There will be nearly 70 million women over the age of 50 in the United States by the year 2030. The current health system is inadequately prepared to meet the needs of older women, especially vulnerable women such as the poor, racial and ethnic minorities, the chronically ill and disabled, and those over the age of 80. On the other hand, recent developments in assessing and improving quality of care and outcomes offer a promising foundation for reducing the excess disability suffered by older women in developed countries, according to a recent commentary on the topic.
Carolyn M. Clancy, M.D., Director of the Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, and Arlene S. Bierman, M.D., M.S., also of AHRQ, describe some of these developments. A growing number of clinical trials now include one or more patient-reported outcome measures, such as functional status. This outcome is particularly important to women with chronic disease, who live longer but report greater disability than men.
In addition, different models of service delivery that recognize the impact of nonclinical determinants of health may be needed to improve outcomes for different populations. This is especially relevant for older women, who are more likely to be poor, live alone, or serve as caretakers for ailing spouses. Establishment of a Women's Health Measures Advisory Panel by the National Committee for Quality Assurance and similar efforts have challenged researchers, clinicians, and policymakers to identify which health outcomes are important to older women.
Two new measures of quality offer innovative solutions to some of the challenges unique to women's health. First, a new measure of management of menopause provides an alternative approach to assessing quality for a condition where the science continues to evolve and where women's preferences for treatment and outcomes vary. The second, the Medicare Health Outcomes Survey, uses change in functional status over 2 years as a measure of quality of care provided to Medicare beneficiaries enrolled in health maintenance organizations.
More details are in "Quality and outcomes of care for older women with chronic disease," by Drs. Clancy and Bierman, in the July 2000 Women's Health Issues 10(4), pp. 178-191.
Reprints (AHRQ Publication No. 00-R059) are available from the AHRQ Publications Clearinghouse.