The focus of this study is to examine the relationships between alcohol consumption, alcohol disorder diagnosis, and quality indicators for preventive and chronic medical care in elderly Medicare beneficiaries. People with substance abuse disorders often fail to receive regular health care and can be less likely to receive preventive services and treatment for chronic medical disorders. However, for the elderly population in which multiple medical needs are common, the connection between alcohol use and quality of care has not yet been fully examined. Interactions between alcohol consumption levels and diagnosis of alcohol disorders as they affect medical care quality remain similarly unexplored. Predisposing and enabling factors such as health beliefs, social support, and prescription drug coverage must also be taken into account for a full understanding of how alcohol problems may be associated with quality of care. Because administrative and self-reported data have complementary strengths, we will use data from the 1999-2003 rounds of the Medicare Current Beneficiary Survey linked with Medicare claims. This is a continuous, nationally representative survey of the Medicare population of which we will use a subset of over-65, community-dwelling beneficiaries (N=approximately 13,000 per year). This linked data set has been widely used for research and allows both cross-sectional and longitudinal analyses. The survey data includes self-reported alcohol consumption, prescription drug use, health and functional status, health beliefs, and other information. The claims data will allow us to use accepted performance measures such as the HEDIS measures developed by the National Committee for Quality Assurance for substance abuse, medical and psychiatric disorders, and preventive services to examine quality of care indicators as well as detailed utilization and cost parameters. We will address the following specific aims: 1. Determine whether and how alcohol consumption and/or diagnosis are related to receipt of recommended preventive medical services. 2. Determine whether and how alcohol consumption and/or diagnosis are related to quality indicators for selected chronic medical and psychiatric conditions. 3. Develop a summary quality indicator reflecting quality of care across various types of medical care to examine the relationship between alcohol consumption/diagnosis and """"""""treating the whole person."""""""" This exploratory research will contribute to developing an important yet understudied area of inquiry. The results will delineate the gap between current practice and goals for care of the elderly population, identify those most at risk for both untreated substance abuse and other unmet medical needs, and identify patient and provider factors related to better performance, thus facilitating effective strategies for improving care.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Exploratory/Developmental Grants (R21)
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Health Services Research Review Subcommittee (AA)
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Yahr, Harold
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Brandeis University
Schools of Social Work
United States
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