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Does Quality of Care for Cardiovascular Disease and Diabetes Differ by Gender for Enrollees in Managed Care Plans?

Published:April 19, 2007DOI:https://doi.org/10.1016/j.whi.2007.03.001

      Purpose

      To assess gender differences in the quality of care for cardiovascular disease and diabetes for enrollees in managed care plans.

      Methods

      We obtained data from 10 commercial and 9 Medicare plans and calculated performance on 6 Health Employer Data and Information Set (HEDIS) measures of quality of care (β-blocker use after myocardial infarction [MI], low-density lipoprotein cholesterol [LDL-C] check after a cardiac event, and in diabetics, whether glycosylated hemoglobin [HgbA1c], LDL cholesterol, nephropathy, and eyes were checked) and a 7th HEDIS-like measure (angiotensin-converting enzyme [ACE] inhibitor use for congestive heart failure). A smaller number of plans provided HEDIS scores on 4 additional measures that require medical chart abstraction (control of LDL-C after cardiac event, blood pressure control in hypertensive patients, and HgbA1c and LDL-C control in diabetics). We used logistic regression models to adjust for age, race/ethnicity, socioeconomic status, and plan.

      Main Findings

      Adjusting for covariates, we found significant gender differences on 5 of 11 measures among Medicare enrollees, with 4 favoring men. Similarly, among commercial enrollees, we found significant gender differences for 8 of 11 measures, with 6 favoring men. The largest disparity was for control of LDL-C among diabetics, where women were 19% less likely to achieve control among Medicare enrollees (relative risk [RR] = 0.81; 95% confidence interval [CI] = 0.64–0.99) and 16% less likely among commercial enrollees (RR = 0.84; 95%CI = 0.73–0.95).

      Conclusion

      Gender differences in the quality of cardiovascular and diabetic care were common and sometimes substantial among enrollees in Medicare and commercial health plans. Routine monitoring of such differences is both warranted and feasible.
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      Biography

      Chloe E. Bird, PhD, is a sociologist with interests in gender differences in mental and physical health and health care. She is currently completing a book with Patricia Rieker titled Gender and Health: The Effects of Constrained Choice and Social Policies in which they examine how differences in the social organization of men’s and women’s lives contribute to differences in their health.

      Biography

      Allen M. Fremont, MD, PhD, is a physician, sociologist, and health services researcher. His research focuses on reducing social disparities in and improving overall quality of care.

      Biography

      Arlene S. Bierman, MD, MS, holds the Ontario Women’s Health Council Chair in Women’s Health and is Associate Professor of Medicine; Health Policy, Management and Evaluation: and Nursing at the University of Toronto. She is a Senior Scientist at the Center for Inner City Health Research, St. Michaels Hospital, Toronto.

      Biography

      Steve Wickstrom, MS, is the Senior Director of Research and Development and currently is focusing on health care risk assessment.

      Biography

      Mona Shah, MS, is Research Manager. Her research interests include comparing cost, utilization, and quality for different health plan populations with focus on consumer-driven health plans and managed care plans.

      Biography

      Thomas Rector, PharmD, PhD, currently works as an investigator in a Center for Chronic Disease Outcomes Research.

      Biography

      Thomas Horstman, BS, is a Lead Programmer Analyst specializing in SAS programming for Health Economic & Outcomes Research studies using large, administrative database. His previous work at the Center for Health Care Policy and Evaluation involved HEDIS reporting, cost and utilization reporting, database development, as well as FDA and other government sponsored studies.

      Biography

      José J. Escarce, MD, PhD, is Professor of Medicine at the David Greffen School of Medicine at UCLA and Senior Natural Scientist at RAND. His research addresses racial/ethnic and socioeconomic disparities in health and health care.