Differences in quality of care for hospitalized elderly men and women
M. L. Pearson, K. L. Kahn, E. R. Harrison, L. V. Rubenstein, W. H. Rogers, R. H. Brook and E. B. Keeler
Health Program of RAND, Santa Monica, CA 90407-2138.
OBJECTIVE--To analyze whether important gender differences exist in the
quality of hospital care provided to patients with four major medical
conditions. DESIGN--Bivariate and multivariate comparisons of clinically
detailed sickness at admission, quality, utilization, and outcome measures.
SETTING--Acute care hospitals located in five states. PATIENTS OR OTHER
PARTICIPANTS--A total of 11,242 patients 65 years or older who were
hospitalized with one of four diseases: congestive heart failure, acute
myocardial infarction, pneumonia, and cerebrovascular accident. We derived
our data from the nationally representative sample used to study the
quality of hospital care for Medicare patients before and after the
implementation of the prospective payment system. A hierarchical (nested)
cluster sampling design was used to draw disease-specific samples of
patients hospitalized in 1981, 1982, 1985, or 1986 in one of 297 hospitals
located in 30 areas within five states. INTERVENTIONS--This was an
observational study. MAIN OUTCOME MEASURES--Sickness at admission, process,
use rates, length of stay, discharge status, discharge destination, and
mortality. RESULTS--Sex differences in sickness at admission varied by
disease. There was some evidence that women received worse process of care,
but the difference was very small. We found many similarities in the
process and outcomes of care for male and female patients.
CONCLUSIONS--After controlling for sickness at admission, age, and other
important covariates, the in-hospital experiences of elderly men and women
showed greater similarities than differences. The concern that sex bias
enters into clinical decision making during hospitalization is eased,
although not entirely eliminated.
