Quality of Care Among Obese Patients, Vol. 303 No. 13, April 7, 2010

Quality of Care Among Obese Patients
Virginia W. Chang, MD, PhD; David A. Asch, MD, MBA; Rachel M. Werner, MD, PhD
JAMA. 2010;303(13):1274-1281.

Context Clinicians often have negative attitudes toward obesity and express dissatisfaction in caring for obese patients. Moreover, obese patients often feel that clinicians are biased or disrespectful because of their weight. These observations raise the concern that obese patients may receive lower quality of care.

Objective To determine whether performance on common outpatient quality measures differs by patient weight status.

Design, Setting, and Participants Eight different performance measures were examined in 2 national-level patient populations: (1) Medicare beneficiaries (n = 36 122) using data from the Medicare Beneficiary Survey (1994-2006); and (2) recipients of care from the Veterans Health Administration (VHA) (n = 33 550) using data from an ongoing performance-evaluation program (2003-2004).

Main Outcome Measures Performance measures among eligible patients for diabetes care (eye examination, glycated hemoglobin [HbA1c] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening. Measures were based on a combination of administrative claims, survey, and chart review data.

Results We found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients. Moreover, success rates were marginally higher for obese and/or overweight patients on several measures. The most notable differentials were observed for recommended diabetes care among Medicare beneficiaries: comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%; odds ratio, 1.37 [95% confidence interval, 1.09-1.73]) and HbA1c testing (74% vs 62%; odds ratio, 1.73 [95% confidence interval, 1.41-2.11]). All analyses were adjusted for sociodemographic factors, health status, clinical complexity, and visit frequency.

Conclusions Among samples of patients from the Medicare and VHA populations, there was no evidence across 8 performance measures that obese or overweight patients received inferior care when compared with normal-weight patients. Being obese or overweight was associated with a marginally higher rate of recommended care on several measures.

Author Affiliations: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Department of Medicine, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (Drs Chang, Asch, and Werner); and Department of Sociology, University of Pennsylvania (Dr Chang), Philadelphia, Pennsylvania. Quality of Care Among Obese Patients, Vol. 303 No. 13, April 7, 2010