A major task of this report—categorization of select measures of diabetes quality of care, along with certain cardiovascular and depression care measures—revealed some important themes in limitations of existing research on disparities, particularly in care for older adults. First, most health care measures for priority conditions in older adults, such as diabetes and cardiovascular conditions, are largely concentrated in the IOM domain of effectiveness of care, with relatively few items found in the safety, patient-centered or timely/accessible domains. No indicators were found in the efficiency of
Second, to enhance disparities research and ultimately improve health outcomes, studies must focus on a wider spectrum of personal factors than race and ethnicity. Some data sets used for quality of care research, including insurance claims data and medical record reviews, do not always have a wide range of sociodemographic variables. However, national survey data often include information on race and ethnicity or gender, as well as other important sociodemographic factors such as income, education level and country of origin. Taking better advantage of these data would enhance understanding of the extent of inequities in health care based on personal factors.
Third, the majority of studies on disparities in quality of care have focused exclusively on effectiveness of care measures, such as processes of care or intermediate outcomes (e.g., receipt of recommended diabetes tests such as eye examinations or HbA1c levels in diabetics; beta-blocker prescription and LDL levels following hospital discharge for a cardiovascular event). Potential disparities in other IOM domains of safety, patient-centered, timely/accessible and efficient care have received less attention. It is unclear whether this is a result of disparities not being observed in those domains, difficulty in collecting data or simply a lack of interest by researchers.
Fourth, the issue of how patterns of disparities in care differ between midlife and older adults has received very little attention in the literature. For example, a Medline search for diabetes studies, limited to those that include people 45–64 and ≥65, yielded many studies that encompassed these two age groups but did not necessarily stratify results by these groups. Thus, very little additional information on this issue could be gleaned, despite applying criteria to maximize the sensitivity and specificity of search results. While studies in cardiovascular and depression care examine results by age, they do not discuss the differences between these two age groups. Differences in the prevalence of these conditions, as well as differences in insurance coverage, may contribute to this finding.