Disability stage and receipt of recommended care among elderly medicare beneficiaries.

This was an observational survey-claims study, so it cannot show that disability stage caused lower receipt of recommended care. The activity limitation stages were based on self- or proxy-reported difficulty with activities, which can introduce reporting bias. The analysis excluded beneficiaries enrolled in HMO plans, so it mainly describes fee-for-service Medicare and may miss differences in preventive care. The care indicators were first published in 2000, and the data were from 2001 to 2008 with follow-up to 2010, so they may not match current guidelines. The indicator system did not cover some conditions, such as dementia, and it did not provide guidance for patients with multiple co-existing conditions. About 18% of beneficiaries contacted for the survey did not consent to the initial interview, which may reduce generalizability, although the study used survey weights. The study did not examine temporal trends, so its percentages reflect an average over the period rather than changes over time.

The research was supported by a National Institutes of Health grant, R01HD074756. The authors reported no personal conflicts of interest and no disclosures beyond this funding source. They also stated that no party with a direct interest in the results would confer a benefit.

Do not conclude that disability stage caused missed care or that these patients received low-quality medical care. This was an observational survey-claims study, and the paper says differential receipt is suggestive of but distinct from low quality medical care.