Prevention
Breast Cancer Screening
One out of every eight women will develop breast cancer in the course of a 90-year life span. According to the American Cancer society in 2009 about 192,370 women will be diagnosed with invasive breast cancer and there will be 40,170 deaths in the U.S. Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer. If detected early, the 5-year survival rate exceeds 95%. Mammograms are among the best early detection methods, increasing chances for survival and cure. Mammography screening has been shown to reduce mortality by 20 to 40% among women aged 50 and older.
The breast cancer screening rate measures the percentage of women in the health plan population, between the ages of 40 and 69, who were continuously enrolled in their health plan during the measurement year and one prior and had at least one mammogram during that two-year period.
This measure shows the relative performance of plans in providing mammograms to their commercial enrollees. Plans can encourage regular breast cancer screenings by promoting routine physical health exams and providing members with cancer awareness materials. Health plans also send women and their physician’s reminders to schedule a mammogram.
Cervical Cancer Screening
The American Cancer Society estimated that in 2009, about 11,270 cases of invasive cervical cancer would be diagnosed and 4,070 deaths expected from the disease in the U.S. The number of cervical cancer deaths in the U.S. continues to decline by about 2% a year. The main reason for this decline is the increased use of the Papanicolau (Pap) test. Cervical cancer can be detected early, when it is most treatable, by the use of routine Pap tests. For this reason, all women between the ages of 21 and 64 should have a Pap test at least once every three years.
Health plans provide coverage for regular Pap testing. This measure shows the percentage of women between the ages of 21 to 64 who had at least one Pap test during the past three years. Women can help reduce the risk of cervical cancer by getting regular Pap tests according to the schedules recommended by their doctors. Most plans compare the frequency of Pap tests for their members to the recommended schedule for screenings and remind both women and their physicians when appointments or tests should be scheduled.
Childhood Immunization Status
Immunizations are one of the safest and most effective ways to protect children from serious diseases.
Combo 2 shows the performance of California health plans in providing all of the following immunizations:
- Four DTaP (diphtheria-tetanus-pertussis)
- Three IPV polio immunizations
- One dose of MMR (measles-mumps-rubella)
- Three HiB (H influenza type B)
- Three HepB (hepatitis B)
- One Varicella Vaccine (VZV, chicken pox) by the second birthday
Combo 3 includes all of the above plus at least four pneumococcal conjugate vaccinations on or before the child's second birthday. Individual vaccine rates are reported as well.
Health plans promote childhood immunizations during regular well-infant and well-child visits with doctors. Some health plans assist their physicians by following up directly with families who are late in receiving their childhood immunizations.
Chlamydia Screening in Women
Chlamydia is currently the most commonly reported infectious sexually transmitted disease in the United States with an estimated 2.8 million cases occurring each year. Chlamydia is especially common in teenagers and young adults. Untreated infections are easily spread between sexual partners and can cause serious health complications. Chlamydia is frequently called a "hidden" disease since approximately 75% of women and 50% of men have no symptoms. Therefore, routine screening tests are very important in limiting the complications of an infection. Chlamydia can cause pelvic inflammatory disease, infertility, and tubal or ectopic pregnancies and some of these complications may be life threatening. Chlamydia infections can also cause health problems in newborns whose mothers have an undetected or untreated infection during pregnancy.
Simple, routine-screening tests identify the presence of Chlamydia infections. Treatment with antibiotics is usually successful in preventing further transmission of the disease and limiting future complications. The screening rates reported on this page are intended to measure the percentage of sexually active women between the ages of 16 and 25 who received at least one routine screening test for Chlamydia during the measurement year. Health plans can successfully improve Chlamydia screening rates through distribution of educational materials to both physicians and members. Three rates are reported; ages 16 - 20, ages 21 - 24, and total.
Colorectal Cancer Screening
Colorectal cancer—cancer of the colon or rectum—is the second leading cause of cancer-related deaths in the U.S. The American Cancer Society estimates that 49,920 Americans will die of colorectal cancer in 2009. Colorectal cancer is also one of the most commonly diagnosed cancers in the U.S.; approximately 146,970 new cases will be diagnosed in 2009. Colorectal cancer is the third most common cancer in men and in women. The risk of developing colorectal cancer increases with advancing age, with more than 90% of cases occurring in persons aged 50 years or older.
Reducing the number of deaths from colorectal cancer depends on detecting and removing precancerous colorectal polyps, as well as detecting and treating the cancer in its early stages. Colorectal cancer can be prevented by removing precancerous polyps or growths, which can be present in the colon for years before invasive cancer develops. Findings from the National Health Interview Survey indicate that in 2000, only 42.5% of U.S. adults aged 50 years or older had undergone a sigmoidoscopy or colonoscopy within the previous 10 years or had used an FOBT home test kit within the preceding year.
This HEDIS measure estimates the percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer. The screening criteria can be met with any one of four tests: a fecal occult blood test (FOBT) during the measurement year; a flexible sigmoidoscopy within the last four years prior to the measurement year; or a colonoscopy within the last nine years prior to the measurement year. Screening for colorectal cancer lags far behind screening for breast and cervical cancers.
Flu Shot for Adults
Influenza, also known as the flu, is a contagious disease that is caused by the influenza virus. Millions of people in the U.S. - about 5% to 20% of U.S. residents - will get influenza each year. Most people who get influenza will recover in one or two weeks, but some people will develop life-threatening complications as a result of the flu. An average of about 36,000 people each year in the U.S. dies from influenza, and more than 200,000 have to be admitted to the hospital as a result of influenza. Some people with certain health conditions are at high risk for serious flu complications such as bacterial pneumonia, dehydration and worsening of chronic medical conditions such as asthma or diabetes. Nearly one-third of people 50-64 years of age in the U.S. have one or more medical conditions that place them at increased risk for serious flu complications.
This HEDIS measure is collected using survey methodology and estimates the percentage of members 50-64 who received an influenza vaccination during the measurement year. The single best way to prevent the flu is to get a flu vaccination each fall. People who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications should get vaccinated each year.
Adult BMI Assessment
Obesity is the second leading cause of preventable death in the US. It is a complex chronic disease that effects about 127 million American adults who are overweight, 60 million who are obese and 9 million who are severely obese. According to the Centers for Disease Control and Prevention (CDC), overweight and obese adults (age 18 or older) are considered at risk for developing morbidities or diseases such as hypertension, type 2 diabetes, coronary artery disease, osteoarthritis, some cancers and other health conditions.
According to AHRQ overweight and obesity are also contributing causes to more than 50 percent of all-cause mortality among American adults aged 20 to 74, which results in a significant economic impact - approximately $99.2 billion is spent annually on obesity-related medical care and disability in the United States. It is estimated that the aggregate cost of obesity ranges from 5 percent - 7 percent of the total of annual medical expenditures in the U.S. ($75 billion per year). In 1994 the estimated cost of obesity to U.S. business was $12.7 billion ($10.1 billion due to moderate or severe obesity; $2.6 billion due to mild obesity). Obesity-attributable business expenditures include paid sick leave, life insurance and health insurance, totaling $2.4 billion, $1.8 billion and $800 million, respectively. Not only is the prevalence of obesity increasing, but the relative per capita spending among obese Americans is also increasing.
Body mass index (BMI) is a statistical measure of the weight of a person scaled according to their height. According to the CDC BMI is a fairly reliable indicator of body fatness for most people. BMI does not measure body fat directly, but research has shown that BMI correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA).
This measure identifies the percentage of members 18 - 74 years of age who had an outpatient visit and who had their body mass index (BMI) documented during the measurement year or year prior.
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
The Centers for Disease Control and Prevention (CDC) states that overweight children and adolescents are more likely to become obese as adults For example, one study found that approximately 80 percent of children who were overweight at age 10 to 15 years were obese adults at age 25. Another study found that 25 percent of obese adults were overweight as children; it also found that if overweight begins before 8 years of age, obesity in adulthood is likely to be more severe.
Screening for overweight or obesity begins in the provider's office with the calculation of body mass index (BMI). The BMI percentile is determined after BMI is calculated for children and teens, the BMI number is plotted on the CDC BMI-for-age growth charts (for either girls or boys) to obtain a percentile ranking. Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children in the United States.
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