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  1. Is referral source a risk factor for coronary surgery ? Health maintenance organization versus fee-for-service system. Discussion.

    Article, Communication - En anglais

    Annual Meeting of The American Association for Thoracic Surgery. Boston, Mass, USA, 1995/04/23.

    We began performing coronary artery bypass grafting for a large health maintenance organization (HMO) in 1974, as the sole provider of their cardiac surgery.

    The outcomes of our HMO group of patients were compared with those of our patients treated on a fee-for-service (FFS) basis.

    The HMO system entails preintervention and multidisciplinary screening conferences and is devoid of self-referral and personal financial incentives.

    Since 1985, the operative mortality for HMO patients has been consistently lower than for FFS patients.

    There were 8483 operations during this study period : 3168 (37%) were in the HMO group, with an overall operative mortality of 2.7%, and 5315 (63%) were in the FFS group, with an operative mortality of 4.6% (p=0.00002).

    This difference was investigated with univariate and multivariable analyses.

    Sixteen factors were found to univariately affect the risk of operative mortality ; for five of these risk correlates there was a significant maldistribution between the HMO and FFS patients.

    Logistic regression was used to explore the influence of this imbalance in risk factors.

    The model found seven independent risk factors (left ventricular failure, emergency coronary bypass, redo bypass, nonuse of the internal thoracic artery, unstable angina, age, and diabetes) that significantly affected operative mortality.

    The FFS group variable closely approached independent risk significance at p=0.059.

    This multivariable model explained only one...

    Mots-clés Pascal : Cardiopathie coronaire, Traitement, Chirurgie, Résultat, Système santé, Secteur public, Secteur privé, Etude comparative, Homme, Appareil circulatoire pathologie

    Mots-clés Pascal anglais : Coronary heart disease, Treatment, Surgery, Result, Health system, Public sector, Private sector, Comparative study, Human, Cardiovascular disease

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    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 96-0226886

    Code Inist : 002B25E. Création : 199608.