.8%

2.2% 2.1%

2.8% 2.6%

2.8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

1999 2001 2003 2005 2006 2007Pre

va

len

ce

(p

erc

en

t w

ith

95

% C

I) %

Prevalence of Stroke by Demographic, Texas, 2007


2.7%2.8% 2.6%3.0% 2.9%

4.4%

2.1%

0.6%0.8%

3.6%

4.8%

3.5%

2.2%1.7%

4.7%

1.4%

9.1%

2.3%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Pre

vale

nce

(P

erce

nt

95%

CI)

Prevalence of Stroke by Public Health Service Region, 2007


More Information on BRFSS

http://www.dshs.state.tx.us/chs/brfss/default.sht http://www.cdc.gov/brfss/index.htm

MORTALITY DATA

Mortality Data

Death certificate data compiled and tabulated by the Statistical Services Division of the Texas Vital Statistical Unit (VSU)

Sex-, race- and age-specific mortality data were computed for 1999 through 2005

All death rates are age-adjusted using the 2000 US standard population

Mortality Rate Calculation

000,100*population US2000

deaths ofnumber expected total 100,000per rate adjusted-Age

Mortality: The occurrence of death in a population

ICD Codes for CVD Mortality Data

Cause of Death ICD-9 Codes

(1969-1998)

ICD-10 Codes

(1999-2005)

Ischemic Heart Disease (IHD)

410-414 I20-I25

Stroke 430-438 I60-I69

Congestive Heart Failure (CHF)

428 I50

Changes in Mortality Data Reporting

ICD 9 to ICD 10 Population standard was used for age

standardization (age adjustment) of death rates. The standard is based on the year 2000 population

MAPS

Data maps are available for selected chronic disease death rates for the state as a whole and at the county level.

Maps allow the reader to identify areas in the state with high rates and areas with low rates.

Although county rates provide a high degree of specificity, rates in counties with small populations and few deaths for a specific condition can be unstable.

MAPS

For each map, county specific rates are ranked from highest to lowest and then categorized into quartiles

The maps also use a graded color scheme to differentiate each quartile, with the darkest color representing counties with the highest rates and the lightest color representing areas with the lowest rates

Leading Causes of Death

Texas Race/Ethnic Groups

Leading Causes of Death Texas-2005

Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

36,845

2,539

2,697

3,637

4,612

5,593

7,962

8,504

9,342

34,197

39,996

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000

Other Causes

Septicemia

Nephritis, Nephrotic Syndrome, Nephrosis

Influenza and Pneumonia

Alzheimer's Disease

Diabetes Mellitus

Chronic Low er Respiratory Diseases

Accidents [Injuries]

Cerebrovascular Disease [Stroke]

Malignant Neoplasms [Cancer]

Diseases of the Heart

Leading Causes of Death Texas Whites, 2005


23,552

1,596

1,811

2,698

2,808

3,831

5,362

6,553

6,851

24,470

28,739

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000

Other Causes

Nephritis, NephroticSyndrome, Nephrosis

Intentional Self harm


Diabetes Mellitus

Alzheimer's Disease


Cerebrovascular Disease[Stroke]

Chronic Low er RespiratoryDiseases

Malignant Neoplasms[Cancer]


Leading Causes of Death Texas African Americans,2005


4,766

421

436

446

491

536

923

925

1,210

4,259

4,848

0 1,000 2,000 3,000 4,000 5,000 6,000

Other Causes

Septicemia

Human Immunodeficiency Virus disease

Assault (Homicide)



Diabetes Mellitus





Leading Causes of Death Texas Hispanics,2005


7549

575

575

610

613

935

1,579

1,862

2,217

5,468

6,409

0 1000 2000 3000 4000 5000 6000 7000 8000

All Other Cause




Assault (Homicide)

Chronic Live diseases and cirrhosis


Diabetes Mellitus




Leading Causes of Death

In 2005, around 32% of all deaths in Texas were attributed to heart disease and stroke.

Heart disease and stroke were the first and third leading causes of death, respectively among all racial/Ethnic groups

Ischemic Heart Disease

Heart Disease Mortality Trends, US and Texas, 1969-2005

Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1969-2005

0

100

200

300

400

500

600

Ag

e-a

dju

ste

d M

ort

ali

ty R

ate

s P

er

10

0,0

00

US Texas

Mortality Rates for Ischemic Heart Disease, Texas 1999-2005


0

50

100

150

200

250

300

Total Males Females Whites Blacks Hispanics Other

Age-

adju

sted

Mor

talit

y Ra

tes

per 1

00,0

00 1999

2000

2001

2002

2003

2004

2005

Ischemic Heart Disease (ICD 10 I20-I25) 5-year Average Age-Adjusted Mortality Rates Per 100,000, Texas 2001-

2005


Stroke

Stroke Mortality Trends, US and Texas, 1969-2005


0

20

40

60

80

100

120

140

160

180

200

Ag

e-a

dju

ste

d M

ort

ali

ty R

ate

s P

er

100,0

00

US Texas

Mortality Rates for Stroke, Texas 1999-2005


0

20

40

60

80

100

120

Total Males Females Whites Blacks Hispanics Other

Ag

e-ad

just

ed M

ort

alit

y R

ates

Per

100

,000

1999

2000

2001

2002

2003

2004

2005

Stroke (ICD 10 I60-I69)5-year Average Age-Adjusted Mortality Rates Per 100,000, Texas 2001-

2005


Disparities in Heart Disease and Stroke Mortality in Texas

The overall age-adjusted mortality rates (AAMR) for ischemic heart disease (IHD) and stroke have steadily declined since 1970.

Texas males had a higher risk of dying from IHD than females.

Texas females had a higher risk of dying from stroke than males.

African Americans had a higher risk of dying from IHD and stroke than Whites, Hispanics and Others.

More Information on Mortality Data

http://www.dshs.state.tx.us/vs/default.shtm

Prevalence of Risk Factors for CVD and Stroke, Texas, 1995-

2007


0

5

10

15

20

25

30

35

40

Prev

alen

ce (p

erce

nt 9

5% C

I)

Obesity(BMI >(30) No Leisure time Physical Activity DIABETES Current SMOKING CHOLES High HBP

Prevalence of Risk Factors With and Without CVD, Texas 2007


59.6%

27.2%

41.2%

47.6%

30.9% 32.8%

53.0%

26.1%33.4%

8.9%

27.6%27.3%

38.9%

18.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Pre

vale

nce

(p

erce

nt

wit

h 9

5% C

I)

With CVD Without CVD

Behavioral Risk Factors

Cigarette Smoking

Overweight/Obesity

Lack of Physical Activity

Poor Nutrition

Prevalence of Current Cigarette Smoking Texas and US Adults, 1995-2007


0

5

10

15

20

25

30

Years

Pre

vale

nce (

Perc

en

t w

ith

95%

)

US Texas


Prevalence of Current Smoking by Demographic, Texas, 2007

19.4%

16.9%

21.9%21.4%

20.5%17.5%

24.3%

20.1%20.2%

9.8%

19.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Pre

va

len

ce

(p

erc

en

t w

ith

95

% C

I)

Adult Cigarette Smokingby Health Service Region, 2007


Prevalence of Cigarette Smoking* Among Youth

Texas, 2001, 2005, & 2007

Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005, 2007High School Survey *Percentage of Students who smoked cigarettes on one or more of the past 30 days

0

10

20

30

40

50

Male Female White AfricanAmerican

Hispanic Texas

Prev

alen

ce (P

erce

nt w

ith 9

5% )

2001 2005 2007

Overweight/Obesity

Adults Overweight: (BMI 25 or greater) Obesity: (BMI 30 or greater) Youth Overweight: (at or above the 95th

percentile for BMI by age and sex)

Prevalence of Overweight or Obesity Texas and US Adults, 1995-2007

0

10

20

30

40

50

60

70

Years

Pre

vale

nce

(Per

cent

with

95%

)

US Texas


Prevalence of Overweight or Obesity

by Demographic, Texas, 2007


62.8% 65.7%71.5%

59.8% 62.9%

75.3% 71.4%

56.9%

66.4%71.0%

64.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Pre

vale

nce (

Perc

en

t w

ith

95%

)

Prevalence of Overweight or Obesity by Health Service Region, 2007


Prevalence of Overweight among Youth Texas, 2001, 2005, & 2007

Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005, 2007High School Survey

0

5

10

15

20

2530

35

40

45

50


Hispanic TexasPre

vale

nce

(Per

cent

with

95%

)

2001 2005 2007

Lack of Physical Activity

Regular physical activity greatly reduces a person’s risk of dying from heart disease and decreases the risk for colon cancer, diabetes and high blood pressure

Defined as No Leisure Time Physical Activity within the past 30 Days

Prevalence of No Leisure Time Physical Activity,

Texas and US Adults, 1995-2007

* During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days


0

5

10

15

20

25

30

35

40

Pre

vale

nce

( p

erce

nt

wit

h 9

5%C

I)

US Texas


by Demographic, Texas, 2007


24.2%28.3%

25.5%31.0%

23.5%

33.7% 34.3%

22.2%26.4% 29.0%

38.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Prev

alen

ce (

perc

ent w

ith 9

5%C

I)


by Health Service Region, Texas, 2007

* During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days


Intake of Fruit & Vegetables < 5 times a day

Good nutrition, including a diet that is low in saturated fats and high in fruits and vegetables, plays a key role in maintaining good health.

Improving the American diet could extend the productive life span of Americans and reduce the occurrence of chronic diseases.

Prevalence of Fruit & Vegetable Intake < 5

Times a day, by Demographic, Texas, 2007

* % of adults who reported eating fewer than 5 servings of fruits and vegetables per day


75.4% 74.8% 77.8%71.9% 73.4% 75.7% 76.9% 75.4% 76.6% 74.3% 71.3%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Pre

vale

nce

( p

erce

nt

wit

h 9

5%C

I )

Prevalence of Fruit & Vegetable Intake < 5 Times a day by Health Service Region, Texas, 2007

* % of adults who reported eating fewer than 5 servings of fruits and vegetables per day


Prevalence of Fruit & Vegetable Intake < 5 Times a day Among

Texas Public High School Students, 2001,2005, & 2007

0

10

20

30

40

50


Hispanic Texas

Pre

vale

nce

( per

cent

with

95%

CI)

2001 2005 2007

Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005, 2007High School Survey

Behavioral Risk Factors The prevalence of current smoking in Texas

was similar to the national average, around 19%, in 2007.

Texas prevalence of overweight or obesity was higher than the national average in 2007.

Texas prevalence of no leisure time physical activity was significantly higher than the national average (29% vs 24%) in 2007.

Around 75% of adults consumed fruits & vegetables less than 5 times per day in 2007.

Medical Risk Factors

DiabetesHigh CholesterolHigh Blood Pressure

Prevalence of Diabetes, Texas and US Adults, 1995-2007

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Pre

vale

nce

( per

cent

with

95%

CI)

US Texas


Prevalence of Diabetes, by Demographic, Texas, 2007


8.6%10.3% 9.9% 10.8%

8.5%

2.7%

5.5%

14.5%

23.2%

12.3%12.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Pre

vale

nce

(p

erce

nt

wit

h 9

5% C

I)

Prevalence of Diabetes, by Health Service Region, 2007


Prevalence of High Cholesterol, Texas and US Adults, 1995-2007


0

10

20

30

40

50

Prev

alen

ce (

perc

ent w

ith 9

5%C

I)

US Texas

Prevalence of High Cholesterol, by Demographic, Texas, 2007


37.3%40.7% 39.8%

28.3%

48.1%

54.5%

37.3%33.2%

38.5%

13.8%

36.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Pre

vale

nce

(p

erce

nt

wit

h 9

5% C

I)

Prevalence of High Cholesterol by Health Service Region, 2007


Prevalence of High Blood Pressure, Texas and US Adults, 1995-2007

0

10

20

30

40

50

Prev

alen

ce (

perc

ent w

ith

95%

CI)

US Texas


Prevalence of High Blood Pressure, by Demographic, Texas, 2007


27.7% 27.8% 27.7% 28.0% 29.1%

41.4%

21.7%

7.8%

16.3%

38.9%

58.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Pre

vale

nce

(p

erce

nt

wit

h 9

5% C

I)

Prevalence of High Blood Pressure by Health Service Region, 2007


Medical Risk Factors The prevalence of diabetes among adult

Texans has been rising since 1995. Texas prevalence of diabetes was

significantly higher than the national average (10.3% vs 8.8%) in 2007.

Texas prevalence of high blood cholesterol was similar to the national average in 2007.

More than 27% of adult Texans reported being diagnosed with high blood pressure in 2007.

Financial Burden

Hospital Discharge Data Hospital discharge data has been

compiled and tabulated by the Texas Health Care Information Collection (THCIC) since 1999.

THCIC is required to provide a public use data file (PUDF) for computer-to-computer access.

The PUDF contains patient level information for inpatient hospital stays.

Classes of Diagnoses (ICD-9 codes):

Ischemic Heart Disease (ICD-9 codes 410-

414)

Ischemic Stroke (ICD-9 codes 430-432)

Hemorrhagic Stroke (ICD-9 codes 433- 438)

Congestive Heart Failure (ICD-9 code 428)

Number of First-listed Hospital Discharge for Select Diagnoses, Texas, 2006,

Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2006

117,231

81,265

70,991

55,713

53,456

45,882

28,769

25,980

25,182

9,082

4,733

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000

Ischemic Heart Disease

Cancer (Any Type)

Congestive Heart Failure

Arthritis

Stroke (Ischemic and Hemorragic)

Osteoarthritis

Type 2 Diabetes

Hypertension

Asthma

Type 1 Diabetes

Alzheimers Disease

Number of Hospital Discharges, CVD Diagnoses , Texas 2001-2006

Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2001-2006

70,991

44,553

8,903

117,231

71685

44292

8760

118771

72,424

45,110

8,681

126,597

71,432

58,589

8,220

129,578

67,121

59,142

8,251

134,304

64,387

58,603

8,136

136,863

- 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000

CHF

Isch Stroke

Hge Stroke

IHD

Number of Cases

2006 2005 2004 2003 2002 2001

Texas Hospital Charge Data

Estimated potential cost to payers

Does not represent actual reimbursements

Total Hospital Charges for Selected CVD Diagnoses, Texas 2001-2006


Total Hospital Charges for Selected CVD Diagnoses Texas 2001-2006

$2,478

$1,409

$590

$6,315

$2,349

$1,289

$519

$5,927

$2,287

$1,217

$486

$5,846

$1,770

$1,300

$421

$5,216

$1,581

$1,215

$376

$5,032

$1,307

$1,062

$335

$4,405

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000

CHF

Isch Stroke

Hge Stroke

IHD

Millions

2006 2005 2004 2003 2002 2001

Estimated Average Hospital Charge Per Day for Selected CVD Diagnoses, Texas 2001-2006


$6,174

$5,193

$7,068

$12,583

$5,696

$4,694

$6,339

$11,352

$5,143

$4,199

$5,969

$10,223

$4,476

$3,835

$5,425

$8,995

$3,665

$3,288

$4,377

$7,469

$3,293

$3,014

$4,228

$6,803

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000

CHF

Isch Stroke

Hge Stroke

IHD

Average Daily Charge in Dollars

2006 2005 2004 2003 2002 2001


Total Hospital Charges for Ischemic Heart Disease, by Demographic, Texas, 2006

$0

$1,000,000,000

$2,000,000,000

$3,000,000,000

$4,000,000,000

$5,000,000,000

$6,000,000,000

$7,000,000,000


Total Hospital Charges for Ischemic Stroke by Demographic, Texas, 2006

0.0

200,000,000.0

400,000,000.0

600,000,000.0

800,000,000.0

1,000,000,000.0

1,200,000,000.0

1,400,000,000.0

1,600,000,000.0


Total Hospital Charges for Hemorrhagic Stroke, by Demographic, Texas, 2006

0.0

100,000,000.0

200,000,000.0

300,000,000.0

400,000,000.0

500,000,000.0

600,000,000.0

700,000,000.0


Total Hospital Charges for Congestive Heart Failure, by Demographic, Texas, 2006

0.0

500,000,000.0

1,000,000,000.0

1,500,000,000.0

2,000,000,000.0

2,500,000,000.0

3,000,000,000.0

Hospital Discharge Data In 2006, the highest number of discharges

for chronic disease hospitalizations was for IHD, followed by cancer, congestive heart failure and stroke.

Estimated average hospital charges per day and total charge for selected CVD diagnoses have increased each year from 2001 to 2006.

The number of discharges for CVD steadily declined since 2001.

More Information on THCIC

http://www.dshs.state.tx.us/thcic/

Represents cost to Texas/US.Population is low income and generally has less access to primary prevention.

Data cannot be generalized to rest of population

Texas Medicaid Reimbursement Data

Data are based on paid Medicaid claims for Fee- For-Service (FFS) and Patient Care Case Management (PCCM) clients.

Data excludes information on individuals served by Medicaid HMOs or those served by STAR+PLUS.

Data does not include denied or pending claimsData excludes the portion paid by the Medicare

program and other insurance providers.Data is available by type of claim: physician,

emergency dept., or inpatient hospital.

Medicaid Reimbursement Data for CVD

ICD-9 Codes for Medicaid Reimbursement Data

Ischemic Heart Disease (ICD-9 codes 410-414)

Stroke (ICD-9 codes 430-438)

Congestive Heart Failure (ICD-9 code 428)

Hypertension (ICD-9 codes 401-405)

Texas Medicaid Reimbursement Amounts for CVD Diagnoses In Millions, 2007

Data Source: Fee for Service (FFS) and Patient Care Management (PCCM) clients, Texas Health and Human Services

Commission, 2007.

Inpatient Hospital Claims Emergency

ClaimsPhysician

Claims

IHD $41 $8 $22

Stroke $34 $6 $16

CHF $34 $4 $13

Hypertension $15 $9 $20

Total $124 $27 $71

Trends in Texas Medicaid Reimbursement Amounts for CVD, 2003,2005, 2006, 2007


Commission, 2003, 2005, 2006, 2007.

$0

$50

$100

Rei

mbu

rese

mts

in M

illio

ns

2003 2005 2006 2007

2003 $94 $57 $52 $41

2005 $82 $55 $50 $44

2006 $75 $57 $50 $44

2007 $71 $55 $50 $44

IHD Stroke CHF Hypertension

Medicaid Reimbursement Amounts for CVD, Texas , 2007


Commission, 2007.

$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

Inpatient Hospital Emergency Physician

Rei

mb

urs

emen

ts in

Mill

ion

s


Percent of Total Medicaid Reimbursements for Inpatient Hospital, 2007


Commission, 2007.

57.9 61.067.8

33.5

0.015.030.045.060.075.0

Pe

rce

nt

of

Re

imb

urs

em

en

t

Average Medicaid Reimbursement per Claim for Inpatient Hospital, Texas, 2007


Commission, 2007.

$2,966

$3,556

$2,132

$2,461

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000


Rei

mb

urs

emen

t P

er C

laim

Medicaid Reimbursement Data

Texas Medicaid Program paid over $220 million dollars in Medicaid claims for CVD in 2007.

Among CVD diagnose, Medicaid reimbursement was highest for ischemic heart disease followed by stroke, congestive heart failure and hypertension in 2003-2007.

Average Medicaid reimbursement per claims for inpatient hospital was highest for stroke followed by heart disease, hypertension, and congestive heart failure in 2007.

Health Plan Employer Data and Information Set

HEDIS

Standardized performance measures designed for comparing the quality of care of managed care organizations

Trends in Selected Measures for CVDby Percentage of Members, Texas, 2001-2007

Data Source: http://www.opic.state.tx.us/page.php?p_sub_page_id=582001-2007

Measures 2001 2002 2003 2004 2005 2006 2007

A. Controlling High BP 1

47.8 50.9 57.9 59.2 64.5 64.5 57.7

B. Beta Blocker Treatment After a Heart Attack

NA 90.3 86.9 85.2 83.3 84.3 86.0

C. LDL-C Screening after acute CV event3

72.4 76.2 77.1 77.9 79.4 75.6 82.3

D. LDL-C Level < 130 mg/dL4

42.6 57.7 56.3 55.8 46.8 NA

HEDIS

Patient Population Measured:A: Age 18 through 85 years diagnosed with high blood pressure,

whose blood pressure was controlled below 140 mmHg systolic and 90 mm Hg diastolic.

B: Age 35 years and older of diagnosed with acute myocardial infarction (AMI) and who received an ambulatory prescription.

C: The percentage of members 18 through 75 years of age who had an LDL-C screening during the measurement year and the year prior, after discharge for an acute cardiovascular event.

D: The percentage of members 18 through 75 years of age who had an LDL-C level of less than 130 mg/dL during the measurement year, after discharge for an acute cardiovascular event.

Emergency Medical Services (EMS)

EMS Data Suspected CVD illness types include

cardiac arrest, cardiac rhythm disturbance, chest pain/discomfort, and stroke.

Medical-related 911calls only (no inter-facility transfers)

Texas residents only Data provide by Texas Trauma Registry

EMS Response Time for CVD, Texas Health Service Regions, 2003, 2004

Data Source: Texas EMS/Trauma Registry, 2003, 2004.

0

2

4

6

8

10

12

14

Res

pons

e tim

e in

min

utes

2003 2004

EMS Response Time for Stroke, Texas Health Service Regions, 2003, 2004

Data Source: Texas EMS/Trauma Registry, 2003, 2004.

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Res

po

nse

tim

es in

min

ute

s

2003 2004

Interpreting Confidence Interval (CI)

Interpreting CIs

If the confidence intervals do not overlap, the test is statistically significant

There is a statistically significant difference between prevalence of high blood pressure among Whites and African Americans in Texas

Interpreting CIs

Do the CIs Overlap?

(6.5, 7.3)

Prevalence of High Blood Pressure, Texas , 2007

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Pre

va

len

ce

(p

erc

en

t w

ith

95

% C

I)

(45.5, 37.4)

(28.0, 30.3)

Interpreting CIs

If the confidence intervals overlap, the test is not statistically significant

There is not a statistically significant difference between prevalence of heart disease among Health Service Region 4 and Health Service Region 5

Interpreting CIs

Do the CIs Overlap?

Prevalence of Heart Disease by Health Service Region, Texas, 2007

0.02.04.06.08.0

10.012.014.016.0

Pre

vale

nce

(P

erce

nt

wit

h 9

5 %

CI)

(8.3, 14.2)

(5.9, 9.3)

Date post:	27-Mar-2015
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Cardiovascular Disease (CVD) in Texas A Surveillance Report December 2008 Health Promotion Unit...

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