Soumerai SB, McLaughlin TJ, Gurwitz J, Pearson S, Christiansen C, Gao X, Ross-Degnan D; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 165.
Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
RESEARCH OBJECTIVES: A commonly voiced concern is that HMOs reduce speed and provision of urgent, essential care, especially in vulnerable patients like the elderly. We studied the quality of emergent care provided to elderly patients with acute myocardial infarction (MI) under HMO vs. fee-for-service (FFS) insurance. Specifically, we compared the use of drugs known to reduce morbidity and mortality in eligible MI patients (aspirin, thrombolytics, and beta-blockers), as well as treatment delay (>=6 hours), use of emergency transport (ET), and time from hospital contact to thrombolytic administration ("door-to-needle time"). STUDY DESIGN: We reviewed the medical records of 2,304 patients admitted with MI at 22 Minnesota urban community hospitals for the periods 1992-1993 and 1995-1996. We measured medication use among eligible patients, use of ET, and treatment delay in all patients. PRINCIPAL FINDINGS: Demographics, severity, and comorbidity were almost identical among HMO (N=612) and FFS (N=1692) patients. Cardiologists were involved as consultants or attendings in the care of 80% of HMO patients, an 82% of FFS patients (NS). Thrombolytic use and door-to-needle times were almost identical in both settings. However, 56% of HMO patients and 51% of FFS patients used emergency transport (p=0.02); most of this difference was observed for patients with MIs occurring at night. HMO patients were somewhat more likely than FFS patients to receive aspirin and beta-blockers (88% vs. 83% and 73% vs. 62%, respectively, p<0.05). These differences were consistent across the three largest HMOs (one staff model, two IPAs). Logistic regression analyses, controlling for patient demographic and clinical variables, produced results very similar to univariate findings. CONCLUSIONS: Overall, use of life-saving drugs and speed of access to urgent care for elderly MI patients are very similar under HMO and FFS insurance in Minnesota. However, several indicators of quality were slightly, but significantly, higher in the HMO settings (use of aspirin, beta-blockers, and emergency transport). IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Concerns regarding treatment delays or quality of emergent care for elderly MI patients enrolled in Medicare HMOs may not always be warranted. However, further research is needed in other states and in different populations and conditions.
Publication Types:
Keywords:
- Acute Disease
- Adrenergic beta-Antagonists
- Aged
- Aspirin
- Comorbidity
- Fee-for-Service Plans
- Fibrinolytic Agents
- Health Maintenance Organizations
- Health Services for the Aged
- Humans
- Medical Records
- Medicare
- Minnesota
- Myocardial Infarction
- Patient Transfer
- economics
- hsrmtgs
Other ID:
UI: 102234295
From Meeting Abstracts