Elsevier

Women's Health Issues

Volume 17, Issue 3, May–June 2007, Pages 131-138
Women's Health Issues

Article
Does Quality of Care for Cardiovascular Disease and Diabetes Differ by Gender for Enrollees in Managed Care Plans?

https://doi.org/10.1016/j.whi.2007.03.001Get rights and content

Purpose

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 (β-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.

Main Findings

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).

Conclusion

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.

Section snippets

Data and Measures

We obtained 1999 claims and enrollment data from 9 Medicare and 10 commercial plans representing approximately 200,000 Medicare and 2.1 million commercial enrollees in 4 geographic regions. All 19 plans were affiliated with the same national health insurer.

We used the claims and enrollment data to calculate performance rates for 7 quality measures focused on processes of care for patients with CVD and diabetes (Table 1). This set of measures included 6 NCQA HEDIS measures (β-blocker use after

Results

As shown in Table 2, the number of enrollees meeting eligibility criteria varied by measure and insurance type, ranging from 34,981 commercial (45% of whom were women) and 15,252 Medicare (53% of whom were women) enrollees for HgbA1c testing in diabetics to 727 commercial (21% women) and 275 Medicare (40% women) enrollees for β-blocker treatment after MI.

Before adjustment for covariates, gender differences in care were detected for 6 of 11 measures among Medicare enrollees, and for 7 of 11

Discussion

We found gender differences for a variety of quality of care measures for CVD and diabetes among both commercial and Medicare health plan enrollees in a geographically diverse set of health plans associated with 1 national insurer. Gender differences were observed for screening, treatment, and intermediate outcomes. In general, the quality of care was better on process measures than on intermediate outcome measures and the opportunity exists to improve quality of care for both men and women.

Chloe E. Bird, PhD, is a sociologist with interests in gender differences in mental and physical health and health care. She is currently completing a book with Patricia Rieker titled Gender and Health: The Effects of Constrained Choice and Social Policies in which they examine how differences in the social organization of men’s and women’s lives contribute to differences in their health.

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  • Cited by (0)

    Chloe E. Bird, PhD, is a sociologist with interests in gender differences in mental and physical health and health care. She is currently completing a book with Patricia Rieker titled Gender and Health: The Effects of Constrained Choice and Social Policies in which they examine how differences in the social organization of men’s and women’s lives contribute to differences in their health.

    Allen M. Fremont, MD, PhD, is a physician, sociologist, and health services researcher. His research focuses on reducing social disparities in and improving overall quality of care.

    Arlene S. Bierman, MD, MS, holds the Ontario Women’s Health Council Chair in Women’s Health and is Associate Professor of Medicine; Health Policy, Management and Evaluation: and Nursing at the University of Toronto. She is a Senior Scientist at the Center for Inner City Health Research, St. Michaels Hospital, Toronto.

    Steve Wickstrom, MS, is the Senior Director of Research and Development and currently is focusing on health care risk assessment.

    Mona Shah, MS, is Research Manager. Her research interests include comparing cost, utilization, and quality for different health plan populations with focus on consumer-driven health plans and managed care plans.

    Thomas Rector, PharmD, PhD, currently works as an investigator in a Center for Chronic Disease Outcomes Research.

    Thomas Horstman, BS, is a Lead Programmer Analyst specializing in SAS programming for Health Economic & Outcomes Research studies using large, administrative database. His previous work at the Center for Health Care Policy and Evaluation involved HEDIS reporting, cost and utilization reporting, database development, as well as FDA and other government sponsored studies.

    José J. Escarce, MD, PhD, is Professor of Medicine at the David Greffen School of Medicine at UCLA and Senior Natural Scientist at RAND. His research addresses racial/ethnic and socioeconomic disparities in health and health care.

    Supported by contract (#290-00-0012) from the Agency for Healthcare Research and Quality.

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