EFFECT OF HEALTH PLANS ON HYPERTENSION AND DIABETES CARE

对管理型医疗成本控制努力的担忧刺激了 尝试评估在不同财务状况下提供的护理质量 和行政安排。我们建议检查一下 为在三个管理型医疗机构中接受治疗的患者提供的医疗服务 在明尼阿波利斯/圣保罗地区。我们将研究的组织 包括Allina Health Systems，一个独立执业协会； HealthPartners，Inc.通过员工模式的HMO提供护理，以及 独立执业协会安排；首选一号，一个 首选-提供商组织。每个组织都有一个既定的 质量改进计划，但改进的方法不同 质量。这些组织对财政的依赖程度也不同 和行政激励，以提高他们的护理质量 提供。我们将评估管理型医疗保健的四个功能 组织-与提供者的财务安排、战略 护理的管理、提供护理的方法和程度 由患者承担的费用分担--影响所接受的护理质量 由高血压或糖尿病患者引起的，两种高发疾病 已尝试定义有效指标的条件 对护理质量的影响。鉴于我们感兴趣的两个功能 财务安排和护理管理--可通过以下方式修改 雇佣提供商的中介组织，我们还将 评估这些功能在提供商级别上的各个方面 影响提供的护理质量。将进行这项研究 作为卫生署调查人员之间的合作 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。我们将对667名高血压患者进行研究 组织和每个组织的667名糖尿病患者(用于 总计4,002名患者)。这项研究的结果将确定 相关的财务、交付和管理功能 提供高质量的护理，从而帮助政策制定者制定计划 人员和供应商努力提高质量，以及 消费者和购买者在他们的健康计划的选择中。

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.