Using Big Data to Improve Care for Older Adults

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This guest blog by Marcus Escobedo, Senior Program Officer at The John A. Hartford Foundation, was originally published February 18 in the foundation’s Health AGEnda blog.

To fulfill our mission of improving the care of older adults, it is critical to know what is working—and what is not—when it comes to health care for the nation’s growing number of older people. That is why The John A. Hartford Foundation supported a new report from the Dartmouth Atlas Project titled Our Parents, Ourselves: Health Care for an Aging Population.

“This report is really about success,” says Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “Life expectancy has almost doubled since the 1900s, from 40 years to 80 years today. The number of adults over age 65 also is projected to almost double in the coming decades, from 43.1 million in 2012 to 83.7 million by 2050. This is truly remarkable and something to celebrate. However, we now need to achieve the same level of success in meeting the care needs of this growing aging population.”

The Dartmouth Atlas report should help. In fact it should be required reading for health system leaders, advocates, and policymakers. It can help them understand the composition of Medicare beneficiaries in their communities, those beneficiaries’ experience of care, and whether they are receiving evidence-based health care along a number of dimensions directly meaningful to older adults and their families. For example, the report looks at the number of unique clinicians that patients see on average, as well as end-of-life treatments, such as late hospice referral and the number of days spent in intensive care.

Based on 2012 Medicare data, this report card is helpful because it breaks down by geographic region where the United States is making progress in patient-centered care for older adults and where improvements are needed. It also breaks new ground, sharing data that has never been public before, including:

  • Older adults with two or more chronic conditions spent 33 days—or just over one month of the year—in contact with the health care system (in the hospital, at a doctor’s office, or at a lab visit).
  • The average Medicare beneficiary was in contact with the health care system on 17 days. Looking at the data by geographic region, the range spanned from 10.2 days in Lebanon, N.H., to 24.9 days in East Long Island, N.Y.
  • 18.4 percent of older adults filled at least one prescription for medication identified as high-risk by the National Committee for Quality Assurance. Again, the rates varied greatly depending on geographic region, from 9.8 percent in Rochester, Minn., to 29.1 percent in Monroe, La. Progress in this area is being made, as the percentage of Medicare beneficiaries who filled at least one high-risk medication prescription dropped 43 percent from 2006. But more work is needed to eliminate this dangerous practice.
  • Preventable hospital readmissions have declined 23 percent, from 5.5 percent of Medicare beneficiaries in 2003 to 4.2 percent in 2012. Again, since these are by definition “preventable” readmissions, we must keep working to lower the rate to as close to zero as possible.

The John A. Hartford Foundation is very proud to support the work of the Dartmouth Atlas Project, and our commitment to patient-centered and patient-directed care for all older adults is only strengthened after reading about the large variations in quality of care that currently exist depending on where people live. This report describes both the real and potential care needs that we must address. The discussion we need to have in light of this eye-opening report must center on the kind of care that older adults want, need, and how they want that care delivered.

The John A. Hartford Foundation was one of the earliest supporters of Dartmouth’s work looking at regional variation in the 1980s. The resulting Dartmouth Atlas Project underscores that big data can make a big difference in our ability to improve the care of older adults. The Atlas provides a huge service to everyone who does research, makes policy, or cares about the health of older people. It is a great tool that we know our grantees and the field will find helpful.

Download and share Our Parents, Ourselves: Health Care for an Aging Population so that it will be referenced and used by hospitals, community providers, and others in their field to make important and needed changes in the care we deliver to older people in this country.

For more information, including links to The John A. Hartford Foundation’s full press release and key data tables, visit the foundation’s Our Parents, Ourselves page.

Marcus Escobedo
Senior Program Officer, The John A. Hartford Foundation