Association of Quality of Care with Survival of Elderly Managed Care Patients

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The summary below is from the full report titled "Quality of Care Is Associated with Survival in Vulnerable Older Patients." It is in the 16 August 2005 issue of Annals of Internal Medicine (volume 143, pages 274-281). The authors are T. Higashi, P.G. Shekelle, J.L. Adams, C.J. Kamberg, C.P. Roth, D.H. Solomon, D.B. Reuben, L. Chiang, C.H. MacLean, J.T. Chang, R.T. Young, D.M. Saliba, and N.S. Wenger.

What is the problem and what is known about it so far?

Evaluations of the quality of medical care often focus on processes of care, such as how often patients receive certain tests or treatments. Some people believe that a better way to measure quality of care would be to look at patient outcomes, such as how often they become sick enough to need hospitalization or how long they live. Unfortunately, it is often more difficult to measure patient outcomes than to measure processes of care. First, measuring patient outcomes requires following the patient for a long period of time. Second, patient outcomes depend on other factors, such as patient age or their baseline level of health, in addition to the quality of the medical care they receive. Theoretically, there should be a link between recommended processes of care and outcomes (such as patient survival), but few studies have examined this link.

Why did the researchers do this particular study?

To see whether patients who received higher-quality care lived longer than similar patients who received lower-quality care.

Who was studied?

372 patients who were at least 65 years of age and were enrolled in 1 of 2 managed care organizations from July 1, 1998, through July 31, 1999. All patients lived in the community but were at high risk for worsening health over the next 2 years.

How was the study done?

The researchers used a set of 236 measures of quality of care that their group had developed for use in older patients. The measures were process-of-care measures, meaning that they looked at whether the patient had received a certain test, screening, or treatment. Every quality-of-care measure did not apply to every patient. For example, the quality-of-care measures for high blood pressure applied only to patients who had high blood pressure. The researchers reviewed patients' medical records to determine the number of applicable quality-of-care measures met for each patient and followed patients for 3 years to see whether patients died. They looked for a relationship between the number of quality-of-care measures met and whether a patient was alive after 3 years.

What did the researchers find?

The researchers found that the fewer quality-of-care measures that a patient's care met, the more likely a person was to die during the 3 years of follow-up.

What were the limitations of the study?

This study cannot prove that poor quality of care causes death. Health care providers may have refrained from providing some types of care to patients who had a high chance of dying or to patients who declined some types of care.

What are the implications of the study?

This study suggests that, in older patients at high risk for worsening health, better performance on process measures of quality of care are associated with better patient survival.