HEALTH PLANS EFFECT ON HYPERTENSION AND DIABETES CARE

对管理式医疗成本控制措施的担忧刺激了 试图评估在不同财政状况下提供的护理质量， 和行政安排。 我们建议检讨 为在三个管理式护理机构接受治疗的患者提供的护理， 在明尼阿波利斯/圣保罗地区。我们将研究的组织 包括Allina保健系统，一个独立执业协会; 健康伙伴公司它通过员工模式的HMO提供护理， 一个独立的执业协会安排;以及 首选供应商组织 每个组织都有一个既定的 质量改进计划，但其改进方法不同 质量. 各组织对财务的依赖程度也各不相同。 和行政激励措施，以提高护理质量， 提供. 我们将评估管理式医疗的四个特征 组织-与供应商的财务安排、 护理管理、护理提供方法以及 病人分担费用-影响所接受的护理质量 高血压或糖尿病患者，两个高度流行 已试图界定有效指标的条件 护理质量。 考虑到我们感兴趣的两个特征 财务安排和护理管理-可以通过以下方式进行修改： 一个中介组织，雇用一个供应商，我们也将 评估这些功能的各个方面是否在提供商级别上 影响护理质量。 这项研究将在 卫生部的调查人员 哈佛医学院的护理政策、医疗保健教育和 明尼苏达州圣保罗研究基金会和明尼苏达大学 马萨诸塞州，波士顿。 我们将研究667例高血压患者， 每个组织有667名糖尿病患者（ 共4,002名患者）。 这项研究的结果将确定 财务、交付和管理功能， 提供高质量的护理，从而协助决策者， 工作人员和供应商努力提高质量， 消费者和购买者选择健康计划。

Concerns about cost containment efforts in managed care have stimulated attempts to assess the quality of care delivered under varying financial and administrative arrangements. We propose to examine the quality of care provided to patients treated in three managed care settings located in the Minneapolis/St. Paul area. The organizations we will study include Allina Health Systems, an independent practice association; HealthPartners, Inc. which delivers care through a staff-model HMO and an independent practice association arrangement; and PreferredOne, a preferred-provider organization. Each organization has an established quality improvement program, but differs in its approach to improving quality. The organizations also differ in their reliance on financial and administrative incentives to improve the quality of care they provide. We will evaluate whether four features of managed care organizations - financial arrangements with providers, strategies for the management of care, methods of delivery of care, and the degree of cost-sharing borne by patients - influence the quality of care received by patients with hypertension or diabetes, two highly prevalent conditions for which attempts have been made to define valid indicators of quality of care. Given that two of the features we are interested in - financial arrangements and management of care -may be modified by an intermediary organization that employs a provider, we will also assess whether aspects of these features at the level of the provider influence the quality of care delivered. The study will be undertaken as a collaboration between investigators from the Department of Health Care Policy at Harvard Medical School, the Healthcare Education and Research Foundation of St. Paul Minnesota, and the University of Massachusetts, Boston. We will study 667 patients with hypertension per organization and 667 patients with diabetes per organization (for a total of 4,002 patients). The results of this study will identify financial, delivery, and management features associated with the delivery of high quality care, and thereby, assist policy-makers, plan personnel, and providers in their efforts to improve quality, and consumers and purchasers in their selection of health plans.