Background Since 1997, all managed-care plans administered byMedicare have reported on quality-of-care measures from theHealth Plan Employer Data and Information Set (HEDIS). Studiesof early data found that blacks received care that was of lowerquality than that received by whites. In this study, we assessedchanges over time in the overall quality of care and in themagnitude of racial disparities in nine measures of clinicalperformance.
Methods In order to compare the quality of care for elderlywhite and black beneficiaries enrolled in Medicare managed-careplans who were eligible for at least one of nine HEDIS measures,we analyzed 1.8 million individual-level observations from 183health plans from 1997 to 2003. For each measure, we assessedwhether the magnitude of the racial disparity had changed overtime with the use of multivariable models that adjusted forthe age, sex, health plan, Medicaid eligibility, and socioeconomicposition of beneficiaries on the basis of their area of residence.
Results During the seven-year study period, clinical performanceimproved on all measures for both white enrollees and blackenrollees (P<0.001). The gap between white beneficiariesand black beneficiaries narrowed for seven HEDIS measures (P<0.01).However, racial disparities did not decrease for glucose controlamong patients with diabetes (increasing from 4 percent to 7percent, P<0.001) or for cholesterol control among patientswith cardiovascular disorders (increasing from 14 percent to17 percent; change not significant, P=0.72).
Conclusions The measured quality of care for elderly Medicarebeneficiaries in managed-care plans improved substantially from1997 to 2003. Racial disparities declined for most, but notall, HEDIS measures we studied. Future research should examinefactors that contributed to the narrowing of racial disparitieson some measures and focus on interventions to eliminate persistentdisparities in the quality of care.
Source Information
From the Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital (A.N.T., E.C.S., J.Z.A.); the Department of Health Care Policy, Harvard Medical School (A.N.T., A.M.Z., J.Z.A.); and the Department of Health Policy and Management, Harvard School of Public Health (E.C.S., J.Z.A.) — all in Boston.
Address reprint requests to Dr. Ayanian at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, or at ayanian{at}hcp.med.harvard.edu.
Trends in Racial Disparities in Care
Kuller L. H., Freedman B. I., Wagenknecht L. E., Bowden D. W., Keppel K. G., Pearcy J. N., Weissman J. S., Akpunonu B. E., Mutgi A. B., Khuder S. A., Vaccarino V., the National Registry of Myocardial Infarction Investigators , Jha A. K., Epstein A. M., Orav E. J., Trivedi A. N., Zaslavsky A. M., Ayanian J. Z.
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N Engl J Med 2005;
353:2081-2085, Nov 10, 2005.
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