Quality Improvement

Patient-Centered Medical Home Implementation in Indian Health Service Direct Service Facilities

This report summarizes strategies Indian Health Service (IHS) clinics have used to implement the Patient-Centered Medical Home (PCMH) model of care, challenges they faced during implementation, and lessons learned that might benefit IHS clinics that have not yet received PCMH recognition. Common strategies to address challenges include use of te

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Rural Hospital Participation and Performance in Value-Based Purchasing and Other Delivery System Reform Initiatives

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

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

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 6.0 References

Adams AS, Trinacty CM, Zhang F, Kleinman K, Grant RW, Meigs JB, Soumerai SB, Ross-Dignan D. Medication adherence and racial differences in A1c control. Diabetes Care. 2008;31:916-921. Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. National Healthcare Quality Report, 2008. (2008). Available onlin

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 5.3 Implications and Recommendations

Efforts are needed to address persistent disparities in care based on race/ethnicity, socioeconomic status and gender, and for subgroups at particular risk.

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 5.2 Key Findings on Disparities in Care for Older Adults

To fill the gap in the literature about consistent disparities in quality of care for midlife vs. older adults, we conducted new analyses, taking advantage of a large, nationally representative sample of Americans evaluated in the MEPS. Analyses showed that racial/ethnic differences were prominent for effectiveness measures, with results favoring

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 5.1 Challenges in Assessing Disparities in Quality of Care for Older Adults

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 adu

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 5.0 Summary and Recommendations

This report developed a conceptual model for assessing quality of care disparities among midlife and older adults; summarized key literature findings on quality of care for diabetes, cardiovascular conditions and depression; and conducted quantitative analyses to address disparities in care among midlife and older adults with diabetes and cardiova

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 4.4 Discussion

The analysis sought to describe the relationship between health insurance coverage and the quality of care that men and women experience. The most significant, consistent findings were related to access to care. For the most part, women were significantly more likely than men to report delays in care. Differences were exhibited among midlife adult

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 4.3 Results

Table 11 shows the distribution of the key independent variables of interest among the study population. To facilitate the multivariate analyses, only persons with complete data on all analytic variables were included in the study sample (hence, the sample for this analysis differs from the previous analysis reported in Chapter 3.0, which did not

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 4.2 Methods

Nationally representative MEPS data were used to examine the relationship of age, gender and insurance status to quality of care among Americans with diabetes and cardiovascular conditions. Persons with missing education or insurance status data were excluded from the analysis (6 percent each for the diabetes and cardiovascular condition populatio

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 4.1 Background

Collectively, diabetes and cardiovascular disease account for nearly 30 percent of all deaths in the U.S. and an estimated $623 billion in direct and indirect medical costs (AHRQ 2008; CDC 2009). These diseases are among the most prevalent chronic conditions in midlife and older adult populations 45 and older. Their impact on overall health and di

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 4.0 Association of Delays, Effectiveness and Patient-Centeredness in Health Care With Age, Gender and Insurance Status Among Americans With Diabetes and Cardiovascular Conditions

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 3.4 Discussion

Although analysis results did not exhibit consistent patterns, several findings are worth noting. The most consistent finding was related to access to care. Women more often reported experiencing one or more delays in care compared to men, and delays were significantly more common among the 45–64 age groups than in the ≥65 age group. These fin

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 3.3 Results

Sociodemographic Characteristics of Midlife and Older Adults With Diabetes and Cardiovascular Conditions

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 3.2 Methods

Data

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 3.1 Background

Although disparities in the use of health services by race and income have diminished since Medicare's implementation, recent studies suggest that marked health care disparities persist among Medicare beneficiaries. Racial/ethnic minority beneficiaries fare worse than their White counter-parts on numerous measures of health status and care. For ex

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 3.0 Disparities in Diabetes and Cardiovascular Quality of Care: An Evaluation of Adults Ages 45–64 vs. the 65 and Older Population

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). Summary

This targeted review of the literature offers several key conclusions:

Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 2.6 Interventions to Reduce Disparities in Diabetes and Other Priority Conditions (Cardiovascular Disease and Depression)

Despite the overarching goal of Healthy People 2010—to reduce or eliminate disparities by 2010 (U.S. Department of Health and Human Services 2000a)—most disparity studies do not explicitly address the reasons for disparities in health care. There are suggestions that the provision of lower quality of care could be an important influence in dis

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