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  1. The effect of managed care on ICU length of stay : Implications for medicare.

    Article - En anglais

    Objective

    - To determine whether insurance status (managed care vs traditional commercial and Medicare) influences resource consumption (as measured by length of stay [LOS]) in the intensive care unit (ICU).

    Design

    - Retrospective analysis of the 1992 Massachusetts state hospital discharge database, using prospectively developed and validated risk-stratification models.

    Setting

    - All nonfederal hospitals in Massachusetts.

    Subjects

    - Of all adult hospitalizations where an ICU stay was incurred (n=104270), we selected those covered by 1 of 4 payer groups (n=88050) :

    • (1) commercial fee-for-service (patients aged<65 years) ;

    • (2) commercial managed care (patients aged<65 years) ;

    • (3) traditional Medicare (patients aged =65 years) ;

    • and (4) Medicare-sponsored managed care (patients aged =65 years).

    Main Outcome Measure

    - Mean ICU LOS.

    Analysis. - The ICU LOS regression models were constructed using split-halves validation to adjust for differences in age, sex, severity of illness, diagnosis, discharge status, and payer.

    Separate models were constructed for those younger than 65 years and those aged 65 years or older.

    Robustness of the models was explored using goodness of fit and correlation.

    The effect of payer on hospital mortality was also explored using logistic regression.

    Observed minus predicted mean ICU LOS and mortality rates were correlated with managed care penetration at the hospital level.

    Results

    - The ICU LOS models performed well (R2=0. (...)

    Mots-clés Pascal : Unité soin intensif, Durée, Hospitalisation, Analyse coût, Economie santé, Homme

    Mots-clés Pascal anglais : Intensive care unit, Duration, Hospitalization, Cost analysis, Health economy, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 96-0464009

    Code Inist : 002B30A04B. Création : 10/04/1997.