Background
Gender disparities in cardiovascular care have been documented in studies of patients,
but little is known about whether these disparities persist among managed health care
plans. This study examined 1) the feasibility of gender-stratified quality of care
reporting by commercial and Medicare health plans; 2) possible gender differences
in performance on prevention and treatment of cardiovascular disease in US health
plans; and 3) factors that may contribute to disparities as well as potential opportunities
for closing the disparity gap.
Methods
We evaluated plan-level performance on Healthcare Effectiveness Data and Information
Set (HEDIS®) measures using a national sample of commercial health plans that voluntarily reported
gender-stratified data and for all Medicare plans with valid member-level data that
allowed the computation of gender-stratified performance data. Key informant interviews
were conducted with a subset of commercial plans. Participating commercial plans in
this study tended to be larger and higher performing than other plans who routinely
report on HEDIS performance.
Results
Nearly all Medicare and commercial plans had sufficient numbers of eligible members
to allow for stable reporting of gender-stratified performance rates for diabetes
and hypertension, but fewer commercial plans were able to report gender-stratified
data on measures where eligibility was based on recent cardiac events. Over half of
participating commercial plans showed a disparity of ≥5% in favor of men for cholesterol
control measures among persons with diabetes and persons with a recent cardiovascular
procedure or heart attack, whereas no commercial plans showed such disparities in
favor of women. These gender differences favoring men were even larger for Medicare
plans, and disparities were not linked to health plan performance or region.
Conclusions and Discussion
Eliminating gender disparities in selected cardiovascular disease preventive quality
of care measures has the potential to reduce major cardiac events including death
by 4,785–10,170 per year among persons enrolled in US health plans. Health plans should
be encouraged to collect and monitor quality of care data for cardiovascular disease
for men and women separately as a focus for quality improvement.
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Biography
Ann F. Chou, PhD, MPH, is an Assistant Professor in the Department of Health Administration and Policy at the University of Oklahoma College of Public Health and College of Medicine. She is a health services researcher whose interests focus on implementation of best practices and quality of care.
Biography
Lok Wong, MHS, is currently a Health Policy doctoral student at Johns Hopkins Bloomberg School of Public Health and previously Senior Health Care Analyst at the National Committee for Quality Assurance. Her work has focused on quality of care among vulnerable populations and development of performance measures.
Biography
Carol S. Weisman, PhD, is Professor of Health Evaluation Sciences and Obstetrics and Gynecology at the Pennsylvania State University College of Medicine. She is a sociologist and health services researcher whose research focuses on women’s health, health care, and health policy.
Biography
Sophia Chan, PhD, is currently pursuing a master’s degree in public health at the Johns Hopkins Bloomberg School of Public Health. Her previous work has focused on survey design and analysis.
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 and Senior Scientist at the Centre for Inner City Health Research, St. Michaels Hospital, Toronto. Her research focuses on improving quality and outcomes of care for older adults with chronic illness.
Biography
Rosaly Correa-de-Araujo, MD, MSc, PhD, is the Director of the Office of the Americas, Office of Global Health Affairs and a cardiovascular pathologist trained at the National Heart, Lung, and Blood Institute. Her main areas of interest include gender-based research and analysis particularly related to chronic diseases, medication use outcomes and safety, and disparities in health care.
Biography
Sarah Hudson Scholle, MPH, DrPH, is Assistant Vice President for Research at the National Committee for Quality Assurance in Washington, DC. She is a health services researcher, and her current research focuses on quality measurement, women’s health, and disparities.
Article info
Publication history
Published online: May 10, 2007
Accepted:
March 22,
2007
Received:
January 12,
2007
Identification
Copyright
© 2007 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.
