Bird Chloe E, Fremont Allen M, Bierman Arlene S, Wickstrom Steve, Shah Mona, Rector Thomas, Horstman Thomas, Escarce José J
RAND, 1776 Main Street, Santa Monica, CA 90407, USA.
Womens Health Issues. 2007 May-Jun;17(3):131-8. doi: 10.1016/j.whi.2007.03.001. Epub 2007 Apr 16.
To assess gender differences in the quality of care for cardiovascular disease and diabetes for enrollees in managed care plans.
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 (beta-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.
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).
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.
评估管理式医疗计划参保者在心血管疾病和糖尿病护理质量方面的性别差异。
我们从10个商业保险计划和9个医疗保险计划中获取数据，并计算了6项健康雇主数据与信息集（HEDIS）护理质量指标的表现（心肌梗死[MI]后β受体阻滞剂的使用、心脏事件后低密度脂蛋白胆固醇[LDL-C]检查，以及糖尿病患者糖化血红蛋白[HgbA1c]、LDL胆固醇、肾病和眼部是否接受检查）以及第7项类似HEDIS的指标（充血性心力衰竭时血管紧张素转换酶[ACE]抑制剂的使用）。较少数量的计划提供了另外4项需要查阅病历的指标的HEDIS评分（心脏事件后LDL-C的控制、高血压患者的血压控制，以及糖尿病患者的HgbA1c和LDL-C控制）。我们使用逻辑回归模型对年龄、种族/民族、社会经济地位和计划进行调整。
在对协变量进行调整后，我们发现医疗保险参保者中11项指标里有5项存在显著性别差异，其中4项对男性有利。同样，在商业保险参保者中，我们发现11项指标里有8项存在显著性别差异，其中6项对男性有利。最大的差异在于糖尿病患者的LDL-C控制，在医疗保险参保者中，女性达到控制标准的可能性低19%（相对风险[RR]=0.81；95%置信区间[CI]=0.64-0.99），在商业保险参保者中低16%（RR=0.84；95%CI=0.73-0.95）。
在医疗保险和商业健康计划的参保者中，心血管疾病和糖尿病护理质量方面的性别差异很常见，有时还很显著。对此类差异进行常规监测既有必要也可行。
