Original research| Volume 100, ISSUE 2, P289-299, February 2019

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Patient Satisfaction and Perceived Quality of Care Among Younger Medicare Beneficiaries According to Activity Limitation Stages

Published:October 11, 2018DOI:



      To examine the association between activity limitation stages and patient satisfaction and perceived quality of medical care among younger Medicare beneficiaries.


      Cross-sectional study.


      Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011.


      A population-based sample (N=9323) of Medicare beneficiaries <65 years of age living in the community.


      Not applicable.

      Main Outcome Measures

      MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physician (PCP), interpersonal skills of PCP, and quality of information provided by PCP. Persons were classified into an activity limitation stage (0-IV) which was derived from self-reported difficulty performing activities of daily living (ADL) and instrumental activities of daily living (IADL).


      Compared to beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (95% confidence intervals) for stage I (mild) to stage IV (complete) for satisfaction with access barriers ranged from 0.62 (0.53-0.72) at stage I to a minimum of 0.31 (0.22-0.43) at stage IV. Similarly, compared to beneficiaries at IADL stage 0, satisfaction with access barriers ranged from 0.66 (0.55-0.79) at stage I to a minimum of 0.36 (0.26-0.51) at stage IV. Satisfaction with care coordination and quality and perceived quality of medical care were not associated with activity limitation stages.


      Younger Medicare beneficiaries with disabilities reported decreased satisfaction with access to medical care, highlighting the need to improve access to health care and human services and to enhance workforce capacity to meet the needs of this patient population.


      List of abbreviations:

      ADL (activities of daily living), IADL (instrumental activities of daily living), MCBS (Medicare Current Beneficiary Survey), PCP (primary care physician)
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        • Donabedian A.
        The quality of care. How can it be assessed?.
        JAMA. 1988; 260: 1743-1748
        • Elliott M.N.
        • Lehrman W.G.
        • Goldstein E.
        • Hambarsoomian K.
        • Beckett M.K.
        • Giordano L.A.
        Do hospitals rank differently on HCAHPS for different patient subgroups?.
        Med Care Res Rev. 2010; 67: 56-73
        • Zolnierek K.B.
        • Dimatteo M.R.
        Physician communication and patient adherence to treatment: a meta-analysis.
        Med Care. 2009; 47: 826-834
        • Trzeciak S.
        • Gaughan J.P.
        • Bosire J.
        • Angelo M.
        • Holzberg A.S.
        • Mazzarelli A.J.
        Association between Medicare star ratings for patient experience and Medicare spending per beneficiary for US hospitals.
        J Patient Exp. 2017; 4: 17-21
        • Bogner H.R.
        • de Vries McClintock H.F.
        • Kurichi J.E.
        • et al.
        Patient satisfaction and prognosis for functional improvement and deterioration, institutionalization, and death among medicare beneficiaries over 2 years.
        Arch Phys Med Rehabil. 2017; 98: 1-10
        • Jha A.
        • Patrick D.L.
        • MacLehose R.F.
        • Doctor J.N.
        • Chan L.
        Dissatisfaction with medical services among Medicare beneficiaries with disabilities.
        Arch Phys Med Rehabil. 2002; 83: 1335-1341
        • Centers for Medicaid and Medicare Services
        Projected Medicare expenditures under an illustrative scenario with alternative payment updates to Medicare providers.
        (Available at:) (Accessed October 10, 2012)
        • Culler S.D.
        • Parchman M.L.
        • Przybylski M.
        Factors related to potentially preventable hospitalizations among the elderly.
        Med Care. 1998; 36: 804-817
        • Lubitz J.
        • Cai L.
        • Kramarow E.
        • Lentzner H.
        Health, life expectancy, and health care spending among the elderly.
        N Engl J Med. 2003; 349: 1048-1055
        • HealthMeasures
        Dynamic tools to measure health from the patient perspective.
        (Available at:) (Accessed January 15, 2010)
        • Kurichi J.E.
        • Kwong P.L.
        • Xie D.
        • Bogner H.R.
        Predictive indices for functional improvement and deterioration, institutionalization, and death among elderly Medicare beneficiaries.
        PM R. 2017; 9: 1065-1076
        • Bogner H.R.
        • de Vries McClintock H.F.
        • Hennessy S.
        • et al.
        Patient satisfaction and perceived quality of care among older adults according to activity limitation stages.
        Arch Phys Med Rehabil. 2015; 96: 1810-1819
        • Iezzoni L.I.
        Quality of care for Medicare beneficiaries with disabilities under the age of 65 years.
        Expert Rev Pharmacoecon Outcomes Res. 2006; 6: 261-273
        • de Vries McClintock H.F.
        • Barg F.K.
        • Katz S.P.
        • et al.
        Health care experiences and perceptions among people with and without disabilities.
        Disabil Health J. 2016; 9: 74-82
        • Centers for Medicare & Medicaid Services
        Medicare Current Beneficiary Survey (MCBS).
        (Available at:) (Accessed July 10, 2014)
        • Centers for Medicare & Medicaid Services
        Medicare Current Beneficiary Survey (MCBS) access to care introduction.
        (Available at:) (Accessed September 21, 2011)
      1. Medicare national coverage determinations manual, chapter 1, part 4 (sections 200-310.1). Coverage determinations (Rev. 135, 09-22-11).
        (Available at:) (Accessed November 20, 2011)
        • Stineman M.G.
        • Henry-Sanchez J.T.
        • Kurichi J.E.
        • et al.
        Staging activity limitation and participation restriction in elderly community-dwelling persons according to difficulties in self-care and domestic life functioning.
        Am J Phys Med Rehabil. 2012; 91: 126-140
        • Stineman M.G.
        • Xie D.
        • Pan Q.
        • Kurichi J.E.
        • Saliba D.
        • Streim J.
        Activity of daily living staging, chronic health conditions, and perceived lack of home accessibility features for elderly people living in the community.
        J Am Geriatr Soc. 2011; 59: 454-462
        • World Health Organization
        International Classification of Functioning, Disability and Health: ICF.
        World Health Organization, Geneva, Switzerland2001
        • Stineman M.G.
        • Streim J.E.
        • Pan Q.
        • Kurichi J.E.
        • Schussler-Fiorenza Rose S.M.
        • Xie D.
        Activity limitation stages empirically derived for activities of daily living (ADL) and instrumental ADL in the U.S. adult community-dwelling Medicare population.
        PM R. 2014; 6 (quiz 987): 976-987
        • Lee Y.
        • Kasper J.D.
        Assessment of medical care by elderly people: general satisfaction and physician quality.
        Health Serv Res. 1998; 32: 741-758
        • Craig B.M.
        • Kreling D.H.
        • Mott D.A.
        Do seniors get the medicines prescribed for them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey.
        Health Aff. 2003; 22: 175-182
        • O'Malley A.S.
        • Forrest C.B.
        • Feng S.
        • Mandelblatt J.
        Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.
        Arch Intern Med. 2005; 165: 2129-2135
        • Chan L.
        • Ciol M.A.
        • Shumway-Cook A.
        • et al.
        A longitudinal evaluation of persons with disabilities: does a longitudinal definition help define who receives necessary care?.
        Arch Phys Med Rehabil. 2008; 89: 1023-1030
        • Belsley D.
        • Kuh E.
        • Welsch R.
        Regression diagnostics.
        John Wiley, New York1980
        • Mason G.
        Coping with collinearity.
        Can J Program Eval. 1987; 2: 87-93
        • Rosenbach M.L.
        Access and satisfaction within the disabled Medicare population.
        Health Care Financ Rev. 1995; 17: 147-167
        • Neuman P.
        • Rowland D.
        • Kitchman M.
        • et al.
        Understanding the diverse needs of the Medicare population: implications for Medicare reform.
        J Aging Soc Policy. 1999; 10: 25-50
        • Cubanski J.
        • Neuman P.
        Medicare doesn’t work as well for younger, disabled beneficiaries as it does for older enrollees.
        Health Aff. 2010; 29: 1725-1733
        • Hermann R.C.
        • Ettner S.L.
        • Dorwart R.A.
        The influence of psychiatric disorders on patients’ ratings of satisfaction with health care.
        Med Care. 1998; 36: 720-727
        • Cubanski J.
        • Neuman T.
        • Damico A.
        Medicare’s role for people under age 65 with disabilities.
        Henry J. Kaiser Foundation Issue Brief, August 2016
        • Copeland S.R.
        • Luckasson R.
        • Shauger R.
        Eliciting perceptions of satisfaction with services and supports from persons with intellectual disability and developmental disabilities: a review of the literature.
        J Intellect Disabil Res. 2014; 58: 1141-1155
        • Stancliffe R.J.
        • Ticha R.
        • Larson S.A.
        • Hewitt A.S.
        • Nord D.
        Responsiveness to self-report interview questions by adults with intellectual and developmental disability.
        Intellect Dev Disabil. 2015; 53: 163-181
        • Horner-Johnson W.
        • Dobbertin K.
        • Lee J.C.
        • Andresen E.M.
        Expert Panel on Disability and Health Disparities. Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.
        Health Serv Res. 2014; 49: 1980-1999
        • Willink A.
        • Schoen C.
        • Davis K.
        How Medicare could provide dental, vision, and hearing care for beneficiaries.
        Issue Brief (Commonw Fund). 2018; 2018: 1-12
        • Mormer E.
        • Cipkala-Gaffin J.
        • Bubb K.
        • Neal K.
        Hearing and health outcomes: recognizing and addressing hearing loss in hospitalized older adults.
        Semin Hear. 2017; 38: 153-159
        • Gichane M.W.
        • Heap M.
        • Fontes M.
        • London L.
        “They must understand we are people”: pregnancy and maternity service use among signing deaf women in Cape Town.
        Disabil Health J. 2017; 10: 434-439
        • Pereira P.C.
        • Fortes P.A.
        Communication and information barriers to health assistance for deaf patients.
        Am Ann Deaf. 2010; 155: 31-37
        • Stineman M.G.
        • Ross R.N.
        • Maislin G.
        Functional status measures for integrating medical and social care.
        Int J Integr Care. 2005; 5: e07
        • Centers for Disease Control and Prevention
        Morbidity and mortality weekly report.
        (Available at:) (Accessed September 13, 2011)
        • Centers for Medicare & Medicaid Services (CMS), Office of Enterprise Data and Analysis, Office of the Actuary
        CMS fast facts.
        (Available at:) (Accessed July 17, 2018)
        • Colligan E.M.
        • Pines J.M.
        • Colantuoni E.
        • Howell B.
        • Wolff J.L.
        Risk factors for persistent frequent emergency department use in medicare beneficiaries.
        Ann Emerg Med. 2016; 67: 721-729