Measuring access to effective care among elderly medicare enrollees in managed and fee-for-service care: a retrospective cohort study

Barton, Mary B.; Dayhoff, Debra A.; Soumerai, Stephen B.; Rosenbach, Margo; Fletcher, Robert H.

doi:10.1186/1472-6963-1-11

Cited by 9 publications

(5 citation statements)

References 52 publications

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“…Data from this medical record system have been used extensively in prior analyses of disease management 18,19 and quality of care. 20,21 We used Harvard Pilgrim Health Care pharmacy claims to identify statin use based on codes available within the National Drug Code directory. 22 A patient was classified as having been treated with a statin during a calendar year if a prescription was filled in that year.…”

Section: Quality Measuresmentioning

confidence: 99%

Effect of Quality Improvement on Racial Disparities in Diabetes Care

Sequist¹,

Adams²,

Zhang³

et al. 2006

Arch Intern Med

135

107

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Background: Racial disparities in care are well documented; information regarding solutions is limited. We evaluated whether generic quality improvement efforts were associated with changes in racial disparities in diabetes care.Methods: Using insurance claims and electronic medical record data, we identified 5101 whites and 1987 blacks with diabetes mellitus receiving care within a multispecialty group practice from 1997 to 2001. We assessed rates of annual low-density lipoprotein cholesterol level testing, low-density lipoprotein cholesterol level control (Ͻ130 mg/dL [Ͻ3.37 mmol/L]), statin therapy, annual glycosylated hemoglobin level testing, glycosylated hemoglobin level control (Ͻ7.0%), and annual dilated eye examinations. We used logistic regression models with generalized estimating equations to adjust for race, year, race ϫ year interactions, age, and sex.Results: Rates of annual low-density lipoprotein cholesterol level testing increased from 39% to 64%, while the white-black disparity decreased from 14% to 4%; rates of low-density lipoprotein cholesterol level control increased from 15% to 43%, while the white-black disparity decreased from 9% to 6% (PϽ.001 for both race ϫ year interactions). Statin therapy rates increased from 20% to 37%; however, black patients remained less likely than white patients to receive therapy. The 1997 rates of annual glycosylated hemoglobin level testing (76%) and annual eye examinations (74%) were high, and there was no white-black disparity over time. Rates of glycosylated hemoglobin level control remained low (31%), and the white-black disparity remained constant at 10%.Conclusions: Racial disparities were diminished in some aspects of diabetes care following variably successful quality improvement, but differences in the use of statins and glycemic level control persisted. Reducing disparities may require a focus on minority health.

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Section: Quality Measuresmentioning

confidence: 99%

Effect of Quality Improvement on Racial Disparities in Diabetes Care

Sequist¹,

Adams²,

Zhang³

et al. 2006

Arch Intern Med

135

107

View full text Add to dashboard Cite

show abstract

“…All the data were collected by means of outpatient electronic medical record review. Data from this system have been used extensively in evaluations of quality of care [23][24][25] and disease management. 26,27 Coronary risk factors, including patient age, sex, blood pressure, cholesterol level, smoking status, and diabetic status, were used to calculate the FRS (Figure 1).…”

Section: Data Collection and Prediction Modelsmentioning

confidence: 99%

Missed Opportunities in the Primary Care Management of Early Acute Ischemic Heart Disease

Sequist

Marshall²,

Lampert³

et al. 2006

Arch Intern Med

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“…The HVMA electronic record system assigns a unique primary care physician to each patient, and data from this medical record system have been used extensively in formal analyses of quality of care. [18][19][20][21][22] We supplemented electronic medical record system data with claims data to assess colorectal cancer screening and diabetic eye exams, as these services are sometimes received outside of the HVMA network. We applied HEDIS criteria to identify appropriate denominator and numerator populations using diagnostic and billing codes within the electronic medical record during 2005.…”

Section: Individual Physician Datamentioning

confidence: 99%

Quality Monitoring of Physicians: Linking Patients’ Experiences of Care to Clinical Quality and Outcomes

et al. 2008

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BACKGROUND: Physicians are increasingly asked to improve the delivery of clinical services and patient experiences of care. OBJECTIVE:We evaluated the association between clinical performance and patient experiences in a statewide sample of physician practice sites and a sample of physicians within a large physician group. DESIGN, SETTING, PARTICIPANTS:We separately identified 373 practice sites and 119 individual primary care physicians in Massachusetts. MEASUREMENTS: Using Health Plan Employer Dataand Information Set data, we produced two composites addressing processes of care (prevention, disease management) and one composite addressing outcomes. Using Ambulatory Care Experiences Survey data, we produced seven composite measures summarizing the quality of clinical interactions and organizational features of care. For each sample (practice site and individual physician), we calculated adjusted Spearman correlation coefficients to assess the relationship between the composites summarizing patient experiences of care and those summarizing clinical performance.RESULTS: Among 42 possible correlations (21 correlations involving practice sites and 21 involving individual physicians), the majority were positive in site level (71%) and physician level (67%) analyses. For the 28 possible correlations involving patient experiences and clinical process composites, 8 (29%) were significant and positive, and only 2 (7%) were significant and negative. The magnitude of the significant positive correlations ranged from 0.13 to 0.19 at the site level and from 0.28 to 0.51 at the physician level. There were no significant correlations between patient experiences and the clinical outcome composite. CONCLUSIONS:The modest correlations suggest that clinical quality and patient experience are distinct, but related domains that may require separate measurement and improvement initiatives.KEY WORDS: quality of care; patient centered care; primary care; quality measurement; quality improvement.

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Measuring access to effective care among elderly medicare enrollees in managed and fee-for-service care: a retrospective cohort study

Cited by 9 publications

References 52 publications

Effect of Quality Improvement on Racial Disparities in Diabetes Care

Effect of Quality Improvement on Racial Disparities in Diabetes Care

Missed Opportunities in the Primary Care Management of Early Acute Ischemic Heart Disease

Quality Monitoring of Physicians: Linking Patients’ Experiences of Care to Clinical Quality and Outcomes

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