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Multiple Risk Factors and the Likelihood of Patient-Physician Communication and Health Maintenance Services in Medicare Health Plans

Ng, Judy H. PhD; Scholle, Sarah Hudson DrPH; Kong, Vivian W. MPH; Pawlson, L. Gregory MD, MPH

The Journal of Ambulatory Care Management: January/March 2013 - Volume 36 - Issue 1 - p 50–60
doi: 10.1097/JAC.0b013e318267473b
Medical Outcomes Survey Part 2

This study examined both individual and combined effects of race, education, and health-based risk factors on health maintenance services among Medicare plan members. Data were from 110 238 elderly completing the 2006 Medicare Health Outcomes Survey. Receipt of recommended patient-physician communication and interventions for urinary incontinence, physical activity, falls, and osteoporosis was modeled as a function of risk factors. Low education decreased the odds of receiving services; poor health increased odds. Race had little effect. Evidence suggested moderation among competing effects. While clinicians target services to most at-risk elderly individuals, patients with low education experience gaps. Synergies among co-occurring risks warrant further research.

The National Committee for Quality Assurance, Washington, DC (Drs Ng and Scholle and Ms Kong); Woodrow Wilson School of Public & International Affairs, Princeton University, Princeton, NJ (Dr Ng); and Blue Cross Blue Shield, Washington, DC (Dr Pawlson).

Correspondence: Judy H. Ng, PhD, The National Committee for Quality Assurance, 1100 13th St, NW, Ste 1000, Washington, DC 20005 (

The authors do not have any conflicts of interest to declare, except for employment by the National Committee for Quality Assurance, which administers the Medicare Health Outcomes Survey for the Centers for Medicare & Medicaid Services. This study was supported by the Centers for Medicare & Medicaid Services, US Department of Health and Human Services (HHSM-500-2004-00015I-0001).

The authors thank Samuel C. Haffer and Sonya Bowen for their leadership and feedback throughout the course of this project. They also acknowledge Janet Holzman, Nkemdiri Iruka, and Lok Wong for their managerial and analytic support. The views expressed in this article are the authors' and do not necessarily represent the views of the US Department of Health and Human Services, or Centers for Medicare & Medicaid Services.

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© 2013 Lippincott Williams & Wilkins, Inc.