Context. - Increasing numbers of Medicare beneficiaries have been enrolling in health maintenance organizations (HMOs) because HMO participation reduces out-of-pocket expenses, and the federal government views HMOs as a way to contain Medicare costs.
However, results comparing outcomes and quality of care in HMOs vs fee for service (FFS) have been mixed, and outcomes after stroke have not been adequately assessed.
- To compare discharge destinations and survival rates following stroke in Medicare HMOs with similar FFS settings.
- An observational study for 2 groups evaluating stroke patients'discharge destinations and survival times from the date of hospital admission.
- A total of 19 HMOS were selected from 12 states.
The FFS sample was drawn from the same geographic areas.
- The sample included 402 HMO patients from 71 hospitals and 408 FFS patients from 60 hospitals.
- Data were abstracted from medical records on demographics, clinical characteristics of stroke, comorbid illnesses, and discharge destinations following hospitalization.
Data on survival were obtained from Medicare files and included 25 to 37 months of follow-up (median, 30.4 months, HMO ; 31.1 months, FFS) from the date of hospital admission.
- There were 109 patients who died during the hospitalization (49 HMO, 12.2% ; 60 FFS, 14.7%), and a total of 410 patients had died by the end of follow-up (191 HMO, 47.5% ; 219 FFS, 53. (...)
Mots-clés Pascal : Accident cérébrovasculaire, Prévalence, Etude comparative, Soin intégré, Honoraires, Qualité service, Pronostic, Homme, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Organisation santé
Mots-clés Pascal anglais : Stroke, Prevalence, Comparative study, Managed care, Fees, Service quality, Prognosis, Human, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0381064
Code Inist : 002B17C. Création : 12/09/1997.