State of the USA Health Indicators: Letter Report (2009)

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Appendix D The Commonwealth Fund Algorithm and Coding for Preventive Services The following all-preventive care indicator was developed by Cathy Schoen, Senior Vice President of The Commonwealth Fund on behalf of the Fund’s Commission on a High Performance Health System for use in the Commission’s national scorecard on U.S. system performance. It was first published in the 2006 report, Why Not the Best?: Results From National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006 and updated in the 2008 National Scorecard published in August 2008. Supported by a grant from The Commonwealth Fund, Bisundev Mahato of Columbia University Mailman School of Public Health provided the programming algorithm for the Medical Expendi- ture Panel Survey (MEPS) and conducted the MEPS data analyses. The Commonwealth Fund provided permission to include the analysis in this report. Using responses to specific questions about preventive services in the MEPS survey, the algorithm to calculate the indicator on receipt of screening services and flu shots uses information on the following specific services and time frames: Blood pressure check in 2 years Cholesterol check in 5 years Fecal occut blood stool test in 2 years Colonoscopy or sigmoidoscopy EVER Flu shot in past year Pap smear in 3 years Mammogram in 2 years 79 

80 STATE OF THE USA HEALTH INDICATORS Since guidelines for receipt of screening and preventive services and both age- and gender-specific, respondents are divided into groups for which specific sets of services are indicated. These groups are: Men, ages 18–49 ==> BP & CHOL Men, ages 50–64 ==> BP & CHOL & FOBT/COLONSIG Men, ages 65+ ==> BP & CHOL & FOBT/COLONSIG & FLU Women, ages 18–39 ==> BP & CHOL & PAP Women, ages 40–49 ==> BP & CHOL & PAP & MAM Women, ages 50–64 ==> BP & CHOL & PAP & MAM & FOBT/COLONSIG Women, ages 65+ ==> BP & CHOL & PAP & MAM & FOBT/ COLONSIG & FLU To calculate the indicator, a provisional value of “yes” is set for each individual in each group, and then reset to “no” if a specific service is not reported by that individual in the appropriate time frame. The indica- tor is then the percentage of respondents (in each group or in all groups combined) for whom the receipt of services variable is “yes” after going through all services. Even though the number of recommended services varies by age and gender, the percent “yes” is interpretable in the same way for each group and combinable across groups to yield an overall percentage for all adults. The detailed coding for this algorithm is presented below. *1. initial preventive care indicator variables capture label drop yn label define yn 0”No” 1”Yes” 9”DK, Refused, Not Ascertained” gen choles5yr=cholck3<=4 replace choles5yr=9 if cholck3<=-7 replace choles5yr=. if cholck3==-1 label var choles5yr “cholesterol screen in past 5 yrs” label values choles5yr yn gen bp2yr=bpchek3<=2 replace bp2yr=9 if bpchek3<=-7 replace bp2yr=. if bpchek3==-1 label var bp2yr “blood pressure checked in past 2 yrs” label values bp2yr yn 

APPENDIX D 81 *cholesterol AND blood pressure in recommended intervals gen choles5yrbp2yr=1 replace choles5yrbp2yr=0 if (choles5yr==0 | bp2yr==0 | (choles5yr==9 & bp2yr==9))&agex>=18 replace choles5yrbp2yr=. if choles5yr==. & bp2yr==. label values choles5yrbp2yr yn gen mam2yr= mamogr3<=2 replace mam2yr=9 if mamogr3<=-7 replace mam2yr=. if mamogr3==-1 label var mam2yr “mammogram in past 2 yrs” label values mam2yr yn gen pap3yr=papsmr3<=3 replace pap3yr=9 if papsmr3<=-7 replace pap3yr=. if papsmr3==-1 label var pap3yr “PAP in past 3 yrs” label values pap3yr yn gen inf1yr=flusht3<=1 replace inf1yr=9 if flusht3<=-7 replace inf1yr=. if flusht3==-1 label var inf1yr “flu shot in past yr” label values inf1yr yn gen bldstool2yr=whenst3==1|whenst3==2 replace bldstool2yr=9 if whenst3<=-7|stool3<=-7 replace bldstool2yr=. if stool3==-1 label var bldstool2yr “blood stool test in past 2 yrs” label values bldstool2yr yn gen sigcolonever=bowel3==1 replace sigcolonever=9 if bowel3<-7 replace sigcolonever=. if bowel3==-1 label var sigcolonever “EVER had a sigmoidscopy or colonoscopy” label values sigcolonever yn *Colon1: FOBT in past 2 years OR ever sig/colonoscopy gen colon1=0 replace colon1=1 if bldstool2yr==1 | sigcolonever==1 | agex<50 replace colon1=. if bldstool2yr==. & sigcolonever==. label values colon1 yn 

82 STATE OF THE USA HEALTH INDICATORS ************************************* *Composite using all of the above using colon1 *Each adult will be coded a yes=1 if received all age and health condition appropriate screening included in MEPS. Or no=0 if missing any of the recommended care * Men: *18–49: blood test and cholesterol gen compositeall1=1 replace compositeall1=0 if choles5yrbp2y==0 & agex>=18 & agex<=49 & sex==1 replace compositeall1=. if choles5yrbp2y==. & agex>=18 & agex<=49 & sex==1 *50 –64: blood test, cholesterol, colon screens (FOBT or scope) replace compositeall1=0 if (choles5yrbp2y==0 |colon1==0) & agex>=50 & agex<=64 & sex==1 replace compositeall1=. if (choles5yrbp2y==. &colon1==.) & agex>=50 & agex<=64 & sex==1 *65 and older: blood test, cholesterol, colon screens (FOBT or scope), flu vaccine past year and pneumococcal immunization ever replace compositeall1=0 if (choles5yrbp2y==0 |colon1==0 | inf1yr==0) & agex>=65 & sex==1 replace compositeall1=. if (choles5yrbp2y==. &colon1==. & inf1yr==.) & agex>=65 & sex==1 *Women: *18–39: blood test, cholesterol, PAP replace compositeall1=0 if (choles5yrbp2y==0 | pap3yr==0) & agex>=18 & agex<=39 & sex==2 replace compositeall1=. if (choles5yrbp2y==. & pap3yr==.) & agex>=18 & agex<=39 & sex==2 *40–49: blood test, cholesterol, PAP + mammogram replace compositeall1=0 if (choles5yrbp2y==0 | pap3yr==0 | mam2yr==0 ) & agex>=40 & agex<=49 & sex==2 replace compositeall1=. if (choles5yrbp2y==.&pap3yr==.&mam2yr==.) &agex>=40&agex<=49&sex==2 *50–64: blood test, cholesterol, PAP + mammogram + colon screens (FOBT or scope) replace compositeall1=0 if (choles5yrbp2y==0 | pap3yr==0 | mam2yr==0 | colon1==0) & agex>=50 & agex<=64 & sex==2 replace compositeall1=. if (choles5yrbp2y==.&pap3yr==.&mam2yr==.& colon1==.)&agex>=50&agex<=64&sex==2 

APPENDIX D 83 *65 and older: blood test, cholesterol, PAP, mammogram + colon screens (FOBT or scope) + flu + pneumococcal immunization ever replace compositeall1=0 if (choles5yrbp2y==0 | pap3yr==0 | mam2yr==0 | colon1==0 | inf1yr==0) & agex>=65 & sex==2 replace compositeall1=. if (choles5yrbp2y==.&pap3yr==.&mam2yr==.& colon1==.&inf1yr==.)&agex>=65&sex==2 label var compositeall1 “composite all using colon1” label values compositeall1 yn ************************************* *weighting command [fw=wtdper]