Healthcare quality for seniors all over the map

Seniors living in Manhattan spend an average of nearly 25 days a year at doctor visits or at a hospital. But in Lebanon, New Hampshire, contact with the healthcare system is far lower – just 10 days on average.

New Yorkers probably are not that much sicker than their New England neighbors. Instead, the statistic reflects the wide variation in the way healthcare is delivered to older adults around the United States.

The Dartmouth Institute for Health Policy and Clinical Practice recently issued a report card on how the United States provides healthcare to seniors by region. Using Medicare enrollment and claims data from 2012, the report compares regions on such factors as where seniors spend the most time with doctors, where they are most likely to be hospitalized, or be subjected to unnecessary tests or risky medications.

The report also points to ways seniors – or children helping to care for elderly parents – can navigate the healthcare system to receive better care. The research is being used to discover whether best practices are being used – and where. The answers vary widely across the country.

Dartmouth-chart-cropFor example, in York, Pennsylvania, 73.4 percent of seniors had a primary care physician as their predominant healthcare provider who coordinated all their care, compared with just 42.6 percent in Metairie, Louisiana. The national average was 56.9 percent. Research has shown that regions with a greater proportion of care provided by primary care physicians tended to have lower costs, higher quality, and lower rates of avoidable hospitalizations.

And 30 percent of male seniors over age 75 in Miami were screened for prostate cancer, despite a 2008 recommendation by the U.S. Preventive Services Task Force that the test not be done on men above that age. In Casper, Wyoming, the rate is 9.9 percent (U.S. average: 19.5 percent.) Current best-practice thinking is that benefits of the screening do not outweigh the harms, including patient worry about false-positive results, invasive follow-up tests and treatment with side effects.

The wide variation in these numbers points to a need for more coordination of care through primary care physicians with expertise caring for elderly patients, said Dr. Julie P.W. Bynum, associate professor at the Geisel School of Medicine at Dartmouth College and the report’s lead author.

Dr. Julie Bynum

Dr. Julie Bynum

“As you age, you have lots of different medical problems competing against one another,” she said. “Having someone who can coordinate all the different doctors is important. If you have two or three diseases, you want the whole person treated.”

For information on the healthcare system’s performance where you live, visit this interactive map produced by the Dartmouth Institute. A good free guide on how to talk with your doctor is available from the National Institute of Aging. The Health in Aging Foundation offers guidance on medications (PDF) that elderly patients should avoid.

Learn more about the findings and how patients and families can assert themselves more effectively in managing healthcare in my Reuters Money column this week.

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