the delivery of evidence-based preventive care for older americans with arthritis美国老年人的交付以证据为基础的预防保健的关节炎.pdf

Curtis et al. Arthritis Research Therapy 2010, 12:R144 /content/12/4/R144 RESEARCH ARTICLE Open Access The delivery of evidence-based preventive care for older Americans with arthritis 1,2* 2 1 2 3 4 Jeffrey R Curtis , Tarun Arora , Pongthorn Narongroeknawin , Allison Taylor , Clifton O Bingham III , Jack Cush , 1,2 5 2 Kenneth G Saag , Monika Safford , Elizabeth Delzell Abstract Introduction: Previous research suggests patients with rheumatoid arthritis (RA) may receive suboptimal care with respect to preventive tests and services. We evaluated the proportion of older Americans with RA, psoriatic arthritis (PsA), and osteoarthritis (OA) receiving these services and the specialty of the providers delivering this care. Methods: Using data from 1999 to 2006 from the Medicare Chronic Conditions Warehouse, we identified persons age /= 65 in the national 5% sample. Over the required five-year observation period, we identified tests and services recommended for older adults and the associated healthcare provider. Services of interest included dual energy x-ray absorptiometry (DXA), influenza and pneumococcal vaccination, hyperlipidemia lab testing, mammography and colonoscopy. Results: After accounting for the sampling fraction, we identified 141,140 RA, 6,300 PsA, and 770,520 OA patients eligible for analysis. Over five years, a majority of RA, PsA, and OA patients were tested for hyperlipidemia (84%, 89% and 87% respectively) and received DXA (69%, 75%, and 52%). Only approximately one-third of arthritis patients received pneumococcal vaccination; 19% to 22% received influenza vaccination each year. Approximately 20% to 35%