Objective and subjective measures of the quality of managed care in nursing homes.
Objective and subjective measures of the quality of managed care in nursing homes.
复制标题
疗养院管理式护理质量的客观和主观衡量。
作者：
J. Schnelle;J. Ouslander;J. Buchanan;G. Zellman;D. Farley;S. Hirsch;D. Reuben
背景
参加管理式护理计划（HMO）的疗养院（NH）居民人数将增加，人们担心他们的医疗质量可能会受到成本控制压力的影响。在这项研究中，我们评估了参加3个健康维护组织（HMO）的居民的医疗保健，这些组织制定了具体的长期护理计划。
目标
比较参加HMO和收费服务（FFS）计划的NH居民接受的医疗护理与客观护理过程和消费者感知（主观）措施。描述客观和主观测量之间的关系。
措施
每月初级保健访问的次数; 2种老年示踪疾病（福尔斯、发烧）的医疗护理过程;家庭和居民对疾病发作管理是否充分的看法;初级提供者访问的频率。
设计
准实验性的。
结果
HMO居民比FFS居民对福尔斯和发烧得到更及时和适当的反应。HMO居民还接受了由医生和执业护士组成的初级保健提供者小组更频繁的例行访问。消费者对质量的看法在HMO和FFS组之间没有差异。两组内的家庭显着更积极的比居民的访问频率由医生和执业护士。在HMO组内，家庭和居民对护士执业访问的频率比医生访问的频率更积极，即使两个提供者的访问频率相似。
结论
虽然HMO居民接受的医疗服务在大多数客观的过程措施上比FFS居民接受的医疗服务更好，但消费者对医疗服务的看法并没有发现这些差异。NH居民和家庭有不同的看法，医生和执业护士的访问是否充分，家庭和居民似乎有不同的期望，他们希望医生访问的频率相比，执业护士。
BACKGROUND
The number of nursing home (NH) residents enrolled in managed care plans (HMO) will increase, and there is concern that the quality of their medical care may be compromised by cost-containment pressures. In this study, we evaluated the medical care of residents enrolled in 3 health maintenance organizations (HMO) that developed specific long-term care programs.
OBJECTIVES
To compare the medical care received by NH residents enrolled in HMO and Fee-for-Service (FFS) plans with both objective process of care and consumer perception (subjective) measures. To describe the relationship between the objective and subjective measures.
MEASURES
Number of primary care visits per month; process of medical care for 2 geriatric tracer conditions (falls, fevers); family and residents' perceptions of the adequacy of sickness episode management; and the frequency of primary provider visits.
DESIGN
Quasi-experimental.
RESULTS
HMO residents received more timely and appropriate responses to falls and fevers than did FFS residents. HMO residents also received more frequent routine visits by a primary care provider team consisting of a physician and nurse practitioner. Consumer perceptions of quality did not differ between the HMO and FFS groups. Families within both groups were significantly more positive than were residents about the frequency of visits by both physicians and nurse practitioners. Within the HMO group, both families and residents were more positive about the frequency of nurse practitioner visits than were physician visits even when the frequency of visits by the 2 providers were similar.
CONCLUSIONS
Although the medical care received by HMO residents was better on most objective process measures than that received by FFS residents, consumer perceptions of care did not detect those differences. NH residents and families have different perceptions about the adequacy of visits by physicians and nurse practitioners, and both families and residents appear to have different expectations concerning how often they want physicians to visit as compared with nurse practitioners.