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Elderly Medicare, Medicaid patients not
receiving quality care
Newswise — If the care
received by vulnerable older people
concurrently enrolled in Medicare and
Medicaid was evaluated on a grading scale,
it would squeak by with a barely passing
mark, a new UCLA study has found.
Using quality-of-care measurements developed
by the Assessing Care of Vulnerable Elders (ACOVE)
project, researchers found that vulnerable
elderly patients received only 65 percent of
the tests and other diagnostic evaluations
and treatments recommended for a variety of
illnesses and conditions, including diabetes
and heart disease. The study findings appear
in the October issue of the peer-reviewed
journal Medical Care.
"Thirty-five percent of
the medical care interventions that they
should have received were not provided,
indicating significant room for
improvement," said lead author Dr. David S.
Zingmond, assistant professor of general
internal medicine and health services
research at the David Geffen School of
Medicine at UCLA. "We'd much rather have
everything higher — say, at least 90
percent."
The researchers based their work on linked
Medicare and Medicaid claims data —
something that is not routinely done.
"Going forward,
measures like these will be increasingly
important because more detailed health care
information, such as electronic health
records, are difficult to obtain," Zingmond
said.
The researchers gathered data from 100,258
community-dwelling geriatric patients in 19
California counties between 1999 and 2000.
All the patients were enrolled in both
Medicare and Medicaid. The mean age of
participants was 81, 70 percent were women,
45 percent were non-Hispanic whites, 26
percent were Asian, 9 percent were African
American, 13 percent were Hispanic and 7
percent were of unknown race or ethnicity.
"Vulnerable elders" are defined as geriatric
patients who are at increased risk of death
or functional decline.
Using linked Medicare and Medicaid data from
the California Center for Long Term Care
Integration — a collaborative effort between
the UCLA Division of Geriatrics and the
University of Southern California School of
Gerontology — researchers examined quality
for 43 specific types of care (for example,
receiving a new medication or having a
diagnostic test) for common conditions such
as depression, diabetes, hypertension and
heart failure.
They found that in too
many instances, elderly patients were not
given the full range of treatments and
services for their conditions. For example,
only 42 percent of patients with diabetes
were tested to gauge their blood sugar
control or received an eye examination
during the one-year study period. Likewise,
many patients who were newly diagnosed with
heart failure did not receive recommended
diagnostic evaluations or medications known
to be effective.
In the absence of electronic medical
records, the use of administrative data such
as those on which the researchers based
their work can be a gauge of the quality of
some important aspects of care for elderly
patients, Zingmond said.
"The Medicare and Medicaid administrative
data contain information on many aspects of
the care that these patients receive," he
said. "This type of monitoring is both
feasible and necessary."
Other researchers on the study included Neil
S. Wenger of the David Geffen School of
Medicine at UCLA; Catherine H. MacLean of
WellPoint Inc.'s Programs for Clinical
Excellence; and Kathleen H. Wilbur of the
University of Southern California.
The study was funded by a Mentored Clinical
Scientist Award from the National Institute
on Aging and by the California Department of
Health and Human Services Office of Long
Term Care.
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