Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Appendix D. Hierarchical Condition Classification and Distribution for Ihss Recipients by Age and Provider Relationship

07/01/2008

TABLE D-1: Hierarchical Condition Classification Distribution for IHSS Recipients Age 3-17 by Provider Relationship, 2005
HCC Parents Other Relative Non-Relative
# % # % # %
Parent is paid as an IHSS worker for their minor child, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient.

HCC refers to the CMS hierarchical condition categories or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCC’s aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CCs hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. This avoids duplicative counting of related conditions. For unrelated diseases (i.e., diseases in other CCs), the number of HCC’s accumulate.

  1. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file.
  2. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table.
  3. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.
  Total Recipients   8,293     100.0     1,455     100.0     1,835     100.0  
  Recipients w/any HCC 6,740 81.3 1,055 72.5 1,261 68.7
 
  Infectious and Parasitic Disease            
1 HIV/AIDS 12 0.1 7 0.5 12 0.7
2 Septicemia/Shock 64 0.8 4 0.3 7 0.4
3 Central Nervous System Infection 31 0.4 3 0.2 6 0.3
4 Tuberculosis 13 0.2 8 0.5 0 -
5 Opportunistic Infections 12 0.1 1 0.1 2 0.1
6 Other Infectious Diseases 967 11.7 141 9.7 152 8.3
  NEOPLASMS            
7 Metastatic Cancer & Acute Leukemia 54 0.7 8 0.5 5 0.3
8 Lung, Upper Digestive Tract, & Other Severe Cancers 11 0.1 1 0.1 0 -
9 Lymphatic, Head & Neck, Brain, and Other Major Cancers 117 1.4 10 0.7 15 0.8
10 Breast, Prostate, Colorectal & Other Cancers & Tumors 114 1.4 11 0.8 14 0.8
11 Other Respiratory & Heart Neoplasms 15 0.2 1 0.1 1 0.1
12 Other Digestive & Urinary Neoplasms 24 0.3 1 0.1 5 0.3
13 Other Neoplasms 82 1.0 7 0.5 9 0.5
14 Benign Neoplasms of Skin, Breast, Eye 49 0.6 12 0.8 9 0.5
a Endocrine, Nutritional and Metabolic Disorders            
15 Diabetes with Renal or Peripheral Circulatory Manifestation 4 0.0 1 0.1 0 -
16 Diabetes with Neurologic or Other Specified Manifestation 7 0.1 1 0.1 2 0.1
17 Diabetes with Acute Complications 6 0.1 4 0.3 4 0.2
18 Diabetes with Ophthalmologic or Unspecified Manifestation 10 0.1 1 0.1 4 0.2
19 Diabetes without Complication 101 1.2 15 1.0 13 0.7
21 Protein-Calorie Malnutrition 29 0.3 4 0.3 4 0.2
22 Other Significant Endocrine and Metabolic Disorders 193 2.3 25 1.7 26 1.4
23 Disorders of Fluid/Electrolyte/Acid-Base Balance 87 1.0 14 1.0 13 0.7
24 Other Endocrine, Metabolic, or Nutritional Disorders 417 5.0 66 4.5 61 3.3
  Liver and Gallbladder Disease            
25 End-Stage Liver Disease 9 0.1 3 0.2 1 0.1
26 Cirrhosis of Liver 4 0.0 2 0.1 0 -
27 Chronic Hepatitis 7 0.1 1 0.1 0 -
28 Acute Liver Failure/Disease 3 0.0 0 - 1 0.1
29 Other Hepatitis & Liver Disease 48 0.6 6 0.4 3 0.2
30 Gallbladder & Biliary Tract Disorders 26 0.3 2 0.1 4 0.2
  Gastrointestinal Disease/Disorders            
31 Intestinal Obstruction/Perforation 97 1.2 20 1.4 9 0.5
32 Pancreatic Disease 82 1.0 4 0.3 10 0.5
33 Inflammatory Bowel Disease 12 0.1 1 0.1 4 0.2
34 Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders 125 1.5 17 1.2 12 0.7
35 Appendicitis 16 0.2 5 0.3 1 0.1
36 Other Gastrointestinal Disorders 1,492 18.0 202 13.9 203 11.1
  Musculoskeletal/Connective Tissue Disease Disorders            
37 Bone/Joint/Muscle Infections/Necrosis 34 0.4 9 0.6 2 0.1
38 Rheumatoid Arthritis & Inflammatory Connective Tissue Disease 56 0.7 5 0.3 13 0.7
39 Disorders of the Vertebrae & Spinal Discs 654 7.9 76 5.2 96 5.2
40 Osteoarthritis of Hip or Knee 10 0.1 1 0.1 3 0.2
41 Osteoporosis & Other Bone/Cartilage Disorders 157 1.9 20 1.4 12 0.7
42 Congenital/Developmental Skeletal and Connective Tissue Disorders 214 2.6 37 2.5 26 1.4
43 Other Musculoskeletal & Connective Tissue Disorders 1,384 16.7 175 12.0 214 11.7
  Blood and Blood Forming Organ Disease/Disorders            
44 Severe Hematological Disorders 66 0.8 5 0.3 8 0.4
45 Disorders of Immunity 37 0.4 8 0.5 14 0.8
46 Coagulation Defects & Other Specified Hematological Disorders 67 0.8 9 0.6 8 0.4
47 Iron Deficiency & Other Unspecified Anemias & Blood Disease 163 2.0 27 1.9 27 1.5
  Mental Disorders            
48 Delirium & Encephalopathy 147 1.8 37 2.5 15 0.8
49 Dementia/Cerebral Degeneration 319 3.8 29 2.0 43 2.3
50 Nonpsychotic Organic Brain Syndromes/Conditions 132 1.6 14 1.0 16 0.9
51 Drug/Alcohol Psychosis 1 0.0 1 0.1 0 -
52 Drug/Alcohol Dependence 3 0.0 0 - 1 0.1
53 Drug/Alcohol Abuse, Without Dependence 1 0.0 1 0.1 3 0.2
54 Schizophrenia 14 0.2 3 0.2 3 0.2
55 Major Depressive, Bipolar, and Paranoid Disorders 51 0.6 12 0.8 11 0.6
56 Reactive and Unspecified Psychosis 17 0.2 4 0.3 6 0.3
57 Personality Disorders 10 0.1 0 - 1 0.1
58 Depression 38 0.5 9 0.6 7 0.4
59 Anxiety Disorders 71 0.9 14 1.0 10 0.5
60 Other Psychiatric Disorders 214 2.6 32 2.2 40 2.2
  Mental Retardation/Developmental Disability            
61 Profound Mental Retardation, Developmental Disability 87 1.0 7 0.5 10 0.5
62 Severe Mental Retardation, Developmental Disability 41 0.5 8 0.5 9 0.5
63 Moderate Mental Retardation, Developmental Disability 20 0.2 7 0.5 5 0.3
64 Mild Mental Retardation, Autism, Down's Syndrome 860 10.4 111 7.6 136 7.4
65 Other Developmental Disability 438 5.3 69 4.7 62 3.4
66 Attention Deficit Disorder 190 2.3 37 2.5 55 3.0
  Central Nervous System Injuries/Disorders            
67 Quadriplegia/Other Extensive Paralysis 667 8.0 102 7.0 103 5.6
68 Paraplegia 162 2.0 36 2.5 29 1.6
69 Spinal Cord Disorders/Injuries 488 5.9 66 4.5 68 3.7
70 Muscular Dystrophy 134 1.6 14 1.0 22 1.2
71 Polyneuropathy 81 1.0 14 1.0 12 0.7
72 Multiple Sclerosis 6 0.1 0 - 1 0.1
73 Parkinson's & Huntington's Diseases 4 0.0 1 0.1 0 -
74 Seizure Disorders & Convulsions 1,583 19.1 243 16.7 267 14.6
75 Coma, Brain Compression/Anoxic Damage 45 0.5 6 0.4 6 0.3
76 Mononeuropathy, Other Neurological Conditions/Injuries 144 1.7 16 1.1 20 1.1
  Respiratory System Disorders            
77 Respirator Dependence, Tracheostomy Status 148 1.8 11 0.8 19 1.0
78 Respiratory Arrest 11 0.1 1 0.1 3 0.2
79 Cardio-Respiratory Failure & Shock 284 3.4 35 2.4 45 2.5
  Cardiovascular System Disease/Disorders            
80 Congestive Heart Failure 130 1.6 16 1.1 10 0.5
81 Acute Myocardial Infarction 1 0.0 0 - 1 0.1
82 Unstable Angina & Other Acute Ischemic Heart Disease 3 0.0 1 0.1 0 -
83 Angina Pectoris/Old Myocardial Infarction 4 0.0 0 - 0 -
84 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease 11 0.1 1 0.1 2 0.1
85 Heart Infection/Inflammation, Except Rheumatic 29 0.3 2 0.1 3 0.2
86 Valvular & Rheumatic Heart Disease 130 1.6 8 0.5 18 1.0
87 Major Congenital Cardiac, Circulatory Defect 97 1.2 10 0.7 8 0.4
88 Other Congenital Heart/Circulatory Disease 220 2.7 23 1.6 21 1.1
89 Hypertensive Heart & Renal Disease or Encephalopathy 12 0.1 0 - 3 0.2
90 Hypertensive Heart Disease 5 0.1 1 0.1 0 -
91 Hypertension 97 1.2 11 0.8 14 0.8
92 Specified Heart Arrhythmias 46 0.6 6 0.4 7 0.4
93 Other Heart Rhythm & Conduction Disorders 114 1.4 20 1.4 13 0.7
94 Other & Unspecified Heart Disease 84 1.0 12 0.8 5 0.3
  Cerebral and Other Vascular System Disease/Disorders            
95 Cerebral Hemorrhage 24 0.3 1 0.1 6 0.3
96 Ischemic or Unspecified Stroke 21 0.3 2 0.1 4 0.2
97 Precerebral Arterial Occlusion & Transient Cerebral Ischemia 14 0.2 0 - 5 0.3
98 Cerebral Atherosclerosis & Aneurysm 11 0.1 1 0.1 2 0.1
99 Cerebrovascular Disease, Unspecified 8 0.1 1 0.1 1 0.1
100 Hemiplegia/Hemiparesis 129 1.6 21 1.4 16 0.9
101 Cerebral Palsy & Other Paralytic Syndromes 1,122 13.5 177 12.2 170 9.3
102 Speech, Language, Cognitive, Perceptual Deficits 5 0.1 1 0.1 2 0.1
103 Cerebrovascular Disease Late Effects, Unspecified 3 0.0 0 - 1 0.1
104 Vascular Disease with Complications 17 0.2 3 0.2 1 0.1
105 Vascular Disease 32 0.4 2 0.1 4 0.2
106 Other Circulatory Disease 53 0.6 5 0.3 10 0.5
  Pulmonary System Disease/Disorders            
107 Cystic Fibrosis 48 0.6 10 0.7 10 0.5
108 Chronic Obstructive Pulmonary Disease 182 2.2 24 1.6 28 1.5
109 Fibrosis of Lung & Other Chronic Lung Disorders 91 1.1 12 0.8 22 1.2
110 Asthma 846 10.2 137 9.4 141 7.7
111 Aspiration & Specified Bacterial Pneumonias 146 1.8 20 1.4 28 1.5
112 Pneumococcal Pneumonia, Empyema, Lung Abscess 44 0.5 4 0.3 6 0.3
113 Viral & Unspecified Pneumonia, Pleurisy 633 7.6 86 5.9 96 5.2
114 Pleural Effusion/Pneumothorax 64 0.8 5 0.3 11 0.6
115 Other Lung Disorders 1,266 15.3 184 12.6 195 10.6
  Eyes and Vision Disorders            
116 Legally Blind 24 0.3 3 0.2 5 0.3
117 Major Eye Infections, Inflammations 7 0.1 0 - 5 0.3
118 Retinal Detachment 22 0.3 1 0.1 4 0.2
119 Proliferative Diabetic Retinopathy & Vitreous Hemorrhage 0 - 0 - 1 0.1
120 Diabetic & Other Vascular Retinopathies 34 0.4 5 0.3 7 0.4
121 Retinal Disorders, Except Detachment & Vascular Retinopathies 25 0.3 3 0.2 1 0.1
122 Glaucoma 54 0.7 6 0.4 4 0.2
123 Cataract 26 0.3 6 0.4 5 0.3
124 Other Eye Disorders 1,290 15.6 160 11.0 184 10.0
  Ear, Nose, and Throat Disorders            
125 Significant Ear, Nose, & Throat Disorders 46 0.6 5 0.3 7 0.4
126 Hearing Loss 218 2.6 28 1.9 24 1.3
127 Other Ear, Nose, Throat, & Mouth Disorders 3,802 45.8 556 38.2 613 33.4
  Renal System Disorders            
128 Kidney Transplant Status 23 0.3 6 0.4 5 0.3
130 Dialysis Status 11 0.1 1 0.1 3 0.2
131 Renal Failure 63 0.8 6 0.4 7 0.4
132 Nephritis 16 0.2 1 0.1 0 -
  Other Genitourinary System Disorders            
133 Urinary Obstruction & Retention 311 3.8 38 2.6 24 1.3
134 Incontinence 99 1.2 21 1.4 17 0.9
135 Urinary Tract Infection 384 4.6 49 3.4 56 3.1
136 Other Urinary Tract Disorders 170 2.0 22 1.5 17 0.9
137 Female Infertility 0 - 0 - 0 -
138 Pelvic Inflammatory Disease & Other Specified Female Genital Disorders 21 0.3 3 0.2 2 0.1
139 Other Female Genital Disorders 146 1.8 32 2.2 35 1.9
140 Male Genital Disorders 115 1.4 21 1.4 15 0.8
b Pregnancy/Child Birth Complications            
141 Ectopic Pregnancy 0 - 0 - 0 -
142 Miscarriage/Abortion 3 0.0 1 0.1 0 -
143 Completed Pregnancy With Major Complications 0 - 1 0.1 0 -
144 Completed Pregnancy With Complications 6 0.1 0 - 0 -
145 Completed Pregnancy Without Complications (Normal Delivery) 3 0.0 1 0.1 0 -
146 Uncompleted Pregnancy With Complications 4 0.0 1 0.1 0 -
147 Uncompleted Pregnancy With No or Minor Complications 7 0.1 1 0.1 0 -
168 Extremely Low Birthweight Neonates 0 - 0 - 0 -
169 Very Low Birthweight Neonates 0 - 0 - 0 -
170 Serious Perinatal Problem Affecting Newborn 111 1.3 15 1.0 11 0.6
171 Other Perinatal Problems Affecting Newborn 21 0.3 2 0.1 2 0.1
172 Normal, Single Birth 4 0.0 1 0.1 1 0.1
  Dermatological Disorders            
148 Decubitus Ulcer of Skin 54 0.7 11 0.8 3 0.2
149 Chronic Ulcer of Skin, Except Decubitus 21 0.3 5 0.3 4 0.2
150 Extensive Third-Degree Burns 0 - 0 - 0 -
151 Other Third-Degree & Extensive Burns 3 0.0 0 - 0 -
152 Cellulitis, Local Skin Infection 313 3.8 53 3.6 53 2.9
153 Other Dermatological Disorders 969 11.7 144 9.9 150 8.2
  Fractures, Other Injuries, and Poisoning            
154 Severe Head Injury 4 0.0 0 - 0 -
155 Major Head Injury 54 0.7 6 0.4 15 0.8
156 Concussion or Unspecified Head Injury 81 1.0 12 0.8 20 1.1
157 Vertebral Fractures without Spinal Cord Injury 1 0.0 1 0.1 3 0.2
158 Hip Fracture/Dislocation 105 1.3 10 0.7 25 1.4
159 Major Fracture, Except of Skull, Vertebrae, or Hip 90 1.1 13 0.9 21 1.1
160 Internal Injuries 7 0.1 1 0.1 3 0.2
161 Traumatic Amputation 9 0.1 2 0.1 0 -
162 Other Injuries 872 10.5 138 9.5 177 9.6
163 Poisonings & Allergic Reactions 135 1.6 15 1.0 23 1.3
b,c Treatment Complications and Status            
164 Major Complications of Medical Care & Trauma 280 3.4 40 2.7 36 2.0
165 Other Complications of Medical Care 83 1.0 18 1.2 9 0.5
166 Major Symptoms, Abnormalities 2,489 30.0 385 26.5 392 21.4
167 Minor Symptoms, Signs, Findings 1,686 20.3 243 16.7 277 15.1
174 Major Organ Transplant Status 41 0.5 2 0.1 3 0.2
175 Other Organ Transplant, Replacement 46 0.6 5 0.3 3 0.2
176 Artificial Openings for Feeding or Elimination 377 4.5 52 3.6 49 2.7
177 Amputation Status, Lower Limb/Amputation Complications 4 0.0 0 - 1 0.1
178 Amputation Status, Upper Limb 0 - 0 - 0 -
179 Post-Surgical States/Aftercare/Elective 1,034 12.5 121 8.3 140 7.6
  Miscellaneous            
180 Radiation Therapy 9 0.1 1 0.1 0 -
181 Chemotherapy 21 0.3 1 0.1 1 0.1
182 Rehabilitation 81 1.0 14 1.0 20 1.1
183 Screening/Observation/Special Exams 2,240 27.0 334 23.0 356 19.4
184 History of Disease 52 0.6 3 0.2 7 0.4

 

TABLE D-2: Hierarchical Condition Classification Distribution for IHSS Recipients, Age 18-64 by Provider Relationship, 2005
HCC Spouse Parent Other Relatives Non-Relative
# % # % # % # %
Parent is paid as an IHSS worker for their adult child, Spouse is paid as an IHSS worker for recipient, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient.

HCC refers to the CMS hierarchical condition category or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCCs aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CC hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. This avoids duplicative counting of related conditions. For unrelated diseases (i.e., diseases in other CCs), the number of HCCs accumulate.

  1. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file.
  2. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table.
  3. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.
  Total Recipients   6,721     100.0     18,749     100.0     40,603     100.0     59,429     100.0  
  Recipients w/ any HCC 6,003 89.3 13,789 73.5 36,362 89.6 52,197 87.8
 
  Infections and Parasitic Disease                
1 HIV/AIDS 55 0.8 222 1.2 523 1.3 1,987 3.3
2 Septicemia/Shock 198 2.9 280 1.5 861 2.1 1,283 2.2
3 Central Nervous System Infection 48 0.7 75 0.4 148 0.4 288 0.5
4 Tuberculosis 18 0.3 46 0.2 127 0.3 148 0.2
5 Opportunistic Infections 30 0.4 42 0.2 96 0.2 161 0.3
6 Other Infectious Diseases 508 7.6 1,139 6.1 3,119 7.7 4,927 8.3
  Neoplasms                
7 Metastatic Cancer and Acute Leukemia 117 1.7 78 0.4 556 1.4 573 1.0
8 Lung, Upper Digestive Tract, and Other Severe Cancers 114 1.7 54 0.3 569 1.4 726 1.2
9 Lymphatic, Head and Neck, Brain, and Other Major Cancers 154 2.3 165 0.9 658 1.6 914 1.5
10 Breast, Prostate, Colorectal and Other Cancers and Tumors 265 3.9 253 1.3 1,589 3.9 1,931 3.2
11 Other Respiratory and Heart Neoplasms 36 0.5 25 0.1 149 0.4 183 0.3
12 Other Digestive and Urinary Neoplasms 216 3.2 137 0.7 1,115 2.7 1,568 2.6
13 Other Neoplasms 172 2.6 207 1.1 1,188 2.9 1,838 3.1
14 Benign Neoplasms of Skin, Breast, Eye 174 2.6 315 1.7 1,991 4.9 2,589 4.4
a Endocrine, Nutritional and Metabolic Disorders                
15 Diabetes with Renal or Peripheral Circulatory Manifestation 231 3.4 108 0.6 897 2.2 881 1.5
16 Diabetes with Neurologic or Other Specified Manifestation 322 4.8 213 1.1 1,608 4.0 1,984 3.3
17 Diabetes with Acute Complications 39 0.6 61 0.3 221 0.5 331 0.6
18 Diabetes with Ophthalmologic or Unspecified Manifestation 206 3.1 117 0.6 1,078 2.7 1,214 2.0
19 Diabetes without Complication 1,383 20.6 958 5.1 7,830 19.3 8,880 14.9
21 Protein-Calorie Malnutrition 32 0.5 47 0.3 92 0.2 162 0.3
22 Other Significant Endocrine and Metabolic Disorders 89 1.3 216 1.2 469 1.2 623 1.0
23 Disorders of Fluid/Electrolyte/Acid-Base Balance 182 2.7 272 1.5 999 2.5 1,408 2.4
24 Other Endocrine/Metabolic/ Nutritional Disorders 837 12.5 1,350 7.2 5,987 14.7 7,459 12.6
  Liver and Gallbladder Disease                
25 End-Stage Liver Disease 77 1.1 50 0.3 318 0.8 453 0.8
26 Cirrhosis of Liver 136 2.0 97 0.5 619 1.5 897 1.5
27 Chronic Hepatitis 153 2.3 154 0.8 628 1.5 1,321 2.2
28 Acute Liver Failure/Disease 12 0.2 24 0.1 93 0.2 160 0.3
29 Other Hepatitis and Liver Disease 271 4.0 278 1.5 1,357 3.3 2,235 3.8
30 Gallbladder and Biliary Tract Disorders 106 1.0 158 0.8 771 1.9 897 1.5
  Gastrointestinal Disease                
31 Intestinal Obstruction/Perforation 108 1.6 211 1.1 576 1.4 817 1.4
32 Pancreatic Disease 74 1.1 111 0.6 443 1.1 689 1.2
33 Inflammatory Bowel Disease 22 0.3 55 0.3 142 0.3 260 0.4
34 Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders 348 5.2 383 2.0 2,015 5.0 2,485 4.2
35 Appendicitis 11 0.2 27 0.1 50 0.1 61 0.1
36 Other Gastrointestinal Disorders 1,438 21.4 2,207 11.8 8,714 21.5 11,943 20.1
  Musculoskeletal/Connective Tissue                
37 Bone/Joint/Muscle Infections/Necrosis 111 1.7 176 0.9 457 1.1 905 1.5
38 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 181 2.7 276 1.5 1,397 3.4 1,857 3.1
39 Disorders of the Vertebrae and Spinal Discs 561 8.3 564 3.0 3,535 8.7 5,652 9.5
40 Osteoarthritis of Hip or Knee 181 2.7 150 0.8 1,671 4.1 2,266 3.8
41 Osteoporosis and Other Bone/Cartilage Disorders 235 3.5 338 1.8 2,025 5.0 2,385 4.0
42 Congenital/Developmental Skeletal and Connective Tissue Disorders 7 0.1 49 0.3 32 0.1 92 0.2
43 Other Musculoskeletal and Connective Tissue Disorders 2,533 37.7 3,363 17.9 17,451 43.0 25,016 42.1
  Diseases of the Blood and Blood Forming Organs                
44 Severe Hematological Disorders 47 0.7 114 0.6 298 0.7 459 0.8
45 Disorders of Immunity 7 0.1 37 0.2 32 0.1 113 0.2
46 Coagulation Defects and Other Specified Hematological Disorders 71 1.1 125 0.7 381 0.9 569 1.0
47 Iron Deficiency and Other/Unspecified Anemias and Blood Disease 466 6.9 568 3.0 2,649 6.5 3,344 5.6
  Mental Disorders                
48 Delirium and Encephalopathy 56 0.8 187 1.0 319 0.8 522 0.9
49 Dementia/Cerebral Degeneration 128 1.9 241 1.3 553 1.4 767 1.3
50 Nonpsychotic Organic Brain Syndromes/Conditions 66 1.0 127 0.7 346 0.9 502 0.8
51 Drug/Alcohol Psychosis 13 0.2 46 0.2 130 0.3 397 0.7
52 Drug/Alcohol Dependence 33 0.5 56 0.3 209 0.5 602 1.0
53 Drug/Alcohol Abuse, Without Dependence 38 0.6 106 0.6 330 0.8 887 1.5
54 Schizophrenia 45 0.7 464 2.5 654 1.6 1,367 2.3
55 Major Depressive, Bipolar, and Paranoid Disorders 119 1.8 344 1.8 1,048 2.6 2,375 4.0
56 Reactive and Unspecified Psychosis 44 0.7 192 1.0 320 0.8 627 1.1
57 Personality Disorders 3 0.0 17 0.1 32 0.1 104 0.2
58 Depression 130 1.9 256 1.4 1,072 2.6 1,921 3.2
59 Anxiety Disorders 56 0.8 152 0.8 389 1.0 787 1.3
60 Other Psychiatric Disorders 199 3.0 452 2.4 1,313 3.2 2,492 4.2
  Mental Retardation/ Developmental Disability                
61 Profound Mental Retardation/Developmental Disability 1 0.0 92 0.5 16 0.0 46 0.1
62 Severe Mental Retardation/Developmental Disability - - 43 0.2 11 0.0 21 0.0
63 Moderate Mental Retardation/Developmental Disability - - 44 0.2 26 0.1 19 0.0
64 Mild Mental Retardation, Autism, Down's Syndrome 12 0.2 826 4.4 277 0.7 422 0.7
65 Other Developmental Disability 2 0.0 164 0.9 41 0.1 106 0.2
66 Attention Deficit Disorder 4 0.1 42 0.2 23 0.1 73 0.1
  Central Nervous System Injuries/Disorders                
67 Quadriplegia, Other Extensive Paralysis 65 1.0 443 2.4 145 0.4 487 0.8
68 Paraplegia 67 1.0 281 1.5 217 0.5 497 0.8
69 Spinal Cord Disorders/Injuries 84 1.2 427 2.3 318 0.8 650 1.1
70 Muscular Dystrophy 20 0.3 145 0.8 45 0.1 110 0.2
71 Polyneuropathy 13 2.1 15 0.8 574 1.4 1,031 1.7
72 Multiple Sclerosis 88 1.3 158 0.8 265 0.7 690 1.2
73 Parkinson's and Huntington's Diseases 62 0.9 49 0.3 175 0.4 236 0.4
74 Seizure Disorders and Convulsions 379 5.6 2,359 12.6 2,002 4.9 3,741 6.3
75 Coma, Brain Compression/Anoxic Damage 22 0.3 68 0.4 104 0.3 166 0.3
76 Mononeuropathy, Other Neurological Conditions/Injuries 341 5.1 573 3.1 2,211 5.4 3,469 5.8
  Respiratory System Disorders                
77 Respirator Dependence/Tracheostomy Status 19 0.3 105 0.6 86 0.2 158 0.3
78 Respiratory Arrest 12 0.2 18 0.1 52 0.1 75 0.1
79 Cardio-Respiratory Failure and Shock 268 4.0 425 2.3 1,364 3.4 2,008 3.4
  Cardiovascular System                
80 Congestive Heart Failure 586 8.7 481 2.6 3,331 8.2 4,258 7.2
81 Acute Myocardial Infarction 74 1.1 38 0.2 369 0.9 406 0.7
82 Unstable Angina and Other Acute Ischemic Heart Disease 179 2.7 71 0.4 1,099 2.7 1,269 2.1
83 Angina Pectoris/Old Myocardial Infarction 170 2.5 77 0.4 1,342 3.3 1,207 2.0
84 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease 635 9.4 200 1.1 3,414 8.4 3,718 6.3
85 Heart Infection/Inflammation, Except Rheumatic 46 0.7 44 0.2 237 0.6 301 0.5
86 Valvular and Rheumatic Heart Disease 367 5.5 359 1.9 2,326 5.7 2,623 4.4
87 Major Congenital Cardiac/Circulatory Defect 1 0.0 30 0.2 20 0.0 23 0.0
88 Other Congenital Heart/Circulatory Disease 26 0.4 109 0.6 181 0.4 220 0.4
89 Hypertensive Heart and Renal Disease or Encephalopathy 33 0.5 20 0.1 168 0.4 162 0.3
90 Hypertensive Heart Disease 140 2.1 89 0.5 1,290 3.2 1,229 2.1
91 Hypertension 1,366 20.3 1,089 5.8 10,511 25.9 11,700 19.7
92 Specified Heart Arrhythmias 221 3.3 182 1.0 1,279 3.2 1,700 2.9
93 Other Heart Rhythm and Conduction Disorders 313 4.7 312 1.7 1,784 4.4 2,333 3.9
94 Other and Unspecified Heart Disease 308 4.6 283 1.5 1,763 4.3 2,295 3.9
  Cerebral and Other Vascular Systems                
95 Cerebral Hemorrhage 49 0.7 63 0.3 219 0.5 269 0.5
96 Ischemic or Unspecified Stroke 367 5.5 195 1.0 1,324 3.3 1,635 2.8
97 Precerebral Arterial Occlusion and Transient Cerebral Ischemia 239 3.6 139 0.7 1,252 3.1 1,436 2.4
98 Cerebral Atherosclerosis and Aneurysm 37 0.6 33 0.2 199 0.5 264 0.4
99 Cerebrovascular Disease, Unspecified 19 0.3 26 0.1 94 0.2 139 0.2
100 Hemiplegia/Hemiparesis 114 1.7 154 0.8 279 0.7 522 0.9
101 Cerebral Palsy and Other Paralytic Syndromes 39 0.6 755 4.0 263 0.6 667 1.1
102 Speech, Language, Cognitive, Perceptual Deficits 29 0.4 35 0.2 110 0.3 189 0.3
103 Cerebrovascular Disease Late Effects, Unspecified 48 0.7 24 0.1 168 0.4 226 0.4
104 Vascular Disease with Complications 134 2.0 111 0.6 622 1.5 806 1.4
105 Vascular Disease 386 5.7 256 1.4 2,181 5.4 2,650 4.5
106 Other Circulatory Disease 362 5.4 332 1.8 1,838 4.5 2,467 4.2
  Pulmonary System                
107 Cystic Fibrosis 3 0.0 15 0.1 20 0.0 25 0.0
108 Chronic Obstructive Pulmonary Disease 470 7.0 427 2.3 3,516 8.7 5,731 9.6
109 Fibrosis of Lung and Other Chronic Lung Disorders 141 2.1 207 1.1 803 2.0 1,179 2.0
110 Asthma 325 4.8 557 3.0 2,507 6.2 3,806 6.4
111 Aspiration and Specified Bacterial Pneumonias 72 1.1 183 1.0 299 0.7 479 0.8
112 Pneumococcal Pneumonia, Empyema, Lung Abscess 49 0.7 80 0.4 212 0.5 345 0.6
113 Viral and Unspecified Pneumonia, Pleurisy 488 7.3 807 4.3 2,536 6.2 3,684 6.2
114 Pleural Effusion/Pneumothorax 156 2.3 181 1.0 787 1.9 1,033 1.7
115 Other Lung Disorders 923 13.7 1,630 8.7 5,748 14.2 7,757 13.1
  Eyes and Vision Disorders                
116 Legally Blind 11 0.2 27 0.1 50 0.1 104 0.2
117 Major Eye Infections/Inflammations 9 0.1 23 0.1 49 0.1 88 0.1
118 Retinal Detachment 24 0.4 38 0.2 123 0.3 145 0.2
119 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage 144 2.1 43 0.2 523 1.3 440 0.7
120 Diabetic and Other Vascular Retinopathies 137 2.0 53 0.3 744 1.8 703 1.2
121 Retinal Disorders, Except Detachment and Vascular Retinopathies 79 1.2 44 0.2 399 1.0 447 0.8
122 Glaucoma 240 3.6 184 1.0 1,458 3.6 1,675 2.8
123 Cataract 282 4.2 152 0.8 2,063 5.1 2,072 3.5
124 Other Eye Disorders 672 10.0 1,145 6.1 5,236 12.9 5,736 9.7
  Ears, Nose, and Throat Disorders                
125 Significant Ear, Nose, and Throat Disorders 32 0.5 39 0.2 192 0.5 258 0.4
126 Hearing Loss 57 0.8 141 0.8 373 0.9 628 1.1
127 Other Ear, Nose, Throat, and Mouth Disorders 1,315 19.6 3,826 20.4 8,381 20.6 11,597 19.5
  Renal System                
128 Kidney Transplant Status 65 1.0 86 0.5 207 0.5 225 0.4
130 Dialysis Status 257 3.8 181 1.0 849 2.1 824 1.4
131 Renal Failure 742 11.0 485 2.6 2,549 6.3 2,686 4.5
132 Nephritis 37 0.6 46 0.2 177 0.4 180 0.3
  Other Genitourinary System                
133 Urinary Obstruction and Retention 328 4.9 706 3.8 1,307 3.2 2,063 3.5
134 Incontinence 70 1.0 162 0.9 545 1.3 783 1.3
135 Urinary Tract Infection 543 8.1 1,064 5.7 3,114 7.7 4,629 7.8
136 Other Urinary Tract Disorders 394 5.9 454 2.4 1,842 4.5 2,347 3.9
137 Female Infertility - - 1 0.0 3 0.0 8 0.0
138 Pelvic Inflammatory Disease and Other Specified Female Genital Disorders 78 1.2 159 0.8 662 1.6 821 1.4
139 Other Female Genital Disorders 279 4.2 718 3.8 3,302 8.1 4,013 6.8
140 Male Genital Disorders 232 3.5 201 1.1 719 1.8 1,206 2.0
b Pregnancy/Child Birth Complications                
141 Ectopic Pregnancy 4 0.1 2 0.0 6 0.0 6 0.0
142 Miscarriage/Abortion 10 0.1 34 0.2 47 0.1 110 0.2
143 Completed Pregnancy With Major Complications 5 0.1 17 0.1 14 0.0 35 0.1
144 Completed Pregnancy With Complications 11 0.2 38 0.2 38 0.1 115 0.2
145 Completed Pregnancy Without Complications (Normal Delivery) 13 0.2 41 0.2 35 0.1 105 0.2
146 Uncompleted Pregnancy w/complications 13 0.2 35 0.2 39 0.1 116 0.2
147 Uncompleted Pregnancy With No or Minor Complications 31 0.5 98 0.5 103 0.3 268 0.5
168 Extremely Low Birthweight Neonates 2 0.0 - - 1 0.0 1 0.0
169 Very Low Birthweight Neonates - - 1 0.0 1 0.0 2 0.0
170 Serious Perinatal Problem Affecting Newborn 4 0.1 18 0.1 30 0.1 57 0.1
171 Other Perinatal Problems Affecting Newborn 3 0.0 18 0.1 29 0.1 48 0.1
172 Normal, Single Birth 13 0.2 41 0.2 35 0.1 108 0.2
  Dermatological Disorders                
148 Decubitus Ulcer of Skin 93 1.4 266 1.4 351 0.9 819 1.4
149 Chronic Ulcer of Skin, Except Decubitus 199 3.0 248 1.3 826 2.0 1,366 2.3
150 Extensive Third-Degree Burns - - - - - - 7 0.0
151 Other Third-Degree and Extensive Burns 6 0.1 6 0.0 16 0.0 55 0.1
152 Cellulitis, Local Skin Infection 496 7.4 934 5.0 2,720 6.7 5,032 8.5
153 Other Dermatological Disorders 647 9.6 1,716 9.2 4,779 11.8 7,398 12.4
  Fractures, Other Injuries and Poisoning                
154 Severe Head Injury 2 0.0 9 0.0 10 0.0 24 0.0
155 Major Head Injury 46 0.7 169 0.9 215 0.5 440 0.7
156 Concussion or Unspecified Head Injury 82 1.2 177 0.9 445 1.1 858 1.4
157 Vertebral Fractures without Spinal Cord Injury 30 0.4 41 0.2 181 0.4 351 0.6
158 Hip Fracture/Dislocation 47 0.7 101 0.5 268 0.7 595 1.0
159 Major Fracture, Except of Skull, Vertebrae, or Hip 92 1.4 172 0.9 515 1.3 1,037 1.7
160 Internal Injuries 14 0.2 38 0.2 81 0.2 141 0.2
161 Traumatic Amputation 60 0.9 62 0.3 175 0.4 296 0.5
162 Other Injuries 1,033 15.4 1,932 10.3 6,048 14.9 11,126 18.7
163 Poisonings and Allergic Reactions 186 2.8 340 1.8 948 2.3 1,795 3.0
b,c Treatment Complications and Status                
164 Major Complications of Medical Care and Trauma 298 4.4 444 2.4 1,217 3.0 1,805 3.0
165 Other Complications of Medical Care 113 1.7 183 1.0 572 1.4 911 1.5
166 Major Symptoms, Abnormalities 2,756 41.0 3,993 21.3 16,897 41.6 23,250 39.1
167 Minor Symptoms, Signs, Findings 2,318 34.5 3,609 19.2 14,745 36.3 20,037 33.7
174 Major Organ Transplant Status 52 0.8 55 0.3 140 0.3 165 0.3
175 Other Organ Transplant/Replacement 29 0.4 39 0.2 103 0.3 109 0.2
176 Artificial Openings for Feeding or Elimination 81 1.2 245 1.3 280 0.7 422 0.7
177 Amputation Status, Lower Limb/Amputation Complications 44 0.7 35 0.2 137 0.3 229 0.4
178 Amputation Status, Upper Limb - - - - 2 0.0 4 0.0
179 Post-Surgical States/Aftercare/Elective 563 8.4 994 5.3 2,715 6.7 4,531 7.6
  Miscellaneous                
180 Radiation Therapy 25 0.4 17 0.1 154 0.4 190 0.3
181 Chemotherapy 5 0.1 14 0.1 70 0.2 74 0.1
182 Rehabilitation 205 3.1 273 1.5 772 1.9 1,488 2.5
183 Screening/Observation/Special Exams 1,969 29.3 3,924 20.9 13,199 32.5 18,994 32.0
184 History of Disease 100 1.5 95 0.5 495 1.2 753 1.3

 

TABLE D-3: Hierarchical Condition Classification Distribution for IHSS Recipients Age 65+ by Provider Relationship, 2005
HCC Parents Other Relative Non-Relative
# % # % # %
Spouse is paid as an IHSS worker for recipient, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient.

HCC refers to the CMS hierarchical condition category or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCCs aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CCs hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. For unrelated diseases (i.e., diseases in other CCs), the number of HCCs accumulate.

  1. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file.
  2. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table.
  3. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.
  Total Recipients   4,656     100.0     109,260     100.0     95,551     100.0  
  Recipients w/any HCC 3,847 82.6 91,221 83.5 80,167 83.9
 
  Infections and Parasitic Disease            
1 HIV/AIDS 3 0.1 27 0.0 75 01
2 Septicemia/Shock 119 2.6 1,781 1.6 1,389 1.5
3 Central Nervous System Infection 9 0.2 96 0.1 107 0.1
4 Tuberculosis 14 0.3 192 0.2 106 0.1
5 Opportunistic Infections 14 0.3 94 0.1 75 0.1
6 Other Infectious Diseases 192 4.1 4,263 3.9 5,017 5.3
  Neoplasms            
7 Metastatic Cancer and Acute Leukemia 65 1.4 971 0.9 868 0.9
8 Lung, Upper Digestive Tract, and Other Severe Cancers 97 2.1 1,572 1.4 1,436 1.5
9 Lymphatic, Head and Neck, Brain, and Other Major Cancers 82 1.8 1,182 1.1 1,078 1.1
10 Breast, Prostate, Colorectal and Other Cancers and Tumors 259 5.6 4,206 3.8 4,107 4.3
11 Other Respiratory and Heart Neoplasms 24 0.5 237 0.2 234 0.2
12 Other Digestive and Urinary Neoplasms 167 3.6 3,271 3.0 3,170 3.3
13 Other Neoplasms 56 1.2 1,435 1.3 1,665 1.7
14 Benign Neoplasms of Skin, Breast, Eye 45 1.0 2,181 2.0 2,589 2.7
a Endocrine, Nutritional and Metabolic Disorders            
15 Diabetes with Renal or Peripheral Circulatory Manifestation 109 2.3 1,171 1.1 1,010 1.1
16 Diabetes with Neurologic or Other Specified Manifestation 178 3.8 2,181 2.0 1,919 2.0
17 Diabetes with Acute Complications 8 0.2 161 0.1 153 0.2
18 Diabetes with Ophthalmologic or Unspecified Manifestation 78 1.7 915 0.8 762 0.8
19 Diabetes without Complication 580 12.5 9,905 9.1 8,322 8.7
21 Protein-Calorie Malnutrition 14 0.3 186 0.2 140 0.1
22 Other Significant Endocrine and Metabolic Disorders 25 0.5 341 0.3 318 0.3
23 Disorders of Fluid/Electrolyte/Acid-Base Balance 103 2.2 1,529 1.4 1,406 1.5
24 Other Endocrine/Metabolic/Nutritional Disorders 217 4.7 5,687 5.2 5,007 5.2
  Liver and Gallbladder Disease            
25 End-Stage Liver Disease 18 0.4 186 0.2 142 0.1
26 Cirrhosis of Liver 39 0.8 384 0.4 321 0.3
27 Chronic Hepatitis 14 0.3 198 0.2 174 0.2
28 Acute Liver Failure/Disease 5 0.1 61 0.1 49 0.1
29 Other Hepatitis and Liver Disease 60 1.3 1,050 1.0 844 0.9
30 Gallbladder and Biliary Tract Disorders 73 1.6 1,383 1.3 1,128 1.2
  Gastrointestinal Disease/Disorders            
31 Intestinal Obstruction/Perforation 77 1.7 1,096 1.0 1,083 1.1
32 Pancreatic Disease 41 0.9 651 0.6 590 0.6
33 Inflammatory Bowel Disease 12 0.3 147 0.1 160 0.2
34 Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders 194 4.2 3,758 3.4 3,435 3.6
35 Appendicitis 5 0.1 79 0.1 65 0.1
36 Other Gastrointestinal Disorders 669 14.4 14,064 12.9 13,445 14.1
  Musculoskeletal/Connective Tissue Disease/Disorders            
37 Bone/Joint/Muscle Infections/Necrosis 50 1.1 473 0.4 434 0.5
38 Rheumatoid Arthritis & Inflammatory Connective Tissue Disease 57 1.2 1,032 0.9 1,171 1.2
39 Disorders of the Vertebrae and Spinal Discs 238 5.1 5,441 5.0 5,940 6.2
40 Osteoarthritis of Hip or Knee 102 2.2 3,567 3.3 3,467 3.6
41 Osteoporosis and Other Bone/Cartilage Disorders 89 1.9 3,471 3.2 3,321 3.5
42 Congenital/Developmental Skeletal and Connective Tissue Disorders 1 0.0 19 0.0 20 0.0
43 Other Musculoskeletal and Connective Tissue Disorders 1,037 22.3 28,437 26.0 27,887 29.2
  Blood and Blood Forming Organ Disease/Disorders            
44 Severe Hematological Disorders 32 0.7 5 0.6 470 0.5
45 Disorders of Immunity 1 0.0 16 0.0 19 0.0
46 Coagulation Defects and Other Specified Hematological Disorders 22 0.5 390 0.4 393 0.4
47 Iron Deficiency and Other/Unspecified Anemias and Blood Disease 239 5.1 4,647 4.3 4,316 4.5
  Mental Disorders            
48 Delirium and Encephalopathy 18 0.4 293 0.3 298 0.3
49 Dementia/Cerebral Degeneration 167 3.6 3,510 3.2 3,091 3.2
50 Nonpsychotic Organic Brain Syndromes/Conditions 30 0.6 570 0.5 517 0.5
51 Drug/Alcohol Psychosis 5 0.1 42 0.0 89 0.1
52 Drug/Alcohol Dependence 4 0.1 28 0.0 83 0.1
53 Drug/Alcohol Abuse, Without Dependence 7 0.2 82 0.1 151 0.2
54 Schizophrenia 5 0.1 133 0.1 186 0.2
55 Major Depressive, Bipolar, and Paranoid Disorders 23 0.5 711 0.7 936 1.0
56 Reactive and Unspecified Psychosis 18 0.4 319 0.3 301 0.3
57 Personality Disorders - - 8 0.0 12 0.0
58 Depression 19 0.4 488 0.4 546 0.6
59 Anxiety Disorders 5 0.1 144 0.1 186 0.2
60 Other Psychiatric Disorders 25 0.5 678 0.6 867 0.9
  Mental Retardation/Developmental Disability            
61 Profound Mental Retardation/Developmental Disability - - 2 0.0 2 0.0
62 Severe Mental Retardation/Developmental Disability - - 3 0.0 - -
63 Moderate Mental Retardation/Developmental Disability - - - - - -
64 Mild Mental Retardation, Autism, Down's Syndrome - - 16 0.0 9 0.0
65 Other Developmental Disability 1 0.0 8 0.0 13 0.0
66 Attention Deficit Disorder - - 5 0.0 9 0.0
  Central Nervous System Injuries/Disorders            
67 Quadriplegia, Other Extensive Paralysis 5 0.1 42 0.0 36 0.0
68 Paraplegia 7 0.2 37 0.0 43 0.0
69 Spinal Cord Disorders/Injuries 17 0.4 299 0.3 266 0.3
70 Muscular Dystrophy - - 4 0.0 9 0.0
71 Polyneuropathy 33 0.7 430 0.4 446 0.5
72 Multiple Sclerosis 6 0.1 30 0.0 60 0.1
73 Parkinson's and Huntington's Diseases 60 1.3 569 0.5 493 0.5
74 Seizure Disorders and Convulsions 56 1.2 897 0.8 784 0.8
75 Coma, Brain Compression/Anoxic Damage 2 0.0 86 0.1 79 0.1
76 Mononeuropathy, Other Neurological Conditions/Injuries 82 1.8 1,413 1.3 1,560 1.6
  Respiratory System Disorders            
77 Respirator Dependence/Tracheostomy Status 4 0.1 59 0.1 52 0.1
78 Respiratory Arrest 3 0.1 32 0.0 23 0.0
79 Cardio-Respiratory Failure and Shock 145 3.1 1,770 1.6 1,608 1.7
  Cardiovascular System Disease/Disorders            
80 Congestive Heart Failure 483 10.4 8,575 7.8 7,813 8.2
81 Acute Myocardial Infarction 72 1.5 1,322 1.2 1,074 1.1
82 Unstable Angina and Other Acute Ischemic Heart Disease 127 2.7 2,272 2.1 2,017 2.1
83 Angina Pectoris/Old Myocardial Infarction 111 2.4 2,233 2.0 1,959 2.1
84 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease 520 11.2 9,711 8.9 8,643 9.0
85 Heart Infection/Inflammation, Except Rheumatic 17 0.4 287 0.3 233 0.2
86 Valvular and Rheumatic Heart Disease 234 5.0 5,371 4.9 4,530 4.7
87 Major Congenital Cardiac/Circulatory Defect - - 11 0.0 5 0.0
88 Other Congenital Heart/Circulatory Disease 20 0.4 438 0.4 310 0.3
89 Hypertensive Heart and Renal Disease or Encephalopathy 17 0.4 221 0.2 160 0.2
90 Hypertensive Heart Disease 79 1.7 2,208 2.0 1,721 1.8
91 Hypertension 697 15.0 17,995 16.5 14,887 15.6
92 Specified Heart Arrhythmias 298 6.4 5,575 5.1 5,359 5.6
93 Other Heart Rhythm and Conduction Disorders 239 5.1 4,467 4.1 4,523 4.7
94 Other and Unspecified Heart Disease 172 3.7 3,303 3.0 2,864 3.0
  Cerebral and Other Vascular System Disease/Disorders            
95 Cerebral Hemorrhage 47 1.0 617 0.6 485 0.5
96 Ischemic or Unspecified Stroke 274 5.9 3,714 3.4 3,195 3.3
97 Precerebral Arterial Occlusion and Transient Cerebral Ischemia 235 5.0 4,002 3.7 3,687 3.9
98 Cerebral Atherosclerosis & Aneurysm 47 1.0 896 0.8 761 0.8
99 Cerebrovascular Disease, Unspecified 4 0.1 128 0.1 145 0.2
100 Hemiplegia/Hemiparesis 41 0.9 324 0.3 257 0.3
101 Cerebral Palsy and Other Paralytic Syndromes 9 0.2 58 0.1 66 0.1
102 Speech, Language, Cognitive, Perceptual Deficits 14 0.3 183 0.2 135 0.1
103 Cerebrovascular Disease Late Effects, Unspecified 33 0.7 284 0.3 225 0.2
104 Vascular Disease with Complications 99 2.1 1,248 1.1 1,169 1.2
105 Vascular Disease 288 6.2 4,428 4.1 4,544 4.8
106 Other Circulatory Disease 185 4.0 2,891 2.6 2,887 3.0
  Pulmonary System Disease/Disorders            
107 Cystic Fibrosis - - 3 0.0 4 0.0
108 Chronic Obstructive Pulmonary Disease 339 7.3 5,745 5.3 6,131 6.4
109 Fibrosis of Lung and Other Chronic Lung Disorders 63 1.4 1,249 1.1 1,006 1.1
110 Asthma 69 1.5 1,990 1.8 1,621 1.7
111 Aspiration and Specified Bacterial Pneumonias 68 1.5 921 0.8 716 0.7
112 Pneumococcal Pneumonia, Empyema, Lung Abscess 17 0.4 226 0.2 209 0.2
113 Viral and Unspecified Pneumonia, Pleurisy 287 6.2 5,468 5.0 4,530 4.7
114 Pleural Effusion/Pneumothorax 94 2.0 1,512 1.4 1,312 1.4
115 Other Lung Disorders 320 6.9 6,983 6.4 5,669 5.9
  Eyes and Vision Disorders            
116 Legally Blind 1 0.0 48 0.0 50 0.1
117 Major Eye Infections/Inflammations 5 0.1 74 0.1 53 0.1
118 Retinal Detachment 6 0.1 106 0.1 90 0.1
119 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage 34 0.7 336 0.3 238 0.2
120 Diabetic and Other Vascular Retinopathies 37 0.8 719 0.7 593 0.6
121 Retinal Disorders, Except Detachment and Vascular Retinopathies 34 0.7 1,207 1.1 1,206 1.3
122 Glaucoma 102 2.2 2,670 2.4 2,779 2.9
123 Cataract 248 5.3 6,951 6.4 6,113 6.4
124 Other Eye Disorders 330 7.1 9,446 8.6 8,061 8.4
  Ears, Nose, and Throat Disorders            
125 Significant Ear, Nose, and Throat Disorders 9 0.2 172 0.2 165 0.2
126 Hearing Loss 40 0.9 906 0.8 913 1.0
127 Other Ear, Nose, Throat, and Mouth Disorders 318 6.8 7,595 7.0 6,820 7.1
  Renal System Disorders            
128 Kidney Transplant Status 21 0.5 64 0.1 41 0.0
130 Dialysis Status 127 2.7 1,052 1.0 727 0.8
131 Renal Failure 381 8.2 3,845 3.5 2,875 3.0
132 Nephritis 11 0.2 119 0.1 88 0.1
  Other Genitourinary System Disorders            
133 Urinary Obstruction and Retention 159 3.4 1,905 1.7 1,853 1.9
134 Incontinence 27 0.6 549 0.5 610 0.6
135 Urinary Tract Infection 177 3.8 4,232 3.9 4,021 4.2
136 Other Urinary Tract Disorders 217 4.7 2,884 2.6 2,768 2.9
137 Female Infertility - - 1 0.0 2 0.0
138 Pelvic Inflammatory Disease and Other Specified Female Genital Disorders 9 0.2 583 0.5 536 0.6
139 Other Female Genital Disorders 22 0.5 1,474 1.3 1,490 1.6
140 Male Genital Disorders 180 3.9 1,595 1.5 1,564 1.6
b Pregnancy/Child Birth Complications            
141 Ectopic Pregnancy - - - - - -
142 Miscarriage/Abortion - - 2 0.0 4 0.0
143 Completed Pregnancy With Major Complications - - 1 0.0 - -
144 Completed Pregnancy With Complications 1 0.0 3 0.0 8 0.0
145 Completed Pregnancy Without Complications (Normal Delivery) - - 3 0.0 2 0.0
146 Uncompleted Pregnancy With Complications - - 5 0.0 2 0.0
147 Uncompleted Pregnancy With No or Minor Complications - - 12 0.0 9 0.0
168 Extremely Low Birth weight Neonates - - - - - -
169 Very Low Birth weight Neonates - - - - - -
170 Serious Perinatal Problem Affecting Newborn - - 20 0.0 23 0.0
171 Other Perinatal Problems Affecting Newborn 3 0.1 19 0.0 9 0.0
172 Normal, Single Birth - - 4 0.0 4 0.0
  Dermatological Disorders            
148 Decubitus Ulcer of Skin 34 0.7 523 0.5 636 0.7
149 Chronic Ulcer of Skin, Except Decubitus 105 2.3 1,330 1.2 1,605 1.7
150 Extensive Third-Degree Burns - - - - 2 0.0
151 Other Third-Degree and Extensive Burns 4 0.1 23 0.0 24 0.0
152 Cellulitis, Local Skin Infection 149 3.2 2,424 2.2 2,710 2.8
153 Other Dermatological Disorders 209 4.5 7,171 6.6 8,909 9.3
  Fractures, Other Injuries and Poisoning            
154 Severe Head Injury - - 13 0.0 14 0.0
155 Major Head Injury 23 0.5 454 0.4 368 0.4
156 Concussion or Unspecified Head Injury 34 0.7 869 0.8 855 0.9
157 Vertebral Fractures without Spinal Cord Injury 30 0.6 943 0.9 877 0.9
158 Hip Fracture/Dislocation 47 1.0 1,454 1.3 1,514 1.6
159 Major Fracture, Except of Skull, Vertebrae, or Hip 48 1.0 910 0.8 934 1.0
160 Internal Injuries 8 0.2 68 0.1 76 0.1
161 Traumatic Amputation 28 0.6 98 0.1 85 0.1
162 Other Injuries 362 7.8 8,476 7.8 8,858 9.3
163 Poisonings and Allergic Reactions 32 0.7 683 0.6 694 0.7
b,c Treatment Complications and Status            
164 Major Complications of Medical Care & Trauma 143 3.1 1,639 1.5 1,538 1.6
165 Other Complications of Medical Care 49 1.1 598 0.5 547 0.6
166 Major Symptoms, Abnormalities 1,529 32.8 31,169 28.5 29,015 30.4
167 Minor Symptoms, Signs, Findings 1,133 24.3 23,656 21.7 21,593 22.6
174 Major Organ Transplant Status 10 0.2 49 0.0 36 0.0
175 Other Organ Transplant/Replacement 7 0.2 66 0.1 56 0.1
176 Artificial Openings for Feeding or Elimination 54 1.2 708 0.6 467 0.5
177 Amputation Status, Lower Limb/Amputation Complications 10 0.2 101 0.1 98 0.1
178 Amputation Status, Upper Limb - - 1 0.0 1 0.0
179 Post-Surgical States/Aftercare/Elective 216 4.6 3,778 3.5 3,828 4.0
  Miscellaneous            
180 Radiation Therapy 24 0.5 365 0.3 330 0.3
181 Chemotherapy 10 0.2 111 0.1 91 0.1
182 Rehabilitation 108 2.3 1,566 1.4 1,569 1.6
183 Screening/Observation/Special Exams 644 13.8 15,588 14.3 15,664 16.4
184 History of Disease 33 0.7 776 0.7 842 0.9

 

TABLE D-4: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Ages 3-17, 2005
  Provider Relationship
  # Recipients     Spouse     Parent     Other Relative     Non-Relative  
Ambulatory Care Sensitive Conditions (ACSCs) for those <age 18 are also referred to as Pediatric Quality Indicators (PQIs) (see http://qualityindicators.ahrq.gov). Recipient counts are limited to IHSS recipients not in Medicaid managed care during calendar year 2005. Recipients of Spouse providers were excluded from the analysis. PQIs related to new births, and those <age 3 are not included. Available claims data did not permit the assignment of PQIs for pediatric heart surgery mortality, pediatric heart surgery volume, and postoperative wound dehiscence.
Total Recipients Age 3-17 11,002   7,845 1,449 1,768
Total Recipients w/any Hospitalization 1,439 na 1,118 166 155
Total Recipients w/any ACSC Stay 171 na 128 19 24
ACSC Inpatient Diagnoses
Accidental puncture and laceration 3 na 1 1 1
Decubitus ulcer 4 na 3 - 1
Foreign body left in after procedure - na - - -
Iatrogenic pneumothorax in non-neonates 1 na - 1 -
Postoperative hemorrhage & hematoma 5 na 3 1 1
Postoperative respiratory failure 35 na 28 3 4
Postoperative sepsis 7 na 4 1 2
Selected infection due to medical care 13 na 13 - -
Transfusion reaction - na - - -
Asthma admission rate 34 na 22 5 7
Diabetes short-term complication admission rate 5 na 2 - 3
Gastroenteritis admission rate 33 na 26 4 3
Perforated appendix admission rate 5 na 5 - -
Urinary tract infection admission rate 34 na 27 3 4

 

TABLE D-5: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Ages 18 and Older, 2005
Recipients Age 18-64 Provider Relationship
  # Recipients     Spouse     Parent     Other Relative     Non-Relative  
Ambulatory Care Sensitive Conditions (ACSCs) for those age 18 and over are also referred to as Prevention Quality Indicators (see http://qualityindicators.ahrq.gov). Recipient counts are limited to IHSS recipients not in Medicaid managed care during calendar year 2005. Recipients of Parent providers were excluded from the analysis.

* The records with cardiac procedure codes can be included in the table.
** The records with immunocompromised state procedure codes can be included in the table.
*** The following ICD-9 codes were used: 3536, 9059, 99760~99762, 99769, V4970~V4977, V521.

Total Recipients Age 18-64 123,813 6,282 18,625 40,304 58,602
Total Recipients w/any Hospitalization 28,881 1,923 2,627 9,468 14,863
Total Recipients w/any ACSC Stay 8,046 530 609 2,804 4,103
ACSC Inpatient Diagnoses
Diabetes, short-term complication 277 18 39 78 142
Perforated Appendix 26 4 4 10 8
Diabetes, long-term complication 1,141 105 71 438 527
COPD 1,080 37 33 355 655
Hypertension* 172 8 2 75 87
Congestive Heart Failure* 1,897 142 94 724 937
Dehydration 396 23 36 114 223
Bacterial Pneumonia 2,069 127 226 676 1,040
Urinary Infection** 1,045 80 138 320 509
Angina* 197 9 7 82 99
Diabetes, uncontrolled 167 11 8 54 94
Adult Asthma 847 37 41 292 477
Lower Extremity Amputation*** 17 2 1 7 7
Recipients Age 65+ Provider Relationship
# Recipients Spouse Parent Other Relative Non-Relative
Total Recipients Age 65 or Older 206,579 4,156 na 108,371 94,052
Total Recipients w/any Hospitalization 57,188 1,480 na 28,602 27,106
Total Recipients w/any ACSC Stay 17,507 451 na 8,884 8,172
ACSC Inpatient Diagnoses
Diabetes, short-term complication 109 1 na 57 51
Perforated Appendix 51 - na 28 23
Diabetes, long-term complication 1,394 70 na 700 624
COPD 1,767 41 na 786 940
Hypertension* 415 2 na 205 208
Congestive Heart Failure* 5,410 151 na 2,780 2,479
Dehydration 1,123 23 na 532 568
Bacterial Pneumonia 5,021 130 na 2,660 2,231
Urinary Infection** 2,277 38 na 1,169 1,070
Angina* 308 9 na 144 155
Diabetes, uncontrolled 163 7 na 84 72
Adult Asthma 1,122 19 na 608 495
Lower Extremity Amputation*** 5 - na 3 2

 

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