A major focus among public health scientists and public policy advocates centers on the quality of care provided across all health care settings. The Institute of Medicine defines quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”1. The morbidity and mortality associated with having a chronic disease may be prevented if the quality of care related to preventive care practices were implemented at the provider, facility and federal level2,3. A recent Centers for Disease Control and Prevention statement outlines those quality indicators which, when implemented, may improve health status4. Such measures include behavior and lifestyle modification and early screening to detect the presence of chronic illness.
There is, however, a paucity of research describing the quality of care offered to a growing, diverse older adult population. This is surprising given the tremendous ethnic and racial demographic changes projected by the Census 2000. African Americans, Hispanics, and Asian Americans comprised 8.4 percent, 12 percent and 7.7 percent (respectively) of the older adult population in the year 2000. By the year 2050 African Americans, Hispanics and Asian Americans will comprise 16.1 percent, 20 percent, and 15 percent (respectively) of the older adult population5. In order to proactively reduce any differences in the quality of care offered to racial and ethnic elders, researchers, health care providers and public policy advocates alike must address the various factors that influence poor quality of care.
One such quality indicator is blood pressure screening. Blood pressure screening in the primary care setting is intended to identify disease, and when hypertension is diagnosed, blood pressure screening is used to evaluate response to therapy. The U.S. Preventive Services Task Force recommends (Grade A) regular blood pressure screening to detect those at high risk of developing hypertension. The evidence suggests that poor health outcomes such as heart disease and stroke can be significantly reduced if high blood pressure is well-controlled even among the very old 6.
Investigators at the Department of Geriatric Medicine and Gerontology at Ohio University have recently undertaken an examination of data from the National Ambulatory Medical Care Survey to address disparities in quality of care among the diverse older U.S. population in the primary setting. The survey is an ideal database for such an endeavor since this national survey collects information related to the use of ambulatory medical care services in the United States and as of 1989 has been collected annually by the CDC.
Our initial findings suggest that non-Hispanic black and Hispanic elders, when compared to non-Hispanic white elders, are more likely to receive blood pressure measurement after adjustment for selected patient, provider and facility characteristics. One potential explanation is that physicians who tend to care for older racial and ethnic minorities may be more vigilant with blood pressure screening because they are aware of the increased incidence and prevalence of hypertension among minority populations. These observed differences in blood pressure measurement persisted among a subset of non-hypertensive elders. An interesting finding is that among the subset of hypertensive older adults, there were no differences in blood pressure measurement between the racial and ethnic groups. Perhaps once diagnosed with hypertension, health care providers are more likely to equally address blood pressure measurement as a necessary guide to treatment response.
Our initial research efforts suggest that there are ethnic/racial differences in the quality of care received by older adults, as indicated by differences in blood pressure measurement. This difference appears to occur only among those without diagnosed illness. Identifying whether these differences are attributable to physician practice or patient preference may help untangle the web of multiple causes leading to disparate care. We welcome any suggestions or comments. Please feel free to e-mail your thoughts or concerns to walkerr@oucom.ohiou.edu.
1. Institute of Medicine: The National Academy of Sciences. http://www.iom.edu. Accessed June 5, 2008.
2. Matson Koffman DM, Lanza A, Campbell KP. A purchaser’s guide to clinical preventive services: a tool to improve health care coverage for prevention. Prev Chronic Dis 2008;5(2). http://www.cdc.gov/pcd/issues/2008/apr/07_0220.htm. Accessed June 6, 2008.
3. Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109:3244-3255.
4. Centers for Disease Control and Prevention. http://cdc.gov/aging. Accessed June 3, 2008.
5. Angel J., Hogan D., Population Aging and Diversity in a New Era. Chapter 1: 1-12. Closing the Gap: Improving the Health of Minority Elders in the New Millennium.
6. Leatherman S., McCarthy D., Quality of Health Care for Medicare Beneficiaries: A Chartbook, 2005. New York, NY: The Commonwealth Fund.
Renee’ Walker, MS, Research Assistant in Minority Aging University of Buffalo and Ohio University, College of Osteopathic Medicine
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Michael P. Gerardo, DO, MPH, Assistant ProfessorDepartment of Geriatric Medicine and GerontologyOhio University, College of Osteopathic Medicine