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Featured Research
This page features research conducted by RAND Health research staff that has been published in a scholarly journal.Quality of Care Is Associated with Survival in Vulnerable Older Patients
Higashi T, Shekelle PG, Adams JL, Kamberg CJ, Roth CP, Solomon DH, Reuben DB, Chiang L, MacLean CH, Chang JT, Young RT, Saliba DM, Wenger NS. Annals of Internal Medicine, Vol. 143, No. 4, Aug 16 2005, pp. 274-281, w70-w79.
Read article (may require registration or payment on the Annals of Internal Medicine website)
Background
Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent patient outcomes is unclear.
Objective
To examine the link between quality of care that patients received and their survival.
Design, Setting, and Participants
An observational cohort study of patients in two managed care organizations. Participants were community-dwelling high-risk patients aged 65 years or older who were continuously enrolled in the managed care organizations from July 1, 1998 to July 31, 1999.
Measurements
Quality of care received by patients as measured by a set of quality indicators covering 22 clinical conditions and their survival over the following 3 years.
Results
The 372 vulnerable older patients were eligible for a mean of 21 quality indicators (range: 8-54) and received on average 53% of the care processes prescribed in quality indicators (range: 27%-88%). Eighty-six persons (23%) died during 3-year follow-up. There was a graded positive relationship between quality score and 3-year survival. After adjusting for gender, health status, and health service use, quality score was not associated with mortality for the first 500 days but after that a higher quality score was associated with lower mortality (hazard ratio (HR): 0.64 for a 10% higher quality score, 95% CI: 0.49-0.84). The observational design limits causal inference of quality of care on survival.
Conclusions
Better performance on process quality measures is strongly associated with better survival among community-dwelling vulnerable older adults.
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