Quality of care and short- and long-term outcomes of XXXX care in the elderly.

@entity1 @entity353 @entity55 @entity5 @entity1544 @entity1282 @entity204 @entity734 @entity1224
OBJECTIVES/HYPOTHESIS: To examine associations between quality of care, short- and long-term treatment-related outcomes, and costs in elderly @entity1 treated for @entity1544 ( @entity1544 ). STUDY DESIGN: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We evaluated longitudinal data from 2,370 @entity1 diagnosed with laryngeal @entity1544 from 2004 to 2007 using cross-tabulations, multivariate regression, and survival analysis. Using quality indicators derived from guidelines for recommended care and performance measures, an overall summary measure of quality was calculated incorporating summary quality measures for diagnosis, initial treatment, performance, surveillance, treatment for recurrence, and end-of-life care. RESULTS: Higher-quality care was associated with a lower likelihood of long-term @entity353 (odds ratio [OR]   =   0.6 [0.5-0.8]), stricture (OR   =   0.5 [0.3-0.8]), @entity734 (OR   =   0.5 [0.4-0.7]), @entity1224 (OR   =   0.7 [0.6-0.9]), tracheostomy (OR   =   0.5 [0.3-0.7]), and @entity55 (OR   =   0.7 [0.5-0.9]), but had no impact on the likelihood of @entity1282 . Higher-quality care was associated with lower risk of @entity204 in @entity1 with @entity1282 (hazard ratio [HR]   =   0.7 [0.6-0.8]), @entity353 (HR   =   0.8 [0.6-0.9]), @entity1224 (HR   =   0.7 [0.6-0.8]), tracheostomy (HR   =   0.7 [0.5-0.9]), and @entity55 (HR   =   0.8 [0.6-0.9]), but was not associated with survival differences in @entity1 with @entity734 or stricture. Costs associated with @entity1282 , @entity353 , stricture, @entity1224 , and @entity55 were lower for @entity1 receiving higher-quality care. CONCLUSIONS: Higher-quality @entity5 care was associated with a reduced incidence of late airway and swallowing impairment after laryngeal @entity1544 treatment in elderly @entity1 , with improved survival and reduced costs. These data suggest that greater attention to evidence-based practices associated with quality indicators may lead to improved functional outcomes in the elderly. LEVEL OF EVIDENCE: 2c.
