Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans.
Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans.
复制标题
管理式护理和传统医疗保险计划中中风患者的再住院和生存率。
DOI：
10.1097/01.mlr.0000173597.97232.a0
复制
发表时间：
2005
期刊：
影响因子：
3
通讯作者：
Finch,MichaelD
中科院分区：
文献类型：
--
作者：
Smith,MaureenA;Frytak,JenniferR;Liou,Jinn-Ing;Finch,MichaelD
Background:Stroke affects more than 500,000 older persons each year in the United States, but no studies have compared older stroke patients in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) after recent changes in FFS reimbursement.Objectives:We sought to compare utilization and outcomes after stroke in Medicare HMO and FFS.Design:We reviewed administrative data in 11 regions from Medicare and a large national health plan.Subjects:We studied Medicare beneficiaries 65 years and older discharged with ischemic stroke during 1998–2000, ie, 4816 HMO patients and a random sample of 4187 FFS patients from 422 hospitals.Measures:We measured survival, rehospitalization, length of stay, discharge destination, and warfarin use.Results:Overall, HMO patients were younger, male, non-Caucasian, and had fewer comorbid conditions. When compared with FFS patients, HMO patients were more likely to be rehospitalized within 30 days for a primary diagnosis of ischemic stroke (Adjusted Hazard Ratio= 1.45, 95% Confidence Interval [CI] 1.14–1.83) or ill-defined conditions (eg, rehabilitation services)(2.87, 95% CI 1.85–4.46) and less likely to be rehospitalized for fluid and electrolyte disorders (0.54, 95% CI 0.34–0.87) or circulatory/respiratory problems (0.77, 95% CI 0.60–0.98). There were no consistent differences in 30-day mortality or in 1-year rehospitalization or mortality for 30-day survivors. HMO patients also were much less likely to be discharged to rehabilitation facilities, slightly less likely to be discharged to skilled nursing facilities and to have a shorter length of stay, and did not differ in the use of home care services or warfarin use when compared with FFS patients.Conclusions:Traditional measures of quality such as 30-day rehospitalization may not be valid when comparing HMO and FFS patients if differences might reflect an alternative service mix. Utilization of postacute care for FFS patients appears similar to HMO patients except for discharge to rehabilitation facilities.
