Recorded presentation

Erica R Brody, MPH and Shulamit Bernard, PhD. Health Care Quality Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, 919-485-2788, ebrody@rti.org

Background: Diabetes is the sixth leading cause of death in the United States and is the leading cause of blindness and renal failure. Clinical research has shown that specific preventive care services can delay the onset of diabetes complications, such as yearly dilated eye exams to identify and treat diabetic retinopathy. We used patient satisfaction data collected with the 2000 National Medicare Fee-for-Service CAHPS® survey and data representing 1999-2001 health care claims for the Medicare Fee-for-Service population to evaluate the relationship between patient satisfaction and clinical measures of health care quality. Study Design: This analysis includes 16,532 diabetic beneficiaries identified by ICD 9 codes. Using ICD-9 and CPT codes, and data from the twelve months preceding the survey response date, we constructed 4 clinical indicators of quality including eye exam, physiological test (including hemoglobin A1c, microalbumin, and cholesterol), diabetic education and self blood glucose monitoring, and disease progression. In addition, estimated case-mix adjusted means for 5 CAHPS^TM measures, were constructed using the CAHPS Macro version 3.4. The case-mix adjusted means were stratified by the clinical quality indicators and two-sample tests for mean differences were performed. Due to large sample sizes the Gaussian distribution was assumed. Results: We found no differences in mean CAHPS scores among beneficiaries experiencing disease progression. Having a diabetes-related physiological exam (such as Hemoglobin A1c) is associated with higher mean CAHPS scores for the three composites estimated (Getting Care Quickly, Good Communication, and Getting Needed Care) as well as the two ratings estimated (Rate Plan and Rate Health Care). Beneficiaries having an eye exam report higher mean scores for the two ratings and the getting needed care composite while the self care indicator is associated only with higher plan ratings. Conclusions and Implications: Our findings suggest that overall, diabetic beneficiaries receiving preventive services are more likely to report higher levels of satisfaction and better experience with the Medicare program. Diabetic beneficiaries experiencing worsening of their disease do not differ in their reports of satisfaction or experience. The findings suggest that, among a chronically ill population, subjective ratings and reports are correlated with quality of care as demonstrated by process measures. Further, this analysis suggests that ratings and reports are a direct result of the quality of care received and may be used to monitor clinical quality as well as satisfaction and experience with care.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Describe 4 measures of diabetes health care quality derived from patient claims data.
• Understand the relationship between patient satisfaction as measured by the CAHPS survey and claims-based measures of health care quality among Medicare Fee-for-Service beneficiaries with diabetes.
• Articulate the policy implications of the relationship between patient satisfaction measures and claims-based measures of quality of care.

Keywords: Health Care Quality, Chronic Illness

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation