QUALITY OF CARE PROBLEMS AMONG MEDICARE AND MEDICAID PATIENTS

The purpose of this study was to characterize quality of care problems among Medicare and Medicaid inpatients in New York State. The patient s selected for this study comprised 1991 and 1992 Medicare and all 199 2 Medicaid inpatients in whom quality of care problems with actual or potential adverse effects were found. The patients in this study were drawn from public, proprietary, voluntary and teaching hospitals. A to tal of 1000 quality of care problems with either actual or potential a dverse effects were found in 706 Medicare patients. Two hundred and se venty-five (275) quality of care problems with actual or potential adv erse effects were found in 154 Medicaid patients. Premature death occu rred in 53 (7.4%) of the 706 Medicare and in 42 (27.2%) of the 154 Med icaid patients. Treatment problems and monitoring failures accounted f or the majority of quality of care problems with actual or potential a dverse effects for both Medicare (63.0%) and Medicaid (75.7%) patients . Among Medicare patients, the treatment of infections and antibiotic use, fluid and electrolyte management, and inappropriate drug use were among the leading causes of quality of care problems. Attending physi cians were associated with the majority of Medicare quality of care pr oblems while house staff and attending physicians were associated with the majority of those among Medicaid patients. The results of this st udy indicate that there are several leading causes of quality of care problems among Medicare and Medicaid patients. Treatment problems and monitoring failures together comprise the majority of such problems. A mong Medicare patients, it was found that most quality of care problem s were associated with the treatment of infections and antibiotic use, fluid and electrolyte management, and inappropriate drug use. Most qu ality of care problems among Medicaid patients were associated with th ese categories as well as with labor and delivery problems, and poor d ischarge planning. The results of this study reflect the peer-review p rocess in which providers are given an opportunity to respond to physi cian-reviewer decisions about the presence of actual or potential adve rse effects. Such a process, which permits the presentation of additio nal data and information by providers, produces fewer final adverse ou tcome determinations than a process uniquely based on chart review. Th e quality of care problems observed in this study are amenable to focu sed educational interventions. Such remedial interventions could yield significant improvements in the quality of care for all patients.