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Medicare News
Senior Citizen Patients in Medicare, Medicaid Not
Receiving Quality Care
Elderly patients not given full range of treatments
and services for their conditions
 Oct. 17, 2007 - If the care received by vulnerable
older people concurrently enrolled in Medicare and Medicaid was
evaluated on a grading scale, it would squeak by with a barely passing
mark, a new UCLA study has found. They found that vulnerable
elderly patients received only 65 percent of the tests and other
diagnostic evaluations and treatments recommended for a variety of
illnesses and conditions, including diabetes and heart disease.
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The study, using quality-of-care measurements
developed by the Assessing Care of Vulnerable Elders (ACOVE) project,
appears in the October issue of the peer-reviewed journal Medical Care.
"Thirty-five percent of the medical care
interventions that they should have received were not provided,
indicating significant room for improvement," said lead author Dr. David
S. Zingmond, assistant professor of general internal medicine and health
services research at the David Geffen School of Medicine at UCLA.
"We'd much rather have everything higher say, at
least 90 percent."
The researchers based their work on linked Medicare
and Medicaid claims data something that is not routinely done.
"Going forward, measures like these will be
increasingly important because more detailed health care information,
such as electronic health records, are difficult to obtain," Zingmond
said.
The researchers gathered data from 100,258
community-dwelling geriatric patients in 19 California counties between
1999 and 2000. All the patients were enrolled in both Medicare and
Medicaid.
The mean age of participants was 81, 70 percent
were women, 45 percent were non-Hispanic whites, 26 percent were Asian,
9 percent were African American, 13 percent were Hispanic and 7 percent
were of unknown race or ethnicity.
"Vulnerable elders" are defined as geriatric
patients who are at increased risk of death or functional decline.
Using linked Medicare and Medicaid data from the
California Center for Long Term Care Integration - a collaborative
effort between the UCLA Division of Geriatrics and the University of
Southern California School of Gerontology - researchers examined quality
for 43 specific types of care (for example, receiving a new medication
or having a diagnostic test) for common conditions such as depression,
diabetes, hypertension and heart failure.
They found that in too many instances, elderly
patients were not given the full range of treatments and services for
their conditions.
For example, only 42 percent of patients with
diabetes were tested to gauge their blood sugar control or received an
eye examination during the one-year study period. Likewise, many
patients who were newly diagnosed with heart failure did not receive
recommended diagnostic evaluations or medications known to be effective.
In the absence of electronic medical records, the
use of administrative data such as those on which the researchers based
their work can be a gauge of the quality of some important aspects of
care for elderly patients, Zingmond said.
"The Medicare and Medicaid administrative data
contain information on many aspects of the care that these patients
receive," he said. "This type of monitoring is both feasible and
necessary."
Other researchers on the study included Neil S.
Wenger of the David Geffen School of Medicine at UCLA; Catherine H.
MacLean of WellPoint Inc.'s Programs for Clinical Excellence; and
Kathleen H. Wilbur of the University of Southern California.
The study was funded by a Mentored Clinical
Scientist Award from the National Institute on Aging and by the
California Department of Health and Human Services Office of Long Term
Care.
Source:
University of California, Los Angeles (UCLA), Health
Sciences
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