Abstract 3894: Sex-based Differences in the Quality of Cardiovascular Disease (CVD) Care in Commercial Health Plans
INTRODUCTION: Sex-based disparities in CVD prevention and treatment in acute care settings can contribute to greater adverse clinical outcomes in women. However, few studies have evaluated the quality of CVD care in the ambulatory setting, especially with a nationally representative sample.
HYPOTHESIS: We assessed the hypothesis that women are less likely than men to meet performance standards for 9 CVD-related quality measures.
METHODS: We analyzed member-level data from a national sample of commercial health plans. Sample sizes varied by quality measures because of data submission criteria. Sizes ranged from 2096–11,813 patients reported by 28–31 plans. Nine HEDIS® CVD care measures were examined: beta blocker treatment, blood pressure control, cholesterol screening and control for both those with diabetes and a history of CVD. We used hierarchical generalized linear model to estimate HEDIS® measures as a function of patient demographics, controlling for the clustering effect of health plans.
RESULTS: For 5 of the 9 quality indicators, performance was higher for men, where men were more likely to achieve adequate cholesterol screening and control (Table⇓). In contrast, women had higher performance in controlling blood pressure. Men outperformed women in having LDL controlled to <100 mg/dL by a significant margin of 5.8% among patient with diabetes (p<.0001), and by 8.5% among patients with CVD (p<.0001).
CONCLUSION: In a sample of commercial health plan enrollees, there were significant sex-based differences in the quality of CVD preventive care, despite equal access to health care and prescription therapy. Men were more likely to attain the majority of the HEDIS® CVD quality indicators. Poor performance in LDL control observed in high-risk women suggests the possibility of less intensive cholesterol treatment in women. These sex-based differences demonstrate the need for interventions in improving the quality of care for women.