Dataset Information

Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries.

ABSTRACT: Importance:Satisfaction 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. Objective:This study examined the association between sensory impairment and health care satisfaction among Medicare beneficiaries. Design, Setting, and Participants:This 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. Exposures:Self-reported functional sensory impairment. Main Outcomes and Measures:Multivariable-adjusted odds ratios (ORs) of the association between dissatisfaction with care and sensory impairment. Results:A 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 Relevance:These 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.

SUBMITTER: Assi L

PROVIDER: S-EPMC7666423 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries.

Assi Lama L Shakarchi Ahmed F AF Sheehan Orla C OC Deal Jennifer A JA Swenor Bonnielin K BK Reed Nicholas S NS

JAMA network open 20201102 11

<h4>Importance</h4>Satisfaction 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.<h4>Objective</h4>This study examined the association between sensory impairment and health care satisfaction among Medicare beneficiaries.<h4>Design, setting, and participants</h4>This cross-sectional study used data from the 2017 Medicare Current Benefic ...[more]

PMID: 33185678

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Project description:ImportanceCompared with traditional Medicare (TM) fee-for-service plans, Medicare Advantage (MA) plans may provide more-efficient care for beneficiaries with Alzheimer disease and related dementias (ADRD) without compromising care quality.ObjectiveTo determine differences in health care utilization, care satisfaction, and health status for MA and TM beneficiaries with and without ADRD.Design, setting, and participantsA cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019.ExposuresEnrollment in MA.Main outcomes and measuresSelf-reported health care utilization, care satisfaction, and health status.ResultsThe sample included 47 100 Medicare beneficiaries (25 900 women [54.9%]; mean [SD] age, 72.2 [11.4] years). Compared with TM beneficiaries with ADRD, MA beneficiaries with ADRD had lower utilization across the board, including a mean of -22.3 medical practitioner visits (95% CI, -24.9 to -19.8 medical practitioner visits), -2.3 outpatient hospital visits (95% CI, -3.6 to -1.1 outpatient hospital visits), -0.2 inpatient hospital admissions (95% CI, -0.3 to -0.1 inpatient hospital admissions), and -0.1 long-term care facility stays (95% CI, -0.2 to -0.1 long-term care facility stays). A similar trend was observed among beneficiaries without ADRD, but the difference was greater between MA and TM beneficiaries with ADRD than between MA and TM beneficiaries without ADRD (mean, -15.0 medical practitioner visits [95% CI, -18.7 to -11.3 medical practitioner visits], -1.7 outpatient hospital visits [95% CI, -3.0 to -0.3 outpatient hospital visits], and -0.1 inpatient hospital admissions [95% CI, -1.0 to 0.0 inpatient hospital admissions]). Overall, no or negligible differences were detected in care satisfaction and health status between MA and TM beneficiaries with and without ADRD.Conclusions and relevanceCompared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.

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

Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries.

Publications

Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries.

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