Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death Among Medicare Beneficiaries Over 2 Years

Abstract

OBJECTIVE To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults. DESIGN A national representative sample with two year follow-up. SETTING Medicare Current Beneficiary Survey (MCBS) from calendar years 2001-2008. PARTICIPANTS Our study sample included 23,470 community-dwelling adults aged 65 years and older followed for two years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activity of daily living (ADL) stage transitions, institutionalization, or death after two years, adjusting for baseline socioeconomics and health-related characteristics. RESULTS Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2,508 (10.7% weighted) improved, 3,210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2,281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.54-0.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR = 0.87, 95% CI: 0.79-0.97), be institutionalized (adjusted RRR = 0.72, 95% CI: 0.56-0.92), or die (adjusted RRR = 0.86, 95% CI: 0.75-0.98). CONCLUSIONS Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related healthcare disparities and the impact of ongoing policy changes among Medicare beneficiaries.

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

“…Previous studies have shown that more disabled baseline ADL stage has been associated with functional deterioration, 45 institutionalization, 45,46 and death 10,13,45,47 among the elderly. Beneficiaries categorized at more disabled activity limitation stages will have increased care burden which may require the need for institutionalization, or the burden may be so severe that the beneficiaries are at risk for death.…”

Activities of daily living trajectories among institutionalised older adults: A prospective study

“…Zimmer, Martin, Nagin, and Jones (2012) posited that changes to ADL vary among communityliving older Chinese people; some improve, some deteriorate and some remain the same (Zimmer et al, 2012). Bogner et al (2016) followed 23,470 community-dwelling adults aged 65 years and older for 2 years, and found that 63.8% maintained a stable performance of ADLs, 10.7% improved, 13.3% deteriorated, 2.5% were What does this paper contribute to the wider global clinical community?…”

“…Bogner et al. () followed 23,470 community‐dwelling adults aged 65 years and older for 2 years, and found that 63.8% maintained a stable performance of ADLs, 10.7% improved, 13.3% deteriorated, 2.5% were institutionalised, and 9.7% died. Although some degree of ADL performance decline may be unavoidable because of the patient's clinical condition, research has indicated that a decline in ADL functioning can be reduced through more proactive care and other interventions for some older adults (Boltz, Resnick, Capezuti, Shuluk, & Secic, ).…”

Predicting 3-year mortality and admission to acute-care hospitals, skilled nursing facilities, and long-term care facilities in Medicare beneficiaries

“…Our earlier work demonstrates that higher baseline ADL activity limitation stage is associated with functional deterioration (Bogner et al, 2017), institutionalization (Bogner et al, 2017; Stineman, Xie, Streim, et al, 2012), and mortality (Bogner et al, 2017; Stineman, Xie, Pan, et al, 2012; Stineman, Xie, Streim, et al, 2012; Zhang et al, 2012) among older persons. We found in our current study that all ADL activity limitation stages (I–IV), i.e., beneficiaries with some level of difficulty performing the activities, were highly predictive of mortality and inpatient admissions compared to being classified at stage 0 where beneficiaries have no difficulty performing any ADL (p<0.01).…”