Lower Quality Medical Care Linked to Early Death Among Older Patients at Risk of Declining Health
RAND Office of Media Relations
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August 15, 2005
Older patients at risk of declining health who received lower quality medical care were more likely to die after three years than peers who received higher quality health care, according to a study issued today by researchers from the RAND Corporation and UCLA.
The study is the first to link a comprehensive set of measures of the quality of medical care with whether older patients are likely to live or die. The findings are published in the Aug. 16 edition of the Annals of Internal Medicine.
“Providing care consistent with professional standards may make a significant difference for vulnerable elders,” said Dr. Neil Wenger, a RAND researcher and professor of medicine at UCLA's David Geffen School of Medicine. “Our study shows that deficits in the provision of needed care translate into serious consequences for the elderly.”
Researchers from RAND Health and their colleagues found that among those patients who received more recommended care, 18 percent died after three years, while 28 percent of those who received less care had died after three years.
Overall, the study found that patients received only 53 percent of the care recommended for 22 common medical conditions.
Although there has been much research examining whether patients receive recommended medical care, few studies have linked lower scores on broad measurements of medical quality to poor outcomes among patients, according to researchers.
“These findings strongly suggest that poor care may be responsible for unnecessary deaths among vulnerable older patients,” said study lead author Dr. Takahiro Higashi, now of Kyoto University School of Medicine in Japan.
The results are the latest findings from a project called Assessing the Care of Vulnerable Elders (ACOVE), an effort to examine the quality of health care provided to vulnerable older Americans who live independently. The project is a partnership between RAND Health and Pfizer Inc.
Previous findings from ACOVE showed that older patients who are at risk of declining health receive only a portion of the medical care recommend by experts, and receive medications recommended for their ailments only half of the time.
In the latest phase of the research, researchers studied a group of 372 elderly patients enrolled in two managed health care plans, judging the quality of their health care over a 13-month period. Patients were followed for three years to see whether the quality measures related to their survival.
Dividing the patients into two groups — those who received more recommended care and those who received less care — researchers found that those who received less care were significantly more likely to die during the three-year follow-up period.
Researchers found no evidence that patients who received less care were sicker at the outset of the study, one reason physicians could provide less care since sicker patients might be viewed as having a terminal illness.
“This study provides more evidence that improving the quality of care for older patients can extend patients' lives,” said Robin Hertz, Ph.D., an epidemiologist who heads Pfizer's work on ACOVE. “The challenge now is to take this and other studies about the quality of health care and make changes that will improve and extend patients' lives.”
Researchers say the study not only provides a tool to help judge the quality of medical care, but should be used to improve medical care for elderly patients.
“An important next step is to evaluate whether interventions can be implemented that improve the delivery of care to vulnerable older patients, and whether these improvements lead to longer survival,” said study co-author Dr. Paul G. Shekelle of RAND and the Greater Los Angeles VA Healthcare System.
ACOVE is an eight-year collaboration between RAND and Pfizer Inc. that is developing and testing quality indicators to create a comprehensive geriatric assessment system to inform health care providers and aid consumers.
“We are proud of our long-term partnership with RAND, which has produced many important insights on how quality of care impacts health outcomes for older adults and has led to longer and healthier lives for our parents and grandparents,” said Pat Kelly, president of Pfizer US Pharmaceuticals. “As initiatives such as ACOVE demonstrate the enormous benefits of focusing on healthcare quality, it is also critical to focus on how to maximize the impact of these advances.
“The enabling power of health information technology can help bring the benefit of ACOVE quality standards to more older adults, all as part of a larger effort to help transform America's healthcare system from one focused on acute care to one based on the more clinically and economically effective wellness and prevention approach.”
The quality of medical care given to older patients was judged by assessing more than 200 indicators of quality devised for 22 different conditions, including ailments such as pneumonia, heart disease, malnutrition, falls and mobility disorders, and urinary incontinence.
The patients studied all were identified as having health problems that make them vulnerable to losing their independence and ability to carry out daily activities. About one-third of senior citizens in the United States fall into the vulnerable category.
Other authors of the report are John L. Adams, Caren J. Kamberg and Carol P. Roth, all of RAND; Dr. David H. Solomon, of UCLA's David Geffen School of Medicine and RAND; Dr. David B. Reuben, Dr. Lillian Chiang, Dr. John T. Chang and Dr. Roy T. Young, all of UCLA's David Geffen School of Medicine; and Dr. Catherine H. MacLean and Dr. Debra M. Saliba of the Great Los Angeles VA Healthcare System and RAND.
RAND Health is the nation's largest independent health policy research organization, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.
Pfizer Inc discovers, develops, manufactures and markets leading prescription medicines, for humans and animals, and many of the world's best-known consumer brands.
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