How Do Gender Differences in Quality of Care Vary Across Medicare Advantage Plans?
J Gen Intern Med
; 33(10): 1752-1759, 2018 10.
Article
em En
| MEDLINE
| ID: mdl-30097976
ABSTRACT
BACKGROUND:
Healthcare Effectiveness Data and Information Set (HEDIS) quality measures have long been used to compare care across health plans and to study racial/ethnic and socioeconomic disparities among Medicare Advantage (MA) beneficiaries. However, possible gender differences in seniors' quality of care have received less attention.OBJECTIVE:
To test for the presence and nature of any gender differences in quality of care across MA Plans, overall and by domain; to identify those most at risk of poor care.DESIGN:
Cross-sectional analysis of individual-level HEDIS measure scores from 23.8 million records using binomial mixed-effect models to estimate the effect of gender on performance. For each measure, we assess variation in gender gaps and their correlation with plan performance.PARTICIPANTS:
Beneficiaries from 456 MA plans in 2011-2012 HEDIS data. MAINMEASURES:
Performance on 32 of 34 HEDIS measures which were available in both measurement years. The two excluded measures had mean performance scores below 10%. KEYRESULTS:
Women experienced better quality of care than men for 22/32 measures, with most pertaining to screening or treatment. Men experienced better quality on nine measures, including four related to cardiovascular disease and three to potentially harmful drug-disease interactions. Plans varied substantially in the magnitude of gender gaps for 21/32 measures; in general, the gender gap in quality of care was least favorable to men in low-performing plans.CONCLUSIONS:
Women generally experienced better quality of care than men. However, women experienced poorer care for cardiovascular disease-related intermediate outcomes and potentially harmful drug-disease interactions. Quality improvement may be especially important for men in low-performing plans and for cardiovascular-related care and drug-disease interactions for women. Gender-stratified reporting could reveal gender gaps, identify plans for which care varies by gender, and motivate efforts to address faults and close the gaps in the delivery system.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Qualidade da Assistência à Saúde
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Serviços de Saúde da Mulher
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Medicare Part C
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Atenção à Saúde
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Disparidades em Assistência à Saúde
Tipo de estudo:
Observational_studies
/
Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article