FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 354:1147-1156 March 16, 2006 Number 11 Next

	Full Text PDF PDA Full Text Supplementary Material Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background American adults frequently do not receive recommended health care. The extent to which the quality of health care varies among sociodemographic groups is unknown.

Methods We used data from medical records and telephone interviews of a random sample of people living in 12 communities to assess the quality of care received by those who had made at least one visit to a health care provider during the previous two years. We constructed aggregate scores from 439 indicators of the quality of care for 30 chronic and acute conditions and for disease prevention. We estimated the rates at which members of different sociodemographic subgroups received recommended care, with adjustment for the number of chronic and acute conditions, use of health care services, and other sociodemographic characteristics.

Results Overall, participants received 54.9 percent of recommended care. Even after adjustment, there was only moderate variation in quality-of-care scores among sociodemographic subgroups. Women had higher overall scores than men (56.6 percent vs. 52.3 percent, P<0.001), and participants below the age of 31 years had higher scores than those over the age of 64 years (57.5 percent vs. 52.1 percent, P<0.001). Blacks (57.6 percent) and Hispanics (57.5 percent) had slightly higher scores than whites (54.1 percent, P<0.001 for both comparisons). Those with annual household incomes over $50,000 had higher scores than those with incomes of less than $15,000 (56.6 percent vs. 53.1 percent, P<0.001).

Conclusions The differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality of health care. Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care.

Source Information

From RAND Health, Santa Monica, Calif. (S.M.A., J.K., J.L.A., C.M.S., S.M., E.A.M.); the Veterans Affairs Greater Los Angeles Health Care System and the Department of Medicine, David Geffen School of Medicine, UCLA — both in Los Angeles (S.M.A.); the Veterans Affairs Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Health Care System, and the Department of Internal Medicine, University of Michigan Medical School — both in Ann Arbor, Mich. (E.A.K.); and the Department of Medicine, Division of Cardiology, University of California, Irvine (S.M.).

Full Text of this Article

Related Letters:

Who Is at Greatest Risk for Receiving Poor-Quality Health Care?
Geiger H. J., Betancourt J. R., Williams D. R., Sherrick R., Sinsky C. A., Asch S. M., Kerr E. A., McGlynn E. A.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:2617-2619, Jun 15, 2006. Correspondence

This article has been cited by other articles:

• Miranda, J., McGuire, T. G., Williams, D. R., Wang, P. (2008). Mental Health in the Context of Health Disparities. Am. J. Psychiatry 165: 1102-1108 [Full Text]  
• Spencer, B. A., Miller, D. C., Litwin, M. S., Ritchey, J. D., Stewart, A. K., Dunn, R. L., Gay, E. G., Sandler, H. M., Wei, J. T. (2008). Variations in Quality of Care for Men With Early-Stage Prostate Cancer. JCO 26: 3735-3742 [Abstract] [Full Text]  
• Wesson, D. E. (2008). Is the Ethnic Disparity in CKD a Symptom of Dysfunctional Primary Care in the US?. J. Am. Soc. Nephrol. 19: 1249-1251 [Full Text]  
• McGuire, T. G., Miranda, J. (2008). New Evidence Regarding Racial And Ethnic Disparities In Mental Health: Policy Implications. Health Aff (Millwood) 27: 393-403 [Abstract] [Full Text]  
• Ben-Shlomo, Y, Naqvi, H, Baker, I (2008). Ethnic differences in healthcare-seeking behaviour and management for acute chest pain: secondary analysis of the MINAP dataset 2002-2003. Heart 94: 354-359 [Abstract] [Full Text]  
• Goodman, D. C., Grumbach, K. (2008). Does Having More Physicians Lead to Better Health System Performance?. JAMA 299: 335-337 [Full Text]  
• Fung, C. H., Lim, Y.-W., Mattke, S., Damberg, C., Shekelle, P. G. (2008). Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care. ANN INTERN MED 148: 111-123 [Abstract] [Full Text]  
• Bernheim, S. M., Ross, J. S., Krumholz, H. M., Bradley, E. H. (2008). Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study. Ann Fam Med 6: 53-59 [Abstract] [Full Text]  
• Berkowitz, D. M., Martin, G. S. (2007). Sepsis and Sex: Can We Look Beyond Our Hormones?. Chest 132: 1725-1727 [Full Text]  
• Millett, C., Saxena, S., Ng, A., Mainous, A. III, Majeed, A. (2007). Socio-economic status, ethnicity and diabetes management: an analysis of time trends using the health survey for England. J Public Health (Oxf) 29: 413-419 [Abstract] [Full Text]  
• Yano, E. M., Simon, B. F., Lanto, A. B., Rubenstein, L. V. (2007). The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration's Quality Transformation. Am. J. Public Health 97: 2151-2159 [Abstract] [Full Text]  
• Adrie, C., Azoulay, E., Francais, A., Clec'h, C., Darques, L., Schwebel, C., Nakache, D., Jamali, S., Goldgran-Toledano, D., Garrouste-Orgeas, M., Timsit, J. F., for the OutcomeRea Study Group, (2007). Influence of Gender on the Outcome of Severe Sepsis: A Reappraisal. Chest 132: 1786-1793 [Abstract] [Full Text]  
• Fiscella, K., Holt, K. (2007). Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States. J Am Board Fam Med 20: 587-597 [Abstract] [Full Text]  
• Ferris, T. G., Vogeli, C., Marder, J., Sennett, C. S., Campbell, E. G. (2007). Physician Specialty Societies And The Development Of Physician Performance Measures. Health Aff (Millwood) 26: 1712-1719 [Abstract] [Full Text]  
• Bloche, M. G. (2007). Consumer-Directed Health Care And The Disadvantaged. Health Aff (Millwood) 26: 1315-1327 [Abstract] [Full Text]  
• Taylor, C. R, Hepworth, J. T, Buerhaus, P. I, Dittus, R., Speroff, T. (2007). Effect of crew resource management on diabetes care and patient outcomes in an inner-city primary care clinic. Qual Saf Health Care 16: 244-247 [Abstract] [Full Text]  
• Feifer, C., Nemeth, L., Nietert, P. J., Wessell, A. M., Jenkins, R. G., Roylance, L., Ornstein, S. M. (2007). Different Paths to High-Quality Care: Three Archetypes of Top-Performing Practice Sites. Ann Fam Med 5: 233-241 [Abstract] [Full Text]  
• Casalino, L. P., Elster, A., Eisenberg, A., Lewis, E., Montgomery, J., Ramos, D. (2007). Will Pay-For-Performance And Quality Reporting Affect Health Care Disparities?. Health Aff (Millwood) 26: w405-w414 [Abstract] [Full Text]  
• Jones, L., Wells, K. (2007). Strategies for Academic and Clinician Engagement in Community-Participatory Partnered Research. JAMA 297: 407-410 [Full Text]  
• LaCivita, C. L. (2007). Improving the quality of care for coronary artery disease. Am J Health Syst Pharm 64: 35-35 [Full Text]  
• Werner, R. M., Bradlow, E. T. (2006). Relationship Between Medicare's Hospital Compare Performance Measures and Mortality Rates. JAMA 296: 2694-2702 [Abstract] [Full Text]  
• Mularski, R. A., Asch, S. M., Shrank, W. H., Kerr, E. A., Setodji, C. M., Adams, J. L., Keesey, J., McGlynn, E. A. (2006). The Quality of Obstructive Lung Disease Care for Adults in the United States as Measured by Adherence to Recommended Processes. Chest 130: 1844-1850 [Abstract] [Full Text]  
• Gorin, S. S., Heck, J. E., Cheng, B., Smith, S. J. (2006). Delays in breast cancer diagnosis and treatment by racial/ethnic group.. Arch Intern Med 166: 2244-2252 [Abstract] [Full Text]  
• Hicks, L. S., O'Malley, A. J., Lieu, T. A., Keegan, T., Cook, N. L., McNeil, B. J., Landon, B. E., Guadagnoli, E. (2006). The Quality Of Chronic Disease Care In U.S. Community Health Centers. Health Aff (Millwood) 25: 1712-1723 [Abstract] [Full Text]  
• Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., Ayanian, J. Z. (2006). Relationship between quality of care and racial disparities in medicare health plans.. JAMA 296: 1998-2004 [Abstract] [Full Text]  
• Newton, W. P., DuBard, C. A. (2006). Shaping the Future of Academic Health Centers: The Potential Contributions of Departments of Family Medicine. Ann Fam Med 4: S2-S11 [Abstract] [Full Text]  
• Ruger, J. P. (2006). Measuring disparities in health care.. BMJ 333: 274-274 [Full Text]  
• Geiger, H. J., Betancourt, J. R., Williams, D. R., Sherrick, R., Sinsky, C. A., Asch, S. M., Kerr, E. A., McGlynn, E. A. (2006). Who is at greatest risk for receiving poor-quality health care?. NEJM 354: 2617-2619 [Full Text]  
• Zabel, M R, Stevens, D P (2006). What happens to health care quality when the patient pays?. Qual Saf Health Care 15: 146-147 [Full Text]  
• Tonks, A. (2006). What's new in the other general journals.. BMJ 332: 713-714 [Full Text]