Background: Good quality health care can improve individual and population health. This study aimed to assess the receipt of effective health care interventions by middle aged and older people with common chronic diseases and health problems. Methods: 119 quality indicators were reviewed by an expert panel. Approved indicators were developed into a structured questionnaire for the English Longitudinal Study of Ageing (ELSA). 8,688 participants aged 50 years and over were interviewed in 2004-5 in England, of whom 4,419 reported diagnoses of one or more of 14 study conditions. Outcome measures were the percentage of indicated interventions received by eligible participants for 39 indicators, and aggregate scores. Receipt of hip or knee joint replacement was analysed as an example ofhow receipt could be compared with need, in 7,101 people aged 60 yrs or older in ELSA 2002-3, and 14,807 adults aged 60 years or over in the USA Health and Retirement Study 19982004. Results: Participants were eligible for 19,450 person-disease level quality indicators, and received 62.4% (95% confidence interval 61.5 to 63.3) of all recommended care items. Receipt of indicated care varied substantially by condition, from warfarin 'monitoring at 100.0% (92.0-100.0) to osteoarthritis at 29.0% (26.0-31.9). Indicators were more likely to be achieved for general medical (75.0%, 73.8-76.3) than geriatric conditions (56.1 %, 54.6-57.7). There were few associations between quality achievement and socio-economic factors. Factors associated with lower likelihood of receipt ofjoint replacements, relative to need, were living in the North, being a woman, or being poorer, in England, and in the USA were being Black or less educated. Interpretation: Deficits in the receipt of effective health care for chronic conditions appeared common. Shortfalls were most marked in areas associated with frailty, but few areas were exempt. Efforts to improve care have substantial scope to achieve better population health.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:490364 |
| Date | January 2008 |
| Creators | Steel, Nicholas |
| Publisher | University of East Anglia |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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