Abstract
Objective
To examine the association between activity limitation stages and patient satisfaction
and perceived quality of medical care among younger Medicare beneficiaries.
Design
Cross-sectional study.
Setting
Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011.
Participants
A population-based sample (N=9323) of Medicare beneficiaries <65 years of age living
in the community.
Interventions
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).
Results
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.
Conclusions
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.
Keywords
List of abbreviations:
ADL (activities of daily living), IADL (instrumental activities of daily living), MCBS (Medicare Current Beneficiary Survey), PCP (primary care physician)To read this article in full you will need to make a payment
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References
- The quality of care. How can it be assessed?.JAMA. 1988; 260: 1743-1748
- Do hospitals rank differently on HCAHPS for different patient subgroups?.Med Care Res Rev. 2010; 67: 56-73
- Physician communication and patient adherence to treatment: a meta-analysis.Med Care. 2009; 47: 826-834
- Association between Medicare star ratings for patient experience and Medicare spending per beneficiary for US hospitals.J Patient Exp. 2017; 4: 17-21
- 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
- Dissatisfaction with medical services among Medicare beneficiaries with disabilities.Arch Phys Med Rehabil. 2002; 83: 1335-1341
- Projected Medicare expenditures under an illustrative scenario with alternative payment updates to Medicare providers.(Available at:) (Accessed October 10, 2012)
- Factors related to potentially preventable hospitalizations among the elderly.Med Care. 1998; 36: 804-817
- Health, life expectancy, and health care spending among the elderly.N Engl J Med. 2003; 349: 1048-1055
- Dynamic tools to measure health from the patient perspective.(Available at:) (Accessed January 15, 2010)
- Predictive indices for functional improvement and deterioration, institutionalization, and death among elderly Medicare beneficiaries.PM R. 2017; 9: 1065-1076
- Patient satisfaction and perceived quality of care among older adults according to activity limitation stages.Arch Phys Med Rehabil. 2015; 96: 1810-1819
- Quality of care for Medicare beneficiaries with disabilities under the age of 65 years.Expert Rev Pharmacoecon Outcomes Res. 2006; 6: 261-273
- Health care experiences and perceptions among people with and without disabilities.Disabil Health J. 2016; 9: 74-82
- Medicare Current Beneficiary Survey (MCBS).(Available at:) (Accessed July 10, 2014)
- Medicare Current Beneficiary Survey (MCBS) access to care introduction.(Available at:) (Accessed September 21, 2011)
- 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)
- 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
- 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
- International Classification of Functioning, Disability and Health: ICF.World Health Organization, Geneva, Switzerland2001
- 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
- Assessment of medical care by elderly people: general satisfaction and physician quality.Health Serv Res. 1998; 32: 741-758
- Do seniors get the medicines prescribed for them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey.Health Aff. 2003; 22: 175-182
- Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.Arch Intern Med. 2005; 165: 2129-2135
- 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
- Regression diagnostics.John Wiley, New York1980
- Coping with collinearity.Can J Program Eval. 1987; 2: 87-93
- Access and satisfaction within the disabled Medicare population.Health Care Financ Rev. 1995; 17: 147-167
- Understanding the diverse needs of the Medicare population: implications for Medicare reform.J Aging Soc Policy. 1999; 10: 25-50
- Medicare doesn’t work as well for younger, disabled beneficiaries as it does for older enrollees.Health Aff. 2010; 29: 1725-1733
- The influence of psychiatric disorders on patients’ ratings of satisfaction with health care.Med Care. 1998; 36: 720-727
- Medicare’s role for people under age 65 with disabilities.Henry J. Kaiser Foundation Issue Brief, August 2016
- 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
- Responsiveness to self-report interview questions by adults with intellectual and developmental disability.Intellect Dev Disabil. 2015; 53: 163-181
- 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
- How Medicare could provide dental, vision, and hearing care for beneficiaries.Issue Brief (Commonw Fund). 2018; 2018: 1-12
- Hearing and health outcomes: recognizing and addressing hearing loss in hospitalized older adults.Semin Hear. 2017; 38: 153-159
- “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
- Communication and information barriers to health assistance for deaf patients.Am Ann Deaf. 2010; 155: 31-37
- Functional status measures for integrating medical and social care.Int J Integr Care. 2005; 5: e07
- Morbidity and mortality weekly report.(Available at:) (Accessed September 13, 2011)
- CMS fast facts.(Available at:) (Accessed July 17, 2018)
- Risk factors for persistent frequent emergency department use in medicare beneficiaries.Ann Emerg Med. 2016; 67: 721-729
Article info
Publication history
Published online: October 11, 2018
Footnotes
Supported by a Patient-Centered Outcomes Research Institute Project program award no. AD-12-11-4567 and by the National Institutes of Health (grant no. R01HD074756).
Disclosures: none.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
