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Dissatisfaction with medical services among medicare beneficiaries with disabilities

  • Amitabh Jha
    Affiliations
    Craig Hospital, Denver Health Medical Center, and Department of Rehabilitation Medicine, University of Colorado, Denver, CO (Jha); Departments of Health Services (Patrick, Doctor) and of Rehabilitation Medicine (Patrick, Doctor, Chan), University of Washington; and Division of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Region 10 (Chan, MacLehose), Seattle, WA.
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  • Donald L. Patrick
    Affiliations
    Craig Hospital, Denver Health Medical Center, and Department of Rehabilitation Medicine, University of Colorado, Denver, CO (Jha); Departments of Health Services (Patrick, Doctor) and of Rehabilitation Medicine (Patrick, Doctor, Chan), University of Washington; and Division of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Region 10 (Chan, MacLehose), Seattle, WA.
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  • Richard F. MacLehose
    Affiliations
    Craig Hospital, Denver Health Medical Center, and Department of Rehabilitation Medicine, University of Colorado, Denver, CO (Jha); Departments of Health Services (Patrick, Doctor) and of Rehabilitation Medicine (Patrick, Doctor, Chan), University of Washington; and Division of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Region 10 (Chan, MacLehose), Seattle, WA.
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  • Jason N. Doctor
    Affiliations
    Craig Hospital, Denver Health Medical Center, and Department of Rehabilitation Medicine, University of Colorado, Denver, CO (Jha); Departments of Health Services (Patrick, Doctor) and of Rehabilitation Medicine (Patrick, Doctor, Chan), University of Washington; and Division of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Region 10 (Chan, MacLehose), Seattle, WA.
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  • Leighton Chan
    Affiliations
    Craig Hospital, Denver Health Medical Center, and Department of Rehabilitation Medicine, University of Colorado, Denver, CO (Jha); Departments of Health Services (Patrick, Doctor) and of Rehabilitation Medicine (Patrick, Doctor, Chan), University of Washington; and Division of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Region 10 (Chan, MacLehose), Seattle, WA.
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      Abstract

      Jha A, Patrick DL, MacLehose RF, Doctor JN, Chan L. Dissatisfaction with medical services among Medicare beneficiaries with disabilities. Arch Phys Med Rehabil 2002;83:1335-41. Objective: To test the hypothesis that Medicare beneficiaries who have difficulties performing activities of daily living (ADLs) are more likely to report dissatisfaction with their health care than those without ADL difficulties. Design: Cross-sectional study. Setting: Sample from the 1998 Medicare Current Beneficiaries Survey. Participants: A population-based sample (N=19,650) of noninstitutionalized Medicare beneficiaries. Interventions: Not applicable. Main Outcome Measures: Satisfaction with overall quality and 9 specific aspects of medical services received in the last year. Results: After adjusting for sociodemographic, behavioral, and system characteristics and compared with those without ADL difficulties, Medicare enrollees were more likely to report dissatisfaction with the overall quality of their health care as their number of activity restrictions increased (1–2 ADLs: odds ratio [OR]=1.5; 95% confidence interval [CI], 1.2–2.0; 3–4 ADLs: OR=1.7; 95% CI, 1.2–2.4; 5–6 ADLs: OR=1.9; 95% CI, 1.4–2.8). Analysis of satisfaction with the 9 specific aspects of care yielded similar results. Conclusion: Disability is a significant independent risk factor for dissatisfaction with health care in the Medicare population. Efforts should be made to identify individuals with ADL difficulties and to improve their ease and convenience of getting to a doctor, the availability of care off hours, the access to specialists, and the follow-up care received. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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