Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans?
OBJECTIVE
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 (beta-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.


RESULTS
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).


CONCLUSIONS
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.
Bird
Chloe E
CE
RAND, 1776 Main Street, Santa Monica, CA 90407, USA. Chloe_Bird@rand.org
Fremont
Allen M
AM
Bierman
Arlene S
AS
Wickstrom
Steve
S
Shah
Mona
M
Rector
Thomas
T
Horstman
Thomas
T
Escarce
José J
JJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008078:Cholesterol, LDL; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D016017:Odds Ratio; D019984:Quality Indicators, Health Care; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration
D000319:Adrenergic beta-Antagonists; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin