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  1. Differences in 4-year health outcomes for elderly and poor, chronically III patients treated in HMO and fee-for-service systems : Results from the medical outcomes study.

    Article - En anglais

    Objective

    - To compare physical and mental health outcomes of chronically ill adults, including elderly and poor subgroups, treated in health maintenance organization (HMO) and fee-for-service (FFS) systems.

    Study Design

    - A 4-year observational study of 2235 patients (18 to 97 years of age) with hypertension, non-insulin-dependent diabetes mellitus (NIDDM), recent acute myocardial infarction, congestive heart failure, and depressive disorder sampled from HMO and FFS systems in 1986 and followed up through 1990.

    Those aged 65 years and older covered under Medicare and low-income patients (200% of poverty) were analyzed separately.

    Setting and Participants

    - Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry, in HMO and FFS systems of care.

    Types of practices included both prepaid group (72% of patients) and independent practice association (28%) types of HMOs, large multispecialty groups, and solo or small, single-specialty practices in Boston, Mass, Chicago, III, and Los Angeles, Calif.

    Outcome Measures

    - Differences between initial and 4-year follow-up scores of summary physical and mental health scales from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) for all patients and practice settings.

    Results

    - On average, physical health declined and mental health remained stable during the 4-year follow-up period, with physical declines larger for the elderly than for the nonelderly (P<. (...)

    Mots-clés Pascal : Vieillard, Homme, Pauvreté, Pronostic, Traitement, Système santé, Infarctus, Myocarde, Hypertension artérielle, Diabète non insulinodépendant, Insuffisance cardiaque, Etat dépressif, Etude comparative, Etats Unis, Amérique du Nord, Amérique, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Endocrinopathie, Psychopathologie

    Mots-clés Pascal anglais : Elderly, Human, Poverty, Prognosis, Treatment, Health system, Infarct, Myocardium, Hypertension, Non insulin dependent diabetes, Heart failure, Depression, Comparative study, United States, North America, America, Cardiovascular disease, Coronary heart disease, Myocardial disease, Endocrinopathy, Psychopathology

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

    Cote : 96-0464496

    Code Inist : 002B30A03B. Création : 10/04/1997.