Douglas McCarthy, Sheila Leatherman
Quality of Health Care for Medicare Beneficiaries: A Chartbook, Sheila Leatherman and Douglas McCarthy, The Commonwealth Fund, May 2005, Vol. 815
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We conducted a broad review of recently published studies and reports to present a coherent picture of the quality of health care for elderly Medicare beneficiaries living in the community. We included findings for all Medicare beneficiaries when available data were not limited to the community-dwelling elderly population.
The results, displayed in 60 charts, reveal many signs of progress, especially in areas that have been targeted as national priorities. However, there are also significant gaps and deficiencies in care and wide variation in quality across the country. While Medicare appears to be working well as an insurance program in providing the elderly with access to needed care, there must be increased efforts to assure systematic and predictable improvements in the quality of care.
On the positive side, improvements can be seen in the provision of preventive services such as mammography, in hospital treatment of heart attack, and in outpatient care for chronic conditions such as diabetes. Fewer elderly patients are receiving inappropriate medications and fewer are dying in the hospital after being treated for heart failure, stroke, pneumonia, and other conditions. More seniors have a usual source of care, an important predictor of getting preventive care and having health care needs met.
On the negative side, large gaps need to be addressed in screening for colorectal cancer, treatment for depression, and control of high blood pressure and high cholesterol among the elderly. Potentially preventable hospitalizations have increased for certain conditions, as have recorded rates of adverse events or complications of care in the hospital. Pilot studies suggest that many vulnerable elderly are not receiving care that is important to well-being in later life, such as screening and treatment for those with urinary incontinence or at risk of falls. Up to half of family members report concerns with the care provided to a relative at the end of life.
Disparities and unjustified variations in care appear to be no less an issue for the elderly, despite near-universal coverage by Medicare. Minority and low-income elders and those without any supplemental insurance coverage are less likely to get recommended preventive care. Minorities, especially blacks, are more likely to experience certain preventable adverse events or complications of care in the hospital. The physicians of elderly black patients are more likely to report barriers to providing high-quality care. The amount of care received at the end of life varies dramatically depending on where one receives it.
The good news is that change is possible with concerted effort. The chartbook highlights eight exemplary quality improvement interventions that offer promising approaches for critical needs, such as reducing repeat hospitalizations for patients with heart failure, supporting spouses caring for patients with Alzheimer's disease, helping frail elderly maintain their independence at home, and providing palliative care at the end of life. The Medicare program has several initiatives under way that hold the promise of encouraging improvements in access to and quality of care. Yet, greater effort is needed to assure that all Medicare beneficiaries consistently receive the best care that the American health care system has to offer and to reliably expand capacity for continually improving quality over time.