PURPOSE:To examine use of preventive health services among older women and to assess how age and illness burden influence care patterns. METHODS:The charts of 299 women aged 80+ and 229 women aged 65-79 who did not have dementia or terminal illness at one academic primary care practice in Boston were reviewed between July and December 2005 to determine receipt of screening tests (e.g., mammography), counseling on healthy lifestyle (e.g., exercise) and/or geriatric health issues (e.g., incontinence), and immunizations. Illness burden was quantified using the Charlson Comorbidity Index (CCI). RESULTS:Women aged 80+ were more likely than women aged 65-79 to have a CCI of 3+ (24.0% vs. 16.7%) and were less likely to receive all screening tests. However, receipt of mammography (47.8%) and colon cancer screening (51.2%) was still common among women aged 80+ and was not targeted to older women in good health. Women aged 80+ were less likely to be screened for depression (aRR 0.6 [0.5-0.8]), osteoporosis (aRR 0.6 [0.5-0.9]) or counseled about exercise (aRR 0.8 [0.6-0.9]) than younger women but were more likely to receive counseling about falls (aRR 1.9 [1.4-2.6]) and/or incontinence (aRR 1.8 (1.2-2.6). However notes documenting discussions about mood (28.6%), exercise (40.0%), falls (28.8%) or incontinence (20.8%) were low among all women. CONCLUSION:In a comprehensive review of preventive health measures for elderly women, many in poor health were screened for cancer. Meanwhile, many older women were not screened for depression or counseled about exercise, falls, or incontinence. There is need to improve delivery of preventive health care to older women.
BACKGROUND: Continuity clinics are a critical component of outpatient internal medicine training. Little is known about the population of patients cared for by residents and how these physicians perform. OBJECTIVES: To compare resident and faculty performance on standard population health measures. To identify potential associations with differences in performance, specifically medical complexity, psychosocial vulnerability, and rates of patient loss. SETTING AND PARTICIPANTS: Large academic primary care clinic caring for 40,000 patients. One hundred ten internal medicine residents provide primary care for 9,000 of these patients; the remainder are cared for by faculty. STUDY DESIGN: Descriptive analysis using review of the medical record and hospital administrative data. MAIN MEASURES: We compared resident and faculty performance on standard population health measures, including cancer screening rates, chronic disease care, acute and chronic medical complexity, psychosocial vulnerability, and rates of patient loss. We evaluated the success of resident transition by measuring rates of kept continuity visits 18 months after graduation. KEY RESULTS: Performance on all clinical outcomes was significantly better for faculty compared to residents. Despite similar levels of medical complexity compared to faculty patients, resident patients had significantly higher levels of psychosocial vulnerability across all measured domains, including health literacy, economic vulnerability, psychiatric illness burden, high-risk behaviors, and patient engagement. Resident patients experienced higher rates of patient loss than faculty patients (38.5 vs. 18.8%) with only 46.5% of resident patients with a kept continuity appointment in the practice 18 months after graduation. CONCLUSIONS: In this large academic practice, resident performance on standard population health measures was significantly lower than faculty. This may be explained in part by the burden of psychosocial vulnerability of their patients and systems that do not effectively transition patients after graduation. These findings present an opportunity to improve structural equity for these vulnerable patients and developing physicians.
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