Trends in the quality of care and racial disparities in Medicare managed care.
BACKGROUND
Since 1997, all managed-care plans administered by Medicare have reported on quality-of-care measures from the Health Plan Employer Data and Information Set (HEDIS). Studies of early data found that blacks received care that was of lower quality than that received by whites. In this study, we assessed changes over time in the overall quality of care and in the magnitude of racial disparities in nine measures of clinical performance.


METHODS
In order to compare the quality of care for elderly white and black beneficiaries enrolled in Medicare managed-care plans who were eligible for at least one of nine HEDIS measures, we analyzed 1.8 million individual-level observations from 183 health plans from 1997 to 2003. For each measure, we assessed whether the magnitude of the racial disparity had changed over time with the use of multivariable models that adjusted for the age, sex, health plan, Medicaid eligibility, and socioeconomic position of beneficiaries on the basis of their area of residence.


RESULTS
During the seven-year study period, clinical performance improved on all measures for both white enrollees and black enrollees (P<0.001). The gap between white beneficiaries and black beneficiaries narrowed for seven HEDIS measures (P<0.01). However, racial disparities did not decrease for glucose control among patients with diabetes (increasing from 4 percent to 7 percent, P<0.001) or for cholesterol control among patients with cardiovascular disorders (increasing from 14 percent to 17 percent; change not significant, P=0.72).


CONCLUSIONS
The measured quality of care for elderly Medicare beneficiaries in managed-care plans improved substantially from 1997 to 2003. Racial disparities declined for most, but not all, HEDIS measures we studied. Future research should examine factors that contributed to the narrowing of racial disparities on some measures and focus on interventions to eliminate persistent disparities in the quality of care.
Trivedi
Amal N
AN
Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, USA.
Zaslavsky
Alan M
AM
Schneider
Eric C
EC
Ayanian
John Z
JZ
D000368:Aged; D044383:Black People; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards / Q000639:trends; D006278:Medicare / Q000592:standards / Q000639:trends*; D009203:Myocardial Infarction / Q000188:drug therapy / Q000208:ethnology*; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000639:trends; D011787:Quality of Health Care / Q000639:trends*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People; D001741:Black or African American