Dataset Information

Effect of usual source of care on depression among Medicare beneficiaries: an application of a simultaneous-equations model.

ABSTRACT:

Objective

To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly.

Data sources

The 2001-2003 Medicare Current Beneficiaries Survey and 2002 Area Resource File.

Study design

Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question "Is there a particular medical person or a clinic you usually go to when you are sick or for advice about your health?" Ambulatory care use (ACU) was defined by having at least one physician office visit and/or hospital outpatient visit using Medicare claims. Depression was identified by a two-item screen (sadness and/or anhedonia). All measures were for the past 12 months. A simultaneous-equations (trivariate probit) model was estimated, adjusted for sampling weights and study design effects.

Principal findings

Based on the simultaneous-equations model, USOC is associated with 3.8 percent lower probability of having depression symptoms (p=.03). Also, it had a positive effect on having any ACU (p<.001). Having any ACU had no statistically significant effect on depression (p=.96).

Conclusions

USOC was associated with lower depression prevalence and higher realized access (ACU) among community-dwelling Medicare beneficiaries.

SUBMITTER: Li C

PROVIDER: S-EPMC3165178 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Effect of usual source of care on depression among Medicare beneficiaries: an application of a simultaneous-equations model.

Li Chunyu C Dick Andrew W AW Fiscella Kevin K Conwell Yeates Y Friedman Bruce B

Health services research 20110209 4

<h4>Objective</h4>To investigate whether having a usual source of care (USOC) resulted in lower depression prevalence among the elderly.<h4>Data sources</h4>The 2001-2003 Medicare Current Beneficiaries Survey and 2002 Area Resource File.<h4>Study design</h4>Twenty thousand four hundred and fifty-five community-dwelling person-years were identified for respondents aged 65+, covered by both Medicare Parts A and B in Medicare fee-for-service for a full year. USOC was defined by the question "Is the ...[more]

PMID: 21306366

Similar Datasets

Project description:ImportanceSatisfaction with care is associated with improved quality of care and health outcomes. Sensory impairment can be a barrier to effective communication and access to care, and this may result in reduced satisfaction with care.ObjectiveThis study examined the association between sensory impairment and health care satisfaction among Medicare beneficiaries.Design, setting, and participantsThis cross-sectional study used data from the 2017 Medicare Current Beneficiary Survey (MCBS), a nationally representative in-person survey of Medicare beneficiaries. Functional sensory impairment was categorized as no sensory impairment, hearing impairment, vision impairment, and dual sensory impairment. Patient dissatisfaction included responses on quality of care, ease to get to a doctor, out-of-pocket costs paid, information given, and doctors' concern with overall health rather than an isolated symptom or disease.ExposuresSelf-reported functional sensory impairment.Main outcomes and measuresMultivariable-adjusted odds ratios (ORs) of the association between dissatisfaction with care and sensory impairment.ResultsA total of 10 783 respondents representing 44 736 889 Medicare beneficiaries (8944 [85.3%] aged ≥65 years, 5733 [52.9%] women, and 8195 [75.5%] non-Hispanic White) were included. Dual sensory impairment compared with no sensory impairment was associated with the highest odds of dissatisfaction across outcomes, including quality of care (OR, 1.52; 95% CI, 1.12-2.08). Compared with no sensory impairment, having dual sensory impairment (OR, 1.82; 95% CI, 1.40-2.37), hearing impairment (OR, 1.67; 95% CI, 1.29-2.17), or vision impairment (OR, 1.56; 95% CI, 1.18-2.08) were associated with dissatisfaction with the information provided about what was wrong. Those with hearing impairment (OR, 1.38; 95% CI, 1.03-1.86) or dual sensory impairment (OR, 2.03; 95% CI, 1.55-2.66) were more likely to be dissatisfied with doctors' concern with overall health compared with those with no sensory impairment. Having dual sensory impairment or vision impairment only was associated with greater odds of dissatisfaction with ease to get to a doctor (dual sensory: OR, 1.69; 95% CI, 1.24-2.30; vision: OR, 1.63; 95% CI, 1.14-2.31) and out-of-pocket costs paid (dual sensory: OR, 1.27; 95% CI, 1.04-1.54; vision: OR, 1.31; 95% CI, 1.07-1.61).Conclusions and relevanceThese findings contribute to the growing body of literature on sensory impairment and patient satisfaction and have implications for health care system planning and spending to provide patient-centered care for older adults.

Project description:The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care.To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers.Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (?5000 assigned beneficiaries) and Pioneer (?15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics.Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (-$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care.Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where health care providers accepted greater risk.

Dataset Information

Effect of usual source of care on depression among Medicare beneficiaries: an application of a simultaneous-equations model.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

Effect of usual source of care on depression among Medicare beneficiaries: an application of a simultaneous-equations model.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure