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Measuring the Quality of Care Provided to Community Dwelling Vulnerable Elders Dually Enrolled in Medicare and Medicaid

Zingmond, David S. MD, PhD*; Wilber, Kathleen H. PhD; MacLean, Catherine H. MD, PhDद; Wenger, Neil S. MD, MPH*

doi: 10.1097/MLR.0b013e318127143e
Original Article

Context: Small studies suggest that the quality of healthcare provided to older patients needs improvement. However, measuring the quality of care for larger groups of older adults is difficult.

Objective: To measure the quality of care in a community-dwelling vulnerable geriatric population using administrative data to apply quality indicators (QIs) from the Assessing Care of Vulnerable Elders project.

Design, Setting, and Participants: Cohort study of community-dwelling dual enrollees in Medicare and Medicaid, age 75 years and older, living in 19 California counties in 1999 and 2000.

Main Outcome Measure: Measurement of care provided for 43 QIs by condition (eg, heart failure) and by intervention type (eg, medication use), and identification of care inaccessible to measurement by linked Medicare and Medicaid claims.

Results: A total of 43 out of 230 QIs were captured using linked claims data. The 100,528 patients triggered 930,753 QIs (9.3 QIs/person). The overall QI pass rate (ie, successful receipt of care) was 65%. QIs with the highest pass rates measured avoidance of adverse medications and appropriate medication use. Fewer than half of the QIs were passed for ischemic heart disease, stroke, and osteoporosis. Few QIs aimed at geriatric care could be measured and none assessed counseling, history taking, or information continuity.

Conclusions: The use of claims data-derived quality-of-care process measures is feasible for the vulnerable older population, but requires development of data elements focused on geriatric care. QIs that could be applied to the older patients included in this study identified several areas of care that need improvement.

Supplemental Digital Content is Available in the Text.

From the *Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California; †Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California; ‡RAND Health, Santa Monica, California; §David Geffen School of Medicine at UCLA, Los Angeles, California; and ¶Programs for Clinical Excellence, WellPoint, Inc, Woodland Hills, California.

This research was supported through a NIA Mentored Clinical Scientist Award. The development of this manuscript was supported in part by the California Department of Health and Human Services Office of Long Term Care.

The views expressed in this manuscript are those of the authors and not necessarily those of the California DHHS Office of Long Term Care. This manuscript and its content reflect the views of Dr. MacLean and has not been reviewed or endorsed by her employer, WellPoint, Inc.

Reprints: David S. Zingmond, MD, PhD, Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Los Angeles, CA 90095-1736. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.