Are Low-Income Elderly Patients at Risk for Poor Diabetes Care?
- Daniel T. McCall, MD, MSPH1,
- Angela Sauaia, MD, PHD2,
- Richard F. Hamman, MD, DRPH3,
- Jane E. Reusch, MD4 and
- Phoebe Barton, PHD3
- 1Colorado Foundation for Medical Care, Denver, Colorado
- 2Division of Health Care Policy and Research, Denver, Colorado
- 3Department of Preventive Medicine and Biometrics, University of Colorado Health Science Center, Denver, Colorado
- 4Department of Medicine, University of Colorado Health Science Center, Denver, Colorado
- Address correspondence and reprint requests to Daniel T. McCall, MD, Colorado Foundation for Medical Care, P.O. Box 17300, Denver, CO. E-mail: copro.dmccall{at}sdps.org
Abstract
OBJECTIVE—Diabetes is common among low-income elderly, dual-eligible (DE) Medicare/Medicaid patients resulting in significant morbidity, mortality, and cost. However, the quality of diabetes care delivered to these patients has not been evaluated. The aims of this study were to describe the quality of diabetes care provided to DE patients and compare it with non-DE patients.
RESEARCH DESIGN AND METHODS—This was a cross-sectional analysis of administrative claims from 1 January 1997 through 31 December 1998. A total of 9,453 patients aged 65–75 years with diabetes participated in the study. These were Colorado Medicare fee-for-service (FFS) outpatients. The main outcome measures consisted of a proportion of patients receiving an annual hemoglobin A1c test, biennial eye examination, biennial lipid test, and all three of these care processes.
RESULTS—The mean patient age was 71 ± 2.8 years. Over 22% of patients were identified as dual eligible, and they were significantly more likely to be younger, female, and of minority race/ethnicity; reside in a rural location; and have comorbid conditions compared with the non-DE population. DE patients had more visits to primary care physicians, emergency departments, and hospitalizations but were less likely to visit endocrinologists. DE patients were significantly less likely to receive an annual A1c test (73 vs. 81%; P < 0.0001), biennial ophthalmologic examination (63 vs. 75%; P < 0.0001), and biennial lipid testing (43 vs. 57%; P < 0.0001). The adjusted odds ratio of urban DE patients receiving all three care measures was 0.60 (95% CI 0.52–0.69) compared with urban non-DE patients. Minority race/ethnicity and emergency department use were significantly associated with not receiving diabetes care, whereas endocrinology visits were associated with an increased odds of receiving diabetes care.
CONCLUSIONS—DE Medicare/Medicaid status was independently associated with not receiving diabetes care, especially among those in urban areas.
- ALOS, average length of stay
- CADG, collapsed ambulatory diagnosis group
- DE, dual eligible
- FFS, fee-for-service
Footnotes
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D.T.M. is a paid consultant for Novo Nordisk. J.E.R. is on the advisory board for GSK, Aventis, Merck, Takeda, Pfizer, and Novartis; has received consulting fees from GSK, Merck, Novartis, Takeda, and Pfizer; and has received research support from GSK, Merck, Takeda, Pfizer, and Aventis.
The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, neither does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted February 3, 2004.
- Received October 13, 2003.
- DIABETES CARE
