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Delivery of routine preventive services suboptimal for medicare beneficiaries

e more likely than those with more than 15 percent of revenue derived from Medicaid to receive diabetic eye examinations (48.9 percent vs. 43 percent), hemoglobin A1c monitoring (61.2 percent vs. 48.4), mammograms (52.1 percent vs. 38.9 percent), colon cancer screening (10.0 percent vs. 8.5 percent), and influenza (50.2 percent vs. 39.2 percent) and pneumococcal (8.2 percent vs. 6.4 percent) vaccinations.

Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more, who was a graduate of a U.S. or Canadian medical school, or who reported availability of information technology to generate preventive care reminders or access treatment guidelines.

"We found that this shortfall is neither uniform for all beneficiaries nor explained entirely by characteristics of the beneficiaries such as their race or income level. Rather, it appears that some beneficiaries are treated in practice settings or by physicians who deliver preventive services at particularly low rates. Our results suggest that these variations in quality are substantial and seem to be greatly influenced by the structure and revenue sources of physician practices. If we can understand the mechanisms underlying these relationships, it would be much easier to identify the key leverage points for quality improvement," the authors conclude. (JAMA. 2005;294:473481. Available pre-embargo to the media at http://www.jamamedia.org).

Editor's Note: For funding/support information, please see the JAMA article.


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Contact: Alwyn Cassil
202-264-3484
JAMA and Archives Journals
26-Jul-2005


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