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  1. How far down the managed care road ? A comparison of primary care outpatient services in a Veterans Affairs medical center and a capitated multispecialty group practice.

    Article - En anglais


    Under increasing pressure to provide more efficient, higher-quality care, the Department of Veterans Affairs (VA) is expanding primary care and implementing other managed care techniques.

    To assess the magnitude of performance improvement possible in the VA and to investigate potential barriers to implementation of new techniques, we compared a VA facility with similar managed care organizations on specific managed care performance benchmarks.

    Methods and Data Collection 

    Detailed case studies of a large VA medical center and a large capitated multispecialty group practice in the same region were carried out.

    Various qualitative and quantitative data were collected between October 1,1994, and September 30,1997.

    Unstructured and semistructured interviews, participant and direct observations, document review, electronic data abstractions, and patient surveys were used to collect the data.


    Patients in the VA medical center were poorer (average income, $13 300 per year), older (36.5% aged 65 years and older), and more likely to be homeless (10.5%). The VA patients saw more specialists and made more emergency department visits than managed care patients.

    Although the VA had better electronic information flows, its providers saw fewer patients, had more unscheduled visits, and received fewer consultant reports, and its patients waited longer.

    Inpatient utilization was also higher (length of stay averaged 8 days) among VA primary care patients. (...)

    Mots-clés Pascal : Etats Unis, Amérique du Nord, Amérique, Homme, Soin santé primaire, Centre santé, Assurance qualité, Coût, Analyse qualitative, Analyse quantitative, Etude comparative, Recrutement population, Corrélation, Personne âgée

    Mots-clés Pascal anglais : United States, North America, America, Human, Primary health care, Health center, Quality assurance, Costs, Qualitative analysis, Quantitative analysis, Comparative study, Population recruitment, Correlation, Elderly

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

    Cote : 99-0021992

    Code Inist : 002B30A04D. Création : 31/05/1999.