Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 7.0 Figures and Tables

05/01/2012

Figure 1. How System and Individual Components Affect Quality of Care Disparities in Older Adults

Figure 1. How System and Individual Components Affect Quality of Care Disparities in Older Adults. See Long Description for explanation.

Figure 1 is a flowchart showing how System and Individual Components Affect Quality of Care Disparities in Older Adults. The System level componets used for the external environment are Payment policies, Regulatory environment, Region and Competition, market presents. The Individual Level components are broken down to Plan/Health CCharacteristics and Individual Characteristics. Upon assessing all of these factors, the outcome results through the extent of equitable care.


Figure 2. Delays in Care for Diabetes and Cardiovascular Condition Patients

Figure 2:  Graphs showing the Delays in Care for Diabetes and Cardiovascular Condition Patients

Figure 2 are graphs showing gender differences are significant for Whites <65. Race differences are significant for Hispanic women <65. Age differences are significant for Whites and Black women. Estimate unavailable for Hispanic Men 65+. Gender differences are significant for Whites and Hispanics (both age groups). No race/ethnicity differences were significant. Age differences are significant for Whites, Black women and Hispanics.


Figure 3. Effectiveness of Care for Diabetes and Cardiovascular Conditions

Figure 3:  Graphs showing the Effectiveness of Care for Diabetes and Cardiovascular Conditions

Figure 3 are graphs showing no gender or age differences are significant. Race differences are significant for Black men <65, Hispanic men and Hispanic women <65. Gender differences are significant for White and Blacks 65+. Race differences are significant for Black men (both age groups) and Black women 65+, as well as for Hispanic men 65+ and Hispanic women 65+. Age differences are significant for White men and women.


Figure 4. Patient-Centeredness Among Diabetes and Cardiovascular Condition Patients

Figure 4.  Graphs showing the Patient-Centeredness Among Diabetes and Cardiovascular Condtion Patients

Figure 4 are graphs showing age differences are significant for Hispanic men. Gender differences are significant for Hispanic women 65+. Race differences are significant for Blacks both men and women <65, for Hispanics both men and women <65, for Hispanic women 65+. No age differences are significant. Gender differences are significant for women 65+. Race differences are significant for Hispanic women 65+.


 

TABLE 1: Analytic Grid for Quality Measures: Examples of Measures for Effective (Diabetes and Cardiovascular Conditions), Timely/Accessible,

Quality Indicators Data Source Quality Outcomes
Equity (Overarching Outcome)
Safe Effective Patient-Centered Timely/ Accessible Efficient/Cost/ Utilization
DIABETES EFFECTIVENESS OF CARE        
Diabetes Care & Management: Process Indicators
HbA1c test in last year MEPS   √—G, R/E, I, IS      
Eye exam in last year MEPS   √—G, R/E, I, IS      
Foot exam in last year MEPS   √—G, R/E, I, IS      
Hemoglobin A1C test, eye exam, and foot exam in last year MEPS   √—G, R/E, I, IS      
Blood pressure check in last year MEPS   √—G, R/E, I, IS      
Lipid panel within the past 2 years MEPS   √—G, R/E, I, IS      
Intermediate Outcomes
HbA1c <7.0% NHANES   √—G, E, I, IS, C, EI      
HbA1c >9.0% NHANES   √—G, E, I, IS, C, EI      
BP <130/80 mm Hg NHANES   √—G, E, I, IS, C, EI      
Total cholesterol <200 mg/dL NHANES   √—G, E, I, IS, C, EI      
LDL cholesterol <100 mg/dL NHANES   √—G, E, I, IS, C, EI      
HDL cholesterol <40 mg/dL (males) or <50mg/dL (females) NHANES   √—G, E, I, IS, C, EI      
Triglyceride <150 mg/dL NHANES   √—G, E, I, IS, C, EI      
Additional Indicators
Influenza immunization past 12 months NHANES, MEPS (NHIS)   √—G, E, I, IS, C, EI      
Had pneumococcal immunization NHANES, MEPS (NHIS)   √—G, E, I, IS, C, EI      
Dental visit in the past year (12 months/) NHANES, MEPS   √—G, E, I, IS, C, EI      
Recommended or offered intervention for smoking cessation
Note: Also smokers who received advice to quit
BRFSS, MEPS   √—G, R/E, I, IS      
Diabetes Hospitalizations
Hospital admissions for uncontrolled diabetes HCUP   √—G, R/E, I      
Hospital admissions for lower extremity amputations HCUP   √—G, R/E, I      
Hospital admissions for diabetes with any short-term complications HCUP, MEPS   √—G, R/E, I, IS      
For hypoglycemia HCUP   √—G, R/E, I      
For hypotension HCUP   √—G, R/E, I      
For polypharmacy HCUP   √—G, R/E, I      
For falls or balance problems (falls or balance problems may also be considered long-term complications) HCUP, MEPS   √—G, R/E, I, IS      
Hospital admissions for diabetes with any long-term complications HCUP, MEPS   √—G, R/E, I      
CARDIOVASCULAR EFFECTIVENESS OF CARE
Cardiovascular Care: Hypertension Management
Blood pressure <140/90 mm/Hg NHANES   √—G, E, I, IS, C, EI      
Cardiovascular Care: Hospital Care for AMI
Number of admissions for AMI HCUP   √—G, R/E, I      
AMI mortality rate HCUP   √—G, R/E, I      
PTCA mortality rate HCUP   √—G, R/E, I      
CABG mortality rate HCUP   √—G, R/E, I      
Cardiovascular Care: Hospital Care for CHF
Number of CHF admissions HCUP   √—G, R/E, I      
CHF mortality rate HCUP   √—G, R/E, I      
ACCESS TO CARE
Unable or delayed in receiving care MEPS       √—G, R/E, I, IS  
Difficulty getting to doctor from home MCBS       √—G, R/E, E, I, IS  
Emergency department visits in which patient left without being seen NHAMCS       √—G, R/E, IS  
Waiting 30 minutes or more to see doctor at last visit MCBS       √—G, R/E, E, I, IS  
Without particular place for care MCBS       √—G, R/E, E, I, IS  
PATIENT-CENTEREDNESS IN CARE        
Provider sometimes or never listened carefully to them MEPS     √—G, R/E, I, IS    
Provider sometimes or never explained things clearly MEPS     √—G, R/E, I, IS    
Provider sometimes or never showed respect for what they had said MEPS     √—G, R/E, I, IS    
Provider sometimes or never spent enough time with them MEPS     √—G, R/E, I, IS    
SAFETY IN CARE
Percentage with at least 1 prescribed inappropriate Rx MEPS √—G, R/E, I, IS        
Provider asks about use of Rx/other treatments from other doctors MEPS √—G, R/E, I, IS        

Equity Items in Data Source:
G = Gender, R/E = Race and ethnicity, E = Education, I = Income, IS = Insurance status, C = Country of origin, EI = Employment information

AMI = Acute myocardial infarction, BP = Blood pressure, BRFSS = Behavioral Risk Factors Surveillance System, CABG = Coronary artery bypass graft,
CHF = Chronic heart failure, HCUP = Healthcare Cost and Utilization Project, MCBS = Medicare Current Beneficiary Survey,
MEPS = Medical Expenditure Panel Survey, NHAMCS = National Hospital Ambulatory Medicare Care Survey,
NHANES = National Health and Nutrition Examination Survey, PTCA = Percutaneous transluminal coronary angioplasty.

We gratefully acknowledge the CDC for its assistance on Table 1.

 

Table 2. Published Data on Disparities in Diabetes and Cardiovascular Conditions for Commercial and Medicare Managed Care Populations, by Gender

  Commercial, 19991 Medicare, 19991 Commercial, 20042 Medicare, 20033
Female Male Female Male Female Male Female Male
Diabetes
Cholesterol Screening 58.8 63.0 53.1 56.4 91.6 92.7 92.7 92.6
Cholesterol Control <130 27.6 33.0 33.4 41.3     67.4 73.2
Cholesterol Control <100         37.7 43.3 38.5 45.7
HbA1c Testing 64.4 67.0 60.9 61.8     89.2 87.7
Poor HbA1c Control             22.0 22.2
Eye Examination 39 33.7 46.5 41.7     68.8 66.4
Nephropathy Monitoring 20.4 21.4 17.0 20.2     57.6 58.9
Cardiovascular Disease
Beta-Blocker Treatment After a Heart Attack 63.8 73.6 67.8 67.0 94.7 97.0 92.3 92.9
Persistence of Beta Blocker After a Heart Attack         62.3 65.2    
Controlling High Blood Pressure 30.2 26.0 30.3 35.4 70.8 68.6 59.8 63.3
Cholesterol Screening for People With Acute Cardiovascular Events 66.4 67.5 61.2 60.5 76.8 79.9 80.4 82.7
Lipid Control <130 for People With Acute Cardiovascular Events 33.7 34.8 35.0 45.5        
Lipid Control <100 for People With Acute Cardiovascular Events         45.3 55    
ACE Inhibitor With CHF 56.3 62.2 53.0 55.5        
Depression
Antidepressant Medication Management—Optimal Contacts             11.9 13.7
Antidepressant Medication Management—Acute Phase             66.0 66.2
Antidepressant Medication Management—Continuation Phase             51.3 50.5
Follow-Up After MH Hospitalization (30 Days)             59.5 52.4
Follow-Up After MH Hospitalization (7 Days)             37.9 33.8
Influenza Vaccination         53.9 50    

ACE = Angiotensin-converting enzyme, CHF = Congestive heart failure, HbA1c = Hemoglobin A1c,
MH = Mental health

1= NCQA, unpublished results.

2=Chou AF, Wong L, Weisman CS, Chan S, Bierman AS, Correa-de-Araujo R, Scholle SH. Gender disparities in cardiovascular disease care among commercial and Medicare managed care plans. Women's Health

3=NCQA, unpublished results.

 

Quality of Care Indicator Description Quality of Care Domaina

Table 3. Key Quality of Care Indicators for Diabetes and Cardiovascular Conditions: MEPS, 2004–2006

DIABETES CARE
Testing of HbA1c Percentage of diabetics who had testing of HbA1c levels within the past year Effective
Testing of blood pressure Percentage of diabetics or those with cardiovascular disease who had testing of blood pressure level within the past year Effective
Testing of blood cholesterol Percentage of diabetics or those with cardiovascular disease who had testing of blood cholesterol within the past two years Effective
Eye examination Percentage of diabetics who received an eye examination within the past year Effective
Foot examination Percentage of diabetics who received a foot examination within the past year Effective
Composite: HbA1c, eye and foot examination Percentage of diabetics who received all three services: HbA1c testing, eye examination and foot examination within the past year Effective
Influenza shot Percentage of diabetics who received an influenza vaccination within the past year Effective
Unable to get care Percentage of diabetics or those with cardiovascular disease who reported that they sometimes or never got care for illness or injury as soon as wanted within the past year Timely/Access
Delays in medical care Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in getting necessary medical care within the past year Timely/Access
Delays in dental care Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in getting necessary dental care within the past year Timely/Access
Delays in prescriptions Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in getting necessary prescription medications within the past year Timely/Access
Composite: Delays in care Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in all three types of care: medical care, dental care, getting prescription medications within the past year Timely/Access
Provider listened Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always listened carefully within the past year Patient-centered
Provider explained things Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always explained things clearly within the past year Patient-centered
Provider showed respect Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always showed respect within the past year Patient-centered
Provider spent time Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always spent enough time with them within the past year Patient-centered
Composite: Patient-centeredness Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always listened carefully, explained things clearly, showed respect to what they had to say, and spent enough time with them within the past year Patient-centered
CARDIOVASCULAR CONDITION CARE
Testing of blood pressure Percentage of diabetics or those with cardiovascular disease who had testing of blood pressure level within the past year Effective
Dietary advice Percentage of those with cardiovascular disease who ever received advice to eat fewer high fat and high cholesterol foods Effective
Exercise advice Percentage of those with cardiovascular disease who ever received advice to exercise more Effective
Testing of blood cholesterol Percentage of diabetics or those with cardiovascular who had testing of blood cholesterol within the past two years Effective
Influenza shot Percentage of diabetics or those with cardiovascular disease who received an influenza vaccination within the past year Effective
Unable to get care Percentage of diabetics or those with cardiovascular disease who reported that they sometimes or never got care for illness or injury as soon as wanted within the past year Timely/Access
Delays in medical care Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in getting necessary medical care within the past year Timely/Access
Delays in dental care Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in getting necessary dental care within the past year Timely/Access
Delays in prescriptions Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in getting necessary prescription medications within the past year Timely/Access
Composite: Delays in care Percentage of diabetics or those with cardiovascular disease who reported that they were unable or delayed in all three types of care: medical care, dental care, getting prescription medications within the past year Timely/Access
Provider listened Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always listened carefully within the past year Patient-centered
Provider explained things Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always explained things clearly within the past year Patient-centered
Provider showed respect Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always showed respect within the past year Patient-centered
Provider spent time Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always spent enough time with them within the past year Patient-centered
Composite: Patient-centeredness Percentage of diabetics or those with cardiovascular disease who reported that provider usually or always listened carefully, explained things clearly, showed respect to what they had to say, and spent enough time with them within the past year Patient-centered
a Indicates one of the five quality of care domains identified by the IOM: Effective, timely/accessible, patient-centered, safe and efficient care.

 

Table 4. Sociodemographic Characteristics of 2004–2006 MEPS Respondents ≥45

  Non-Hispanic White Non-Hispanic Black Hispanic, Any Race
Males Females Males Males Females Males
45-64 ≥65 45-64 ≥65 45-64 ≥65 45-64 ≥65 45-64 ≥65 45-64 ≥65
Diabetes Respondents (n=5,077)
Sample size 582 538 616 593 160 137 310 251 226 132 346 239
Mean age in years 56.2 73.8 55.5 75.5 55.4 73.4 55.2 73.7 54.0 72.9 54.1 73.6
Medicaid recipient 13.7% 7.1% 22.9% 17.2% 23.1% 23.4% 38.7% 42.6% 25.2% 43.2% 36.4% 57.7%
Private insurance 71.5% 64.9% 63.5% 52.8% 64.4% 37.2% 39.7% 29.1% 47.3% 24.2% 32.9% 12.6%
Public insurance only 19.1% 35.1% 26.1% 47.2% 28.1% 62.8% 45.8% 70.9% 26.5% 75.8% 38.2% 84.1%
Uninsured 9.5% *** 10.4% *** 7.5% *** 14.5% *** 26.1% *** 28.9% 3.3%
No college 56.2% 57.6% 62.7% 74.5% 63.8% 73.0% 70.6% 80.5% 84.5% 85.6% 85.0% 88.7%
Cardiovascular Condition Respondents (n=23,235)
Sample size 3,171 2,401 3,252 3,292 639 437 1,185 794 671 343 939 682
Mean age in years 54.9 74.2 55 75.7 54.6 73.1 54.1 74.7 53.8 73 54.3 74.2
Medicaid recipient 7.5% 6.2% 11.8% 11.2% 14.4% 24.7% 25.8% 37.5% 18.5% 37.3% 29.3% 52.3%
Private insurance 79.0% 67.3% 76.7% 59.1% 66.0% 43.0% 54.2% 32.0% 55.0% 28.3% 41.6% 16.3%
Public insurance only 10.8% 32.7% 14.2% 40.8% 20.0% 57.0% 29.5% 67.9% 21.9% 70.6% 29.6% 81.1%
Uninsured 10.2% 0.0% 9.1% 0.1% 13.9% *** 16.4% 0.1% 23.1% 1.2% 28.8% 2.6%
No college 45.2% 55.1% 49.8% 67.9% 62.6% 74.1% 60.4% 79.0% 76.8% 84.8% 78.1% 89.7%
*** = Data are statistically unreliable (cell size <100 or relative standard error >0.3)

 

TABLE 5. Relative Rates based on Age and Sex for Quality of Care for Respondents With Diabetes: MEPS 2004–2006 (N=5,077)

  Relative Rates Comparing Men to Women Relative Rates Comparing Adults 45–64 to Adults ≥65
White 45-64 White
≥65
Black 45-64 Black ≥65 Hispanic 45-64 Hispanic ≥65 White Male White Female Black Male Black Female Hispanic Male Hispanic Female
Diabetes Care
Percentage of diabetics who had an HbA1c test in the past year 1.02 0.99 0.93 *** 0.99 0.94 1.03 0.99 *** 1.01 0.98 0.93
Percentage of diabetics who had their blood pressure checked in the past year 0.98 1.00 0.98 1.00 0.98 0.98 0.98 1.00 0.99 1.01 0.95 0.95
Percentage of diabetics who had their blood cholesterol checked in the past 2 years 0.99 1.01 1.01 0.97 0.95 1.00 0.96 0.98 1.03 1.00 0.91 0.96
Percentage of diabetics who received an eye examination in the past year 0.97 1.02 0.91 0.93 1.10 0.98 0.84 0.88 0.89 0.91 0.89 0.79
Percentage of diabetics who received a foot examination the past year 1.02 1.06 0.97 0.91 1.06 0.96 1.01 1.04 1.01 0.95 0.96 0.86
Composite: Percentage of diabetics who had an HbA1c test, eye and foot examination 0.98 1.11 0.77 0.81 0.97 1.11 0.91 1.03 0.98 1.03 0.82 0.95
Preventive Services
Percentage of diabetics who received an influenza vaccine in the past year 0.92 1.03 0.87 1.04 0.85 1.02 0.67 0.75 0.68 0.82 0.59 0.71
Percentage of diabetics who received a dental check-up in the past year 0.96 1.26 1.00 0.90 1.12 1.39 0.95 1.26 1.65 1.49 0.98 1.21
Percentage of diabetic smokers who received advice to quit smoking in the past year *** *** *** *** *** *** *** *** *** *** *** ***
Access to Care
Percentage of diabetics who reported problems receiving care as soon as they wanted in the past year 0.71 1.34 *** *** *** *** 1.40 2.64 *** *** *** ***
Percentage of diabetics who reported delays in getting necessary medical care in the past year 0.53 1.11 *** *** *** *** 1.54 3.24 *** *** *** ***
Percentage of diabetics who reported delays in getting necessary dental care in the past year 0.70 0.50 *** *** *** *** 3.14 2.27 *** 2.28 *** ***
Percentage of diabetics who reported delays in getting necessary prescription medications 0.46 0.69 *** *** *** *** 1.34 2.00 *** 1.86 *** 0.74
Composite: Percentage of diabetics who were delayed in getting medical care, dental care, or prescription medications 0.61 0.83 0.53 1.09 0.63 *** 1.43 1.95 0.82 1.68 *** 0.97
Patient-Centeredness in Care
Percentage of diabetics who felt their provider listened carefully 1.00 1.01 1.06 0.98 1.01 1.06 0.96 0.97 1.02 0.94 0.89 0.94
Percentage of diabetics whose provider explained things clearly 1.00 1.01 1.01 1.01 0.98 1.13 0.97 0.98 0.95 0.95 0.89 1.02
Percentage of diabetics whose provider showed respect 1.00 0.99 1.02 0.95 1.02 1.04 0.96 0.96 0.98 0.92 0.97 0.99
Percentage of diabetics whose provider spent enough time with them 0.98 1.02 1.02 0.95 1.09 1.06 0.93 0.96 0.99 0.92 0.96 0.94

*** = Data are statistically unreliable (cell size <100 or relative standard error >0.3) Bold = Statistically significant difference (p<0.05) in RR

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 6. Relative Rates Based on Age and Sex for Quality of Care for Respondents With Cardiovascular Conditions:
MEPS 2004–2006 (N= 23,235)

  Relative Rates Comparing Men to Women Relative Rates Comparing Adults 45–64 to Adults ≥65
White 45-64 White
≥65
Black 45-64 Black ≥65 Hispanic 45-64 Hispanic ≥65 White Male White Female Black Male Black Female Hispanic Male Hispanic Female
Cardiovascular Care
Percentage of cardio-vascular condition patients who had their blood pressure checked in the past year 0.97 1.00 0.98 1.00 0.96 1.00 0.95 0.98 0.97 0.98 0.95 0.98
Percentage of cardio-vascular condition patients who ever received advice to eat fewer high fat and high cholesterol foods 1.03 1.08 0.99 0.86 1.00 1.07 1.12 1.18 1.14 0.99 1.01 1.08
Percentage of cardio-vascular condition patients who ever received advice to exercise more 0.95 1.06 0.91 1.00 0.93 1.01 1.17 1.30 1.12 1.24 1.09 1.19
Access to Care
Percentage of cardio-vascular condition patients who reported problems receiving care as soon as they wanted in the past year 0.96 1.14 0.53 1.07 1.02 *** 1.76 2.10 1.05 2.11 *** 1.84
Percentage of cardio-vascular condition patients who reported delays in getting necessary medical care in the past year 0.61 0.84 0.77 1.11 0.51 *** 1.90 2.59 1.71 2.47 *** 2.24
Percentage of cardio-vascular condition patients who reported delays in getting necessary dental care in the past year 0.63 0.56 0.73 0.89 0.81 *** 2.27 2.02 1.24 1.51 *** 1.80
Percentage of cardio-vascular condition patients who reported delays in getting necessary prescription medications 0.53 0.77 0.77 0.96 0.67 *** 1.45 2.09 1.21 1.50 *** 1.14
Composite: Percentage of cardiovascular condition patients who were delayed in getting medical care, dental care, or prescription medications 0.63 0.77 0.77 0.91 0.65 0.47 1.50 1.83 1.22 1.44 1.91 1.39
Patient-Centeredness in Care
Percentage of cardio-vascular condition patients who felt their provider listened carefully 1.01 1.03 1.00 1.01 1.01 1.04 0.97 0.98 0.96 0.97 0.93 0.96
Percentage of cardio-vascular condition patients whose provider explained things clearly 1.00 1.01 0.99 0.99 0.98 1.08 0.99 1.00 1.00 0.99 0.94 1.04
Percentage of cardio-vascular condition patients whose provider showed respect 1.01 1.01 0.98 0.97 1.00 1.02 0.97 0.97 0.97 0.96 0.97 0.99
Percentage of cardio-vascular condition patients whose provider spent enough time with them 1.01 1.03 1.01 0.98 1.00 1.04 0.96 0.98 0.96 0.94 0.92 0.96

*** = Data are statistically unreliable (cell size <100 or relative standard error >0.3) Bold = Statistically significant difference (p<0.05) in RR

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 7. Relative Rates based on Race and Ethnicity for Quality of Care for Respondents With Diabetes: MEPS 2004–2006 (N=5,077)

  Relative Rates Comparing Whites
to Blacks
Relative Rates Comparing Whites
to Hispanics
Male 45-64 Male ≥65 Female 45-64 Female ≥65 Male 45-64 Male ≥65 Female 45-64 Female ≥65
Diabetes Testing
Percentage of diabetics who had an HgA1c test in the past year 1.10 *** 1.00 1.02 1.07 1.03 1.05 0.98
Percentage of diabetics who had their blood pressure checked in the past year 0.99 1.00 0.98 0.99 1.04 1.01 1.03 0.99
Percentage of diabetics who had their blood cholesterol checked within the past 2 years 0.98 1.05 1.00 1.01 1.07 1.01 1.03 1.00
Percentage of diabetics who received an eye examination in the past year 1.13 1.20 1.06 1.10 1.08 1.15 1.24 1.11
Percentage of diabetics who received a foot examination the past year 0.99 1.00 0.94 0.86 1.08 1.03 1.12 0.93
Composite: Percentage of diabetics who had an HbA1c test, eye and foot examination 1.33 1.43 1.05 1.05 1.27 1.15 1.26 1.16
Preventive Services
Percentage of diabetics who received an influenza vaccine in the past year 1.45 1.46 1.36 1.48 1.36 1.19 1.26 1.18
Percentage of diabetics who received a dental check-up in the past year 1.05 1.82 1.10 1.30 1.15 1.18 1.34 1.29
Percentage of diabetic smokers who received advice to quit smoking in the past year *** *** *** *** *** *** *** ***
Access to Care
Percentage of diabetics who reported problems receiving care as soon as they wanted in the past year *** *** 0.92 *** *** *** 0.81 ***
Percentage of diabetics who reported delays in getting necessary medical care in the past year *** *** 1.87 *** *** *** 1.24 ***
Percentage of diabetics who reported delays in getting necessary dental care in the past year *** *** 1.15 1.15 1.04 *** *** 0.87
Percentage of diabetics who reported delays in getting necessary prescription medications *** *** 1.13 1.05 *** *** 1.98 0.73
Composite: Percentage of diabetics who were delayed in getting medical care, dental care or prescription medications 1.56 0.90 1.37 1.18 1.52 *** 1.57 0.78
Patient-Centeredness in Care
Percentage of diabetics who felt their provider listened carefully 0.97 1.02 1.02 0.99 1.02 0.95 1.03 1.00
Percentage of diabetics whose provider explained things clearly 1.04 1.01 1.05 1.01 1.07 0.98 1.05 1.10
Percentage of diabetics whose provider showed respect 1.02 1.04 1.04 1.00 0.98 0.99 1.00 1.03
Percentage of diabetics whose provider spent enough time with them 1.00 1.06 1.04 0.99 0.95 0.97 1.05 1.02

*** = Data are statistically unreliable (cell size <100 or relative standard error >0.3) Bold = Statistically significant difference (p<0.05) in RR

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 8. Relative Rates based on Race and Ethnicity for Quality of Care for Respondents With Cardiovascular Conditions: MEPS 2004–2006

  Relative Rates Comparing Whites
to Blacks
Relative Rates Comparing Whites
to Hispanics
Male 45-64 Male ≥65 Female 45-64 Female ≥65 Male 45-64 Male ≥65 Female 45-64 Female ≥65
Cardiovascular Care
Percentage of cardiovascular condition patients who had their blood pressure checked in the past year 0.98 1.00 0.99 0.99 1.02 1.01 1.01 1.01
Percentage of cardiovascular condition patients who ever received advice to eat fewer high fat and high cholesterol foods 1.10 1.11 1.06 0.89 0.96 0.86 0.93 0.85
Percentage of cardiovascular condition patients who ever received advice to exercise more 1.03 0.99 0.99 0.94 0.97 0.90 0.94 0.86
Access to Care
Percentage of cardiovascular condition patients who reported problems receiving care as soon as they wanted in the past year 1.41 0.84 0.79 0.79 0.64 *** 0.68 0.60
Percentage of cardiovascular condition patients who reported delays in getting necessary medical care in the past year 1.12 1.01 1.40 1.34 1.09 *** 0.91 0.78
Percentage of cardiovascular condition patients who reported delays in getting necessary dental care in the past year 0.75 0.41 0.87 0.65 0.65 *** 0.83 0.74
Percentage of cardiovascular condition patients who reported delays in getting necessary prescription medications 0.68 0.57 0.99 0.71 1.05 *** 1.32 0.72
Composite: Percentage of cardiovascular condition patients who were delayed in getting medical care, dental care, or prescription medications 0.88 0.71 1.07 0.84 1.02 1.30 1.05 0.80
Patient-Centeredness in Care
Percentage of cardiovascular condition patients who felt their provider listened carefully 1.02 1.01 1.01 1.00 1.02 0.98 1.02 0.99
Percentage of cardiovascular condition patients whose provider explained things clearly 1.04 1.04 1.03 1.02 1.06 1.01 1.04 1.08
Percentage of cardiovascular condition patients whose provider showed respect 1.04 1.04 1.00 0.99 1.00 1.00 0.99 1.01
Percentage of cardiovascular condition patients whose provider spent enough time with them 1.05 1.05 1.04 0.99 1.03 0.99 1.02 1.00

*** = Data are statistically unreliable (cell size <100 or relative standard error >0.3) Bold = Statistically significant difference (p<0.05) in RR

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 9. Effectiveness, Access and Patient-Centeredness Among Adults With Diabetes, By Age Group, Race/Ethnicity and Sex: MEPS 2004–2006 (N=5,077)

  White Male
45-64
White Male >65 White Female 45-64 White Female >65 Black Male 45-64 Black Male >65 Black Female 45-64 Black Female >65 Hispanic Male
45-64
Hispanic Male >65 Hispanic Female 45-64 Hispanic Female >65
Diabetes Testing
Percentage of diabetics who had an HgA1c test in the past year 93.7 91.3 91.9 92.7 84.9 * 91.6 90.7 87.2 89.1 87.6 94.6
Percentage of diabetics who had their blood pressure checked in the past year 96.2 98.6 98.0 98.1 97.3 98.7 99.8 98.9 92.7 98.0 94.8 99.6
Percentage of diabetics who had their blood cholesterol checked in the past 2 years 96.0 99.6 97.2 98.9 98.1 95.1 97.2 97.5 89.8 98.4 94.5 98.4
Percentage of diabetics who received an eye examination in the past year 59.8 71.6 62.0 70.4 53.1 59.6 58.4 64.2 55.2 62.2 50.2 63.5
Percentage of diabetics who received a foot examination the past year 73.1 72.8 71.6 68.9 73.5 72.8 76.0 80.1 67.4 70.5 63.7 73.7
Composite: Percentage of diabetics who had an HgA1c test, eye and foot examination 44.0 48.2 44.9 43.6 33.0 33.6 42.9 41.6 34.5 41.9 35.6 37.7
Preventive Services
Percentage of diabetics who received an influenza vaccine in the past year 51.7 76.9 56.1 74.5 35.7 52.5 41.2 50.3 37.9 64.4 44.6 63.0
Percentage of diabetics who received a dental check-up in the past year 53.9 56.5 56.4 44.7 51.1 31.0 51.4 34.5 46.9 48.1 42.0 34.6
Percentage of diabetic smokers who received advice to quit smoking in the past year *** *** 83.2 *** *** *** *** *** *** *** *** ***
Access to Care
Percentage of diabetics who reported problems receiving care as soon as they wanted in the past year 11.8 8.4 16.6 6.3 *** *** 18.1 *** *** *** 20.5 ***
Percentage of diabetics who reported delays in getting necessary medical care in the past year 8.7 5.6 16.4 5.1 *** *** 8.8 *** *** *** 13.2 ***
Percentage of diabetics who reported delays in getting necessary dental care in the past year 8.8 2.8 12.6 5.5 *** *** 10.9 4.8 8.5 *** *** 6.3
Percentage of diabetics who reported delays in getting necessary prescription medications 8.3 6.2 18.0 9.0 *** *** 15.9 8.6 *** *** 9.1 12.3
Composite: Percentage of diabetics who were delayed in getting medical care, dental care, or prescription medications 18.8 13.1 31.0 15.9 12.0 14.7 22.7 13.5 12.4 *** 19.7 20.4
Diabetes Patient-Centeredness in Care
Percentage of diabetics who felt their provider listened carefully 90.4 94.1 90.5 93.2 93.6 92.0 88.5 93.7 88.7 99.4 88.1 93.5
Percentage of diabetics whose provider explained things clearly 92.3 94.8 92.6 94.3 89.0 93.8 88.0 93.1 85.9 96.8 87.8 85.8
Percentage of diabetics whose provider showed respect 90.3 94.2 90.6 94.8 88.8 90.5 87.3 94.8 92.3 95.1 90.6 91.7
Percentage of diabetics whose provider spent enough time with them 85.5 91.6 86.9 90.1 85.4 86.4 83.8 90.9 90.3 94.0 83.0 88.3

*** = Data are statistically unreliable (cell size <100 or relative standard error >0.3)

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 10. Effectiveness, Access and Patient-Centeredness Among Adults With Cardiovascular Conditions, by Age Group, Race/Ethnicity and Sex: MEPS 2004–2006 (N=23,235)

  White Male
45-64
White Male ≥65 White Female 45-64 White Female >65 Black Male
45-64
Black Male ≥65 Black Female 45-64 Black Female ≥65 Hispanic Male
45-64
Hispanic Male ≥65 Hispanic Female 45-64 Hispanic Female ≥65
Cardiovascular Care
Percentage of cardiovascular condition patients who had their blood pressure checked in the past year 92.9 97.8 95.6 97.4 94.6 97.7 96.6 98.2 91.2 96.5 95.1 96.9
Percentage of cardiovascular condition patients who ever received advice to eat fewer high fat and high cholesterol foods 68.2 61.0 66.2 56.3 62.1 54.7 62.5 63.4 71.2 70.6 71.1 66.1
Percentage of cardiovascular condition patients who ever received advice to exercise more 66.6 57.0 70.0 53.8 64.4 57.4 71.0 57.4 68.9 63.0 74.3 62.5
Access to Care
Percentage of cardiovascular condition patients who reported problems receiving care as soon as they wanted in the past year 12.3 7.0 12.9 6.1 8.7 8.3 16.3 7.7 19.1 *** 18.8 10.2
Percentage of cardiovascular condition patients who reported delays in getting necessary medical care in the past year 7.0 3.7 11.4 4.4 6.2 3.6 8.1 3.3 6.4 *** 12.5 5.6
Percentage of diabetics who reported delays in getting necessary dental care in the past year 5.9 2.6 9.3 4.6 7.8 6.3 10.7 7.1 9.1 *** 11.2 6.2
Percentage of cardiovascular condition patients who reported delays in getting necessary prescription medications 5.8 4.0 10.9 5.2 8.5 7.0 11.0 7.3 5.5 *** 8.2 7.2
Composite: Percentage of cardiovascular condition patients who were delayed in getting medical care, dental care, or prescription medications 14.0 9.4 22.3 12.2 16.0 13.1 20.8 14.5 13.8 7.2 21.1 15.2
Patient-Centeredness in Care
Percentage of cardiovascular condition patients who felt their provider listened carefully 92.3 95.5 91.4 93.0 90.9 94.3 90.5 93.4 90.4 97.6 89.6 93.6
Percentage of cardiovascular condition patients whose provider explained things clearly 93.3 94.2 93.1 93.2 90.0 90.2 90.4 91.3 87.8 93.0 89.5 86.5
Percentage of cardiovascular condition patients whose provider showed respect 93.0 95.4 91.6 94.1 89.0 92.1 91.2 95.4 92.7 95.1 93.0 93.5
Percentage of cardiovascular condition patients whose provider spent enough time with them 89.1 92.7 87.8 89.7 85.1 88.3 84.7 90.3 86.1 93.8 86.1 89.8
Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

Total Number of Patients Diabetes Cardiovascular Conditions

TABLE 11. Distribution of Age, Insurance Status and Gender Characteristics Among Diabetes and
Cardiovascular Condition Patients: MEPS 2004–2006

Unweighted sample size N=4,076 N=17,636
Weighted sample size N=13,504,000 N=57,707,000
Characteristics
Age Group    
45–64 years 54.4% 55.7%
>65 years 45.6% 44.3%
Gender    
Male 48.4% 46.2%
Female 51.6% 53.8%
Insurance Status a    
45–64 years    
Any private insurance 69.0% 56.0%
Public insurance only 20.2% 10.9%
Uninsured 10.8% 10.1%
>65 years    
Medicare/public insurance only 44.8% 39.1%
Medicare and any private insurance 55.2% 60.9%
Characteristic Profile (Combined Type of Characteristics)
45–64 years, Male    
Any private insurance, male 73.7% 80.4%
Public insurance only, male 16.4% 9.2%
Uninsured, male 9.9% 10.4%
45–64 years, Female    
Any private insurance, female 64.4% 77.6%
Public insurance only, female 23.9% 12.6%
Uninsured, female 11.7% 9.8%
>65 years, Male    
Medicare and any private insurance, male 62.9% 67.4%
Medicare/public insurance only, male 37.1% 32.6%
>65 years, Female    
Medicare and any private insurance, female 48.2% 56.3%
Medicare/public insurance only, female 51.8% 43.7%

a Indicates insurance status in the previous year.

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 12. Basic Characteristics of Diabetes and Cardiovascular Condition Patients: MEPS 2004–2006

    All—Percentage 45–64 ≥65
Any Private Insurance Public Insurance Only Uninsured Medicare/Public Insurance Only Medicare and Any Private Insurance
Male,
%
Female, % Male,
%
Female, % Male,
%
Female, % Male,
%
Female, % Male,
%
Female, %
Diabetes patients (N) 4,076 621 622 216 428 124 207 364 650 430 414
Mean age (in years) 56 55 56 55 55 54 74 a 75 a 73 a 75 a
Race/Ethnicity
Non-Hispanic White 56.8% 66.5% 62.9% 51.4% 37.6% 44.4% 30.9% 50.5% 42.6% 80.7% 75.1%
Non-Hispanic Black 20.6% 16.4% 19.6% 20.8% 31.8% 9.7% 20.8% 22.8% 26.6% 11.9% 17.6%
Hispanic, any race 22.6% 17.1% 17.5% 27.8% 30.6% 46.0% 48.3% 26.6% 30.8% 7.4% 7.2%
Education
< High-school graduate 71.0% 56.4% 59.5% 81.9% 82.5% 75.0% 85.0% 79.9% 86.9% 54.0% 68.8%
Some college or higher 29.0% 43.6% 40.5% 18.1% 17.5% 25.0% 15.0% 20.1% 13.1% 46.0% 31.2%
Income
Poor, near poor, low 47.4% 18.2% 22.3% 83.3% 83.2% 50.0% 72.0% 58.8% 71.4% 23.0% 38.2%
Middle or high 52.6% 81.8% 77.7% 16.7% 16.8% 50.0% 28.0% 41.2% 28.6% 77.0% 61.8%
Self-Rated Health Status
Excellent, very good, good 55.1% 69.4% 63.8% 31.0% 30.1% 59.7% 51.2% 48.6% 49.4% 67.0% 61.4%
Fair or poor 44.9% 30.6% 36.2% 69.0% 69.9% 40.3% 48.8% 51.4% 50.6% 33.0% 38.6%
Cardiovascular patients (N) 17,636 3,276 3,515 616 1,072 558 753 1,249 2,409 1,885 2,303
Mean age (in years) 55 55 55 55 55 55 74 a 76 a 74 a 75 a
Race/Ethnicity
Non-Hispanic White 68.4% 76.2% 70.9% 55.5% 42.9% 57.3% 39.4% 61.9% 55.3% 85.3% 84.2%
Non-Hispanic Black 17.0% 12.8% 18.2% 20.8% 31.5% 15.4% 25.4% 19.4% 21.8% 9.7% 10.9%
Hispanic, any race 14.6% 11.1% 11.0% 23.7% 25.6% 27.2% 35.2% 18.7% 22.8% 5.0% 4.8%
Education
< High-school graduate 61.3% 44.2% 46.5% 81.3% 78.7% 71.5% 78.4% 75.7% 82.1% 52.4% 64.3%
Some college or higher 38.7% 55.8% 53.5% 18.7% 21.3% 28.5% 21.6% 24.3% 17.9% 47.6% 35.7%
Income
Poor, near poor, low 37.5% 12.6% 15.5% 82.3% 82.4% 55.6% 66.3% 55.4% 64.9% 22.0% 34.4%
Middle or high 62.5% 87.4% 84.5% 17.7% 17.6% 44.4% 33.7% 44.6% 35.1% 78.0% 65.6%
Self-Rated Health Status
Excellent, very good, good 70.3% 82.4% 80.6% 32.8% 34.4% 63.1% 61.1% 61.4% 61.2% 78.1% 76.6%
Fair or poor 29.7% 17.6% 19.4% 67.2% 65.6% 36.9% 38.9% 38.6% 38.8% 21.9% 23.4%

a Age was top-coded at 85.

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 13. Prevalence of Quality of Care Indicators for Diabetes and Cardiovascular Conditions, According to Patient Age Group, Insurance Status and Gender: MEPS 2004–2006

Patient Reported Receipt of the Following in the Past Yeara All—Percentage 45–64 ≥65
Any Private Insurance Public Insurance Only Uninsured Medicare/Public Insurance Only Medicare and Any Private Insurance
Male,
%
Female, % Male,
%
Female, % Male,
%
Female, % Male,
%
Female, % Male,
%
Female, %
Effectiveness of Care
Testing of HbA1c 91.67 93.15 93.62 92.38 88.55 78.99 80.79 92.50 92.08 90.04 94.38
Testing of blood pressure 97.60 96.66 98.87 96.74 98.55 88.82 90.69 97.88 99.14 98.88 97.62
Testing of blood cholesterolb 97.32 97.22 98.37 95.33 95.53 82.02 91.09 98.48 97.69 99.17 99.48
Receiving an eye examination 63.41 62.56 64.70 47.24 58.22 46.96 33.09 67.58 66.06 69.90 70.92
Receiving a foot examination 71.93 72.80 71.56 81.29 72.66 57.07 66.73 72.43 67.04 72.80 75.78
Composite: HbA1c, eye and foot examination 43.16 44.53 47.94 31.62 39.04 33.48 24.16 45.29 38.33 46.35 47.64
Receiving an influenza shot 59.41 48.15 55.81 52.81 45.15 35.17 41.19 74.31 64.54 72.29 74.22
Timeliness/Accessibility of Care
Unable to get care for illness/ injury 11.97 9.52 15.76 * 14.64 * * 10.02 9.43 * *
Delays in medical care 8.33 6.21 10.87 * 20.33 11.93 21.70 4.56 6.37 5.29 3.77
Delays in dental care 7.41 4.14 8.54 16.52 19.02 21.21 15.54 5.02 6.33 * 4.83
Delays in prescriptions 10.17 7.21 13.46 11.17 21.05 10.02 21.20 5.66 10.47 6.04 8.20
Composite: delays in care 18.70 13.05 23.26 25.99 36.80 30.41 33.09 11.71 17.52 12.64 14.82
Patient-Centeredness of Care
Provider listened 91.88 91.52 91.05 87.05 85.45 * 91.84 95.31 91.02 93.76 95.70
Provider explained things 92.49 91.74 92.58 89.76 87.88 * 90.66 95.78 90.36 94.37 96.05
Provider showed respect 92.05 90.67 91.67 90.16 86.69 * 86.96 94.72 92.90 93.54 96.04
Provider spent time 88.06 86.73 87.20 83.97 81.85 * 86.53 92.67 87.46 90.34 92.59
Composite: Patient-centeredness 90.14 89.21 89.84 87.16 84.07 * 88.07 93.51 89.64 92.04 93.58
Effectiveness of Care
Testing of blood pressure 95.74 93.68 96.83 96.92 96.74 83.38 85.26 97.73 97.25 97.62 97.58
Dietary advicec 63.45 69.36 66.63 67.04 66.86 56.47 60.25 57.50 58.77 62.77 56.91
Exercise advicec 63.01 68.27 71.84 63.79 67.31 55.80 65.54 54.49 53.59 58.83 55.88
Testing of blood cholesterolb 93.80 92.97 94.45 93.73 92.43 76.66 79.98 95.97 95.44 96.73 95.68
Influenza shot 51.79 34.66 41.17 47.03 41.63 25.29 27.30 66.44 64.68 72.70 72.66
Timeliness/Accessibility of Care
Delays in medical care 6.76 4.68 7.56 12.05 18.74 19.48 27.43 3.86 5.43 3.58 3.43
Delays in dental care 6.34 3.92 6.91 15.18 18.16 17.34 21.61 4.11 6.16 2.34 4.18
Delays in prescriptions 6.85 4.27 8.03 13.06 18.44 13.68 20.74 4.00 6.39 4.19 4.96
Composite: delays in care 15.12 10.53 17.43 28.31 35.12 30.80 40.66 10.06 14.28 9.24 11.37
Unable to get care for illness/ injury 10.31 9.64 10.76 13.59 17.06 30.67 31.55 6.45 8.57 7.32 4.80
Patient-Centeredness of Care
Provider listened 92.75 93.02 92.35 88.53 85.69 86.21 88.15 94.25 91.70 96.20 94.17
Provider explained things 92.81 93.88 93.99 86.83 86.79 86.17 87.26 93.56 90.72 94.00 93.90
Provider showed respect 93.26 93.82 93.00 88.88 86.84 83.92 87.29 94.89 92.87 95.27 95.26
Provider spent time 89.23 89.80 88.58 83.60 81.79 80.21 83.34 91.40 88.29 92.97 90.89
Composite: Patient-centeredness 91.84 92.47 91.93 86.86 84.85 84.10 86.05 93.36 90.66 94.45 93.30

Proportions are weighted.

aAll quality of care measures indicate care in the past year, unless otherwise noted.

bTesting of blood cholesterol indicates testing in the past two years.

cDietary advice and exercise advice indicates receipt of advice at any time in the past.

* = Data are not statistically reliable (cell size <100 or relative standard error >0.3).

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 14. Logistic Regression Predicting Quality of Care Indicators Among Diabetes Patients, by Patient Age Group, Health Insurance –2006 (n=4,076)

Quality of Care Indicator Adjusted Odds Ratioa (95% CI)
45–64 ≥65
Insurance Status Gender Insurance Status Gender
Any Private Insurance (Ref) Public Insurance Only Uninsured Male (Ref) Female Medicare and Any Private Insurance (Ref) Medicare/Public Insurance Only Male (Ref) Female
Effectiveness of Care
Testing of HbA1c 1.00 0.85 (0.53-1.38) 0.35 (0.22-0.57)* 1.00 1.02 (0.67-1.56) 1.00 1.16 (0.74-1.81) 1.00 1.49 (1.02-2.19)
Testing of blood pressure 1.00 1.37 (0.35-5.37) 0.29 (0.11-0.73) 1.00 2.15 (1.05-4.40) 1.00 1.39 (0.53-3.66) 1.00 1.01 (0.38-2.66)
Testing of blood cholesterolb 1.00 0.49 (0.22-1.12) 0.17 (0.08-0.35)* 1.00 1.68 (1.01-2.77) 1.00 0.60 (0.21-1.67) 1.00 1.05 (0.51-2.16)
Receiving an eye examination 1.00 0.88 (0.64-1.22) 0.46 (0.33-0.63)* 1.00 1.13 (0.91-1.41) 1.00 0.97 (0.75-1.25) 1.00 1.07 (0.84-1.36)
Receiving a foot examination 1.00 1.61 (1.12-2.32) 0.82 (0.57-1.19) 1.00 0.96 (0.73-1.25) 1.00 0.75 (0.54-1.03) 1.00 0.98 (0.75-1.28)
Composite :HbA1c, eye and foot examination 1.00 0.95 (0.67-1.35) 0.60 (0.43-0.84) 1.00 1.17 (0.94-1.46) 1.00 0.91 (0.69-1.2) 1.00 0.99 (0.76-1.29)
Receiving an influenza shot 1.00 1.01 (0.73-1.40) 0.68 (0.48-0.96) 1.00 1.25 (0.99-1.58) 1.00 0.99 (0.71-1.39) 1.00 0.91 (0.7-1.19)
Timeliness/Accessibility of Care
Unable to get care for illness/injury 1.00 0.52 (0.27-0.97) 2.43 (1.22-4.86) 1.00 1.27 (0.76-2.12) 1.00 1.45 (0.71-2.97) 1.00 0.75 (0.42-1.33)
Delays in medical care 1.00 1.79 (1.08-2.97) 2.35 (1.40-3.96)* 1.00 1.98 (1.38-2.84)* 1.00 1.30 (0.75-2.24) 1.00 1.02 (0.64-1.63)
Delays in dental care 1.00 2.92 (1.63-5.21)* 3.60 (2.04-6.36)* 1.00 1.46 (0.99-2.16) 1.00 1.62 (0.90-2.93) 1.00 1.67 (0.99-2.81)
Delays in prescriptions 1.00 1.20 (0.75-1.93) 1.63 (0.98-2.73) 1.00 2.11 (1.47-3.02)* 1.00 1.07 (0.67-1.73) 1.00 1.54 (0.97-2.43)
Composite: Delays in care 1.00 1.85 (1.26-2.72)* 2.37 (1.54-3.67)* 1.00 1.85 (1.39-2.47)* 1.00 1.06 (0.72-1.56) 1.00 1.34 (0.97-1.84)
Provider listened 1.00 0.94 (0.55-1.60) 1.17 (0.61-2.22) 1.00 1.00 (0.68-1.47) 1.00 0.68 (0.41-1.14) 1.00 0.85 (0.54-1.36)
Provider explained things 1.00 1.15 (0.66-2.00) 0.98 (0.56-1.72) 1.00 1.16 (0.79-1.70) 1.00 0.73 (0.43-1.24) 1.00 0.79 (0.51-1.23)
Provider showed respect 1.00 1.12 (0.70-1.82) 0.74 (0.43-1.26) 1.00 1.07 (0.73-1.56) 1.00 0.86 (0.51-1.45) 1.00 1.13 (0.72-1.77)
Provider spent time 1.00 1.02 (0.63-1.63) 0.92 (0.52-1.62) 1.00 1.09 (0.75-1.56) 1.00 0.83 (0.52-1.33) 1.00 0.90 (0.60-1.35)
Composite: Patient-centeredness 1.00 1.04 (0.71-1.52) 0.48 (0.33-0.69)* 1.00 1.22 (0.92-1.61) 1.00 0.99 (0.69-1.42) 1.00 1.12 (0.82-1.52)

Analyses are weighted.

aAll models adjust for patient race/ethnicity, education, income, and self-rated health status.

*P <0.002. Statistically significant results are indicated by bold font

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

 

TABLE 15. Logistic Regression Predicting Quality of Care Indicators Among Cardiovascular Condition Patients, by Patient Age Group, Health Insurance Status and Gender: MEPS 2004–2006 (n=17,636)

Quality of Care Indicator Adjusted Odds Ratioa (95% CI)
45–64 ≥65
Insurance Status Gender Insurance Status Gender
Any Private Insurance (Ref) Public Insurance Only Uninsured Male (Ref) Female Medicare and Any Private Insurance (Ref) Medicare/Public Insurance Only Male (Ref) Female
Effectiveness of Care
Testing of blood pressure 1.00 1.44 (0.96-2.15) 0.28 (0.21-0.37)* 1.00 1.67 (1.35-2.07)* 1.00 0.97 (0.67-1.42) 1.00 0.98 (0.69-1.37)
Dietary advicec 1.00 1.00 (0.82-1.23) 0.69 (0.57-0.84)* 1.00 0.93 (0.85-1.02) 1.00 0.97 (0.85-1.10) 1.00 0.90 (0.80-1.02)
Exercise advicec 1.00 0.79 (0.65-0.95) 0.65 (0.54-0.79)* 1.00 1.21 (1.09-1.35)* 1.00 0.90 (0.79-1.01) 1.00 0.95 (0.86-1.06)
Testing of blood cholesterolb 1.00 1.12 (0.86-1.47) 0.29 (0.23-0.37)* 1.00 1.22 (1.01-1.48) 1.00 0.97 (0.71-1.32) 1.00 0.86 (0.62-1.19)
Influenza shot 1.00 1.22 (1.01-1.48) 0.60 (0.48-0.74)* 1.00 1.26 (1.13-1.41)* 1.00 0.81 (0.68-0.96) 1.00 1.00 (0.90-1.12)
Timeliness/Accessibility of Care
Unable to get care for illness/injury 1.00 0.94 (0.62-1.43) 3.02 (2.15-4.24)* 1.00 1.13 (0.86-1.49) 1.00 1.22 (0.83-1.77) 1.00 0.88 (0.63-1.23))
Delays in medical care 1.00 1.77 (1.34-2.35)* 3.99 (3.09-5.16)* 1.00 1.72 (1.46-2.02)* 1.00 1.36 (1.03-1.80) 1.00 1.15 (0.86-1.53)
Delays in dental care 1.00 2.19 (1.53-3.13)* 3.39 (2.61-4.40)* 1.00 1.56 (1.31-1.86)* 1.00 1.36 (1.00-1.84) 1.00 1.61 (1.25-2.08)*
Delays in prescriptions 1.00 1.48 (1.13-1.93) 2.41 (1.88-3.08)* 1.00 1.84 (1.53-2.22)* 1.00 1.03 (0.78-1.37) 1.00 1.34 (1.07-1.66)
Composite: Delays in care 1.00 1.71 (1.40-2.09)* 2.83 (2.33-3.43)* 1.00 1.72 (1.53-1.94)* 1.00 1.13 (0.92-1.38) 1.00 1.34 (1.16-1.55)*
Patient-Centeredness of Care
Provider listened 1.00 0.72 (0.52-1.00) 0.62 (0.44-0.87) 1.00 0.91 (0.76-1.09) 1.00 0.69 (0.50-0.95) 1.00 0.65 (0.51-0.84)*
Provider explained things 1.00 0.71 (0.52-0.98) 0.56 (0.41-0.78)* 1.00 1.05 (0.85-1.28) 1.00 0.88 (0.66-1.17) 1.00 0.90 (0.70-1.15)
Provider showed respect 1.00 0.75 (0.55-1.02) 0.50 (0.36-0.70)* 1.00 0.91 (0.75-1.11) 1.00 0.81 (0.59-1.12) 1.00 0.89 (0.68-1.16)
Provider spent time 1.00 0.78 (0.58-1.05) 0.62 (0.46-0.82)* 1.00 0.92 (0.78-1.08) 1.00 0.81 (0.63-1.04) 1.00 0.74 (0.61-0.90)
Composite: Patient-centeredness 1.00 1.12 (0.91-1.38) 0.40 (0.33-0.49)* 1.00 1.46 (1.29-1.64)* 1.00 0.93 (0.78-1.11) 1.00 0.86 (0.74-1.00)

Analyses are weighted.
a All models adjust for patient race/ethnicity, education, income, and self-rated health status.
* P <0.003. Statistically significant results are indicated by bold font.

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey.

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