Understanding How Older Adults Use the U.S. Health Care System: From Measurement to Meaning
Authors: Madeline R. Sterling, Rishi K. Wadhera
Journal: Annals of Internal Medicine (2024)

Editorials23 January 2024Understanding How Older Adults Use the U.S. Health Care System: From Measurement to MeaningMadeline R. Sterling, MD, MPH, MS, Rishi K. Wadhera, MD, MPP, MPhilMadeline R. Sterling, MD, MPH, MSDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New YorkSearch for more papers by this author, Rishi K. Wadhera, MD, MPP, MPhilSection of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MassachusettsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-3453 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In recent years, the U.S. health care system has moved toward emphasizing the patient perspective when evaluating the quality and effectiveness of care. Policymakers and health care systems are increasingly using measures that more fully capture what matters most to many older adults—the amount of time they spend outside of the health care system (1–3). For example, in 2014, researchers in conjunction with the Medicare Payment Advisory Commission proposed the measure “healthy days at home,” which attempts to quantify how well health care organizations keep people healthy and out of hospital and facility-based settings (4, 5). Other similar measures have ...References1. Laderman M, Jackson C, Little K, et al. “What Matters” to Older Adults? A Toolkit for Health Systems to Design Better Care with Older Adults. Institute for Healthcare Improvement. 2019. Accessed at www.ihi.org/sites/default/files/2023-09/IHI_Age_Friendly_What_Matters_to_Older_Adults_Toolkit.pdf on 22 December 2023. Google Scholar2. AARP and National Alliance for Caregiving. Caregiving in the United States 2020. AARP; May 2020. Accessed at https://doi.org/10.26419/ppi.00103.001 on 15 May 2021. Google Scholar3. Sterling MR, Shaw AL. Sharing the care–a patient and her caregivers. JAMA Intern Med. 2019;179:1617-1618. [PMID: 31566655] doi:10.1001/jamainternmed.2019.4231 CrossrefMedlineGoogle Scholar4. Medicare Payment Advisory Commission. Next steps in measuring quality of care in Medicare. In: Report to the Congress: Medicare and the Health Care Delivery System. MedPAC; June 2015. Accessed at www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/chapter-8-next-steps-in-measuring-quality-of-care-in-medicare-june-2015-report-.pdf on 23 December 2023. Google Scholar5. Burke LG, Orav EJ, Zheng J, et al. Healthy days at home: a novel population-based outcome measure. Healthc (Amst). 2020;8:100378. [PMID: 31708403] doi:10.1016/j.hjdsi.2019.100378 CrossrefMedlineGoogle Scholar6. Greene SJ, O'Brien EC, Mentz RJ, et al. Home-time after discharge among patients hospitalized with heart failure. J Am Coll Cardiol. 2018;71:2643-2652. [PMID: 29880124] doi:10.1016/j.jacc.2018.03.517 CrossrefMedlineGoogle Scholar7. Ganguli I, Chant ED, Orav EJ, et al. Health care contact days among older adults in traditional Medicare: a cross-sectional study. Ann Intern Med. 23 January 2024. [Epub ahead of print]. doi:10.7326/M23-2331 LinkGoogle Scholar8. Wadhera RK, Wang Y, Figueroa JF, et al. Mortality and hospitalizations for dually enrolled and nondually enrolled Medicare beneficiaries aged 65 years or older, 2004 to 2017. JAMA. 2020;323:961-969. [PMID: 32154858] doi:10.1001/jama.2020.1021 CrossrefMedlineGoogle Scholar9. Wadhera RK, Dahabreh IJ. The US health equity crisis–an economic case for a moral imperative? JAMA. 2023;329:1647-1649. [PMID: 37191712] doi:10.1001/jama.2023.4018 CrossrefMedlineGoogle Scholar10. McIlvennan CK, Morris MA, Guetterman TC, et al. Qualitative methodology in cardiovascular outcomes research: a contemporary look. Circ Cardiovasc Qual Outcomes. 2019;12:e005828. [PMID: 31510771] doi:10.1161/CIRCOUTCOMES.119.005828 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Madeline R. Sterling, MD, MPH, MS; Rishi K. Wadhera, MD, MPP, MPhilAffiliations: Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New YorkSection of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3453.Corresponding Author: Madeline R. Sterling, MD, MPH, MS, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, NY 10021; e-mail, mrs9012@med.cornell.edu.This article was published at Annals.org on 23 January 2024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHealth Care Contact Days Among Older Adults in Traditional Medicare Ishani Ganguli , Emma D. Chant , E. John Orav , Ateev Mehrotra , and Christine S. Ritchie Metrics Latest Keywords Elderly Health care Health care utilization Hypertension Medicare Primary care ePublished: 23 January 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...