Are low-income elderly patients at risk for poor diabetes care?
Are low-income elderly patients at risk for poor diabetes care?
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DOI：
10.2337/diacare.27.5.1060
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发表时间：
2004-05-01
期刊：
影响因子：
16.2
通讯作者：
Barton, P
中科院分区：
文献类型：
--
作者：
McCall, DT;Sauaia, A;Barton, P
目的：糖尿病在低收入老年人、双重资格（DE）医疗保险/医疗补助患者中很常见，导致显著的发病率、死亡率和成本。然而，向这些患者提供的糖尿病护理质量尚未得到评估。本研究的目的是描述为DE患者提供的糖尿病护理的质量，并将其与非DE患者进行比较。研究设计和方法：对1997年1月1日至1998年12月31日期间的行政索赔进行横断面分析，共有9453名年龄在65-75岁之间的糖尿病患者参与了这项研究。这些是科罗拉多州医疗保险按服务收费（FFS）的门诊病人。主要结局指标包括接受每年一次血红蛋白测试、两年一次眼科检查、两年一次血脂测试以及所有这三项护理过程的患者比例。结果：患者平均年龄为71±2.8岁。超过22%的患者被确定为双重资格，并且他们更有可能是年轻，女性和居住在农村地区的少数种族/民族；并且与非de人群相比有合并症。DE患者就诊于初级保健医生、急诊科和住院的次数较多，但就诊于内分泌科的次数较少，DE患者接受年度A - I - c检查（73% vs. 81% P < 0.0001）、两年一次的眼科检查（63% vs. 75% P < 0.0001）和两年一次的脂质检查（43% vs. 57% P < 0.0001）的次数明显较少。与城市非DE患者相比，接受所有三种护理措施的城市DE患者的调整优势比为0.60 （95% CI 0.52-0.69）。少数种族/民族和急诊科使用与未接受糖尿病治疗显著相关，而内分泌科就诊与接受糖尿病治疗的几率增加相关。结论：DE医疗保险/医疗补助状况与未接受糖尿病治疗独立相关，尤其是在城市地区。
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 stud), 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 I 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 Ale 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/ethnicny 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 depart-ments, and hospitalizations but were less likely to visit endocrinologists, DE patients were significantly less likely to receive an annual A I c test (73 vs. 81% P < 0.0001), biennial oph-thalmologic 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.