Differences in quality of care for hospitalized elderly men and women.
OBJECTIVE
To analyze whether important gender differences exist in the quality of hospital care provided to patients with four major medical conditions.


METHODS
Bivariate and multivariate comparisons of clinically detailed sickness at admission, quality, utilization, and outcome measures.


METHODS
Acute care hospitals located in five states.


METHODS
A total of 11,242 patients 65 years or older who were hospitalized with one of four diseases: congestive heart failure, acute myocardial infarction, pneumonia, and cerebrovascular accident. We derived our data from the nationally representative sample used to study the quality of hospital care for Medicare patients before and after the implementation of the prospective payment system. A hierarchical (nested) cluster sampling design was used to draw disease-specific samples of patients hospitalized in 1981, 1982, 1985, or 1986 in one of 297 hospitals located in 30 areas within five states.


METHODS
This was an observational study.


METHODS
Sickness at admission, process, use rates, length of stay, discharge status, discharge destination, and mortality.


RESULTS
Sex differences in sickness at admission varied by disease. There was some evidence that women received worse process of care, but the difference was very small. We found many similarities in the process and outcomes of care for male and female patients.


CONCLUSIONS
After controlling for sickness at admission, age, and other important covariates, the in-hospital experiences of elderly men and women showed greater similarities than differences. The concern that sex bias enters into clinical decision making during hospitalization is eased, although not entirely eliminated.
Pearson
M L
ML
Health Program of RAND, Santa Monica, CA 90407-2138.
Kahn
K L
KL
Harrison
E R
ER
Rubenstein
L V
LV
Rogers
W H
WH
Brook
R H
RH
Keeler
E B
EB
D000368:Aged; D002561:Cerebrovascular Disorders / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006333:Heart Failure / Q000628:therapy; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection; D011014:Pneumonia / Q000628:therapy; D011445:Prospective Payment System; D012044:Regression Analysis; D012494:Sampling Studies; D015983:Selection Bias; D012737:Sex Factors; D014481:United States