October 3, 2000 

CHICAGO (AP)--Treatment of elderly Medicare patients varies widely by state when it comes to heart failure, stroke, breast cancer and other life-threatening illnesses, according to a new federal study.

Medicare patients in the Northeast and sparsely populated states were most likely to receive widely accepted treatments for such conditions. However, those in the Southeast and more populated states were least likely to get the same treatments, according to the state-by-state comparison in Wednesday’s Journal of the American Medical Association.

New Hampshire averaged the best quality of care followed by Vermont, Maine, Minnesota and Massachusetts.

The lowest-ranked states were New Jersey, Louisiana, Mississippi and Arkansas, which was second to last. Puerto Rico, the only U.S. commonwealth included in the analysis, finished 52^nd in a tally counting the District of Columbia.

The study, based on tens of thousands of medical records from 1997 to 1999, was done by researchers at the Health Care Financing Administration, the Baltimore-based agency that administers Medicare to elderly Americans.

The researchers offered no explanation for the disparities.

"I’m delighted if this paper stimulates people in states that are ranked a little lower to try harder," said Dr. Stephen Jencks, an assistant surgeon general who also oversees HCFA’s quality improvement group. "But I’m very sad if it leads people who are ranked a little higher ... to say we don’t need to do anything to improve."

The states were ranked based on a total of 22 standards of care for heart attack, heart failure, stroke, pneumonia, breast cancer and diabetes.

The standards included everything from avoiding a potentially deadly treatment - giving stroke victims the blood-pressure-suppressing drug nifedipine - to educating pneumonia patients about immunization.

Of the most populated states, New York, which was 31^st, fared the best. Florida finished 40^th, California 41^st, Texas 45^th and Illinois 46^th.

Quality of Medical Care Delivered to Medicare Beneficiaries

A Profile at State and National Levels

JAMA

Vol. 284 No.13,

October 4, 2000