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October 14, 1992

Differences in Quality of Care for Hospitalized Elderly Men and Women

Author Affiliations

From the Health Program of RAND, Santa Monica, Calif (Drs Pearson, Kahn, Rubenstein, Rogers, Brook, and Keeler and Ms Harrison); the Departments of Medicine (Drs Kahn and Brook) and Health Services (Dr Brook) of the University of California at Los Angeles; and the Sepulveda (Calif) Veterans Health Administration Medical Center (Dr Rubenstein).

JAMA. 1992;268(14):1883-1889. doi:10.1001/jama.1992.03490140091041

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.(JAMA. 1992;268:1883-1889)