Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 2.0 Conceptual Framework and Literature Review: Disparities in Diabetes and Other Priority Conditions


Racial/ethnic disparities in health outcomes exist among midlife and older adults. These include disparities in mortality and quality of care associated with diabetes, cardiovascular disease and other chronic conditions (Gee and Payne-Sturges 2004; U.S. Department of Health and Human Services [HHS] 2000). While it is not always clear why disparities occur, it is widely acknowledged that various factors may play an important role, both at the individual level and at the system wide (ecological) level. This chapter presents a conceptual framework and literature review examining disparities in quality of care.

The conceptual framework emphasizes the individual and system-wide (ecological) level factors that may play a role in quality of care disparities, and illustrates these factors as they relate to six quality domains delineated by the Institute of Medicine (IOM) in its report, "Crossing the Quality Chasm"; (2001). The literature review illustrates these themes with regard to disparity, using diabetes as a prominent condition affecting Americans. The literature review documents well-known disparities in diabetes prevalence, complications and quality of care (Adams et al 2008; Wong et al 2003). The review also documents the small but growing literature on interventions—targeting both individual and system-wide factors in the conceptual framework—that may mitigate disparities. Finally, since diabetes is also linked to other important conditions, such as cardiovascular disease and depression (American Diabetes Association 2008b, 2008c; Egede et al 2005), we conclude our literature review with important examples of disparities from cardiovascular disease and

It should be noted that the literature review focuses on racial and ethnic disparities in diabetes because the research largely focuses on these disparities and pays less attention to other factors. Nevertheless, the review provides examples of what is known about disparities based on other factors illustrated in the conceptual model, such as gender, health

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