Older Adults and Specialty Care Use in Managed Care

管理式医疗组织（MCOs）一直是应对医疗保健成本控制困境的一种措施。 最近对急性卒中患者的研究表明，管理式护理患者接受住院专科护理的概率低于收费服务（FFS）患者，但仅限于老年患者。这种年龄梯度提出了一个有争议的问题：在MCO中基于年龄的配给的可能性。 这些研究结果的后续研究是至关重要的管理式医疗资源管理策略的讨论变得越来越两极分化。 随着医疗保健市场的发展，更新我们对MCO如何管理护理的理解非常重要，特别是对于最脆弱的人群。然而，对于急性中风患者，大部分管理工作都在医院进行。 本项目的长期目标是研究MCO激励措施和医院特征在解释因急性卒中住院的老年患者的专科护理使用（包括年龄梯度）、结局和成本变化方面的贡献。拟议的研究将确定医疗保险受益人65岁及以上出院急性缺血性中风在1997年至2000年使用索赔数据的健康计划，是一个大型的国家MCO的一部分，和比较样本的FFS医疗保险受益人从相同的大都市地区。管理数据将用于获取有关具体MCO激励措施的信息，包括医院和医生支付政策、医院网络和使用审查。 这将通过美国医院协会年度调查的医院特征数据来增强，包括医院的专业化水平和管理式护理的经验。 关于当地环境的信息将从区域资源文件中获得。 将使用多层次建模技术来分离MCO、医院和患者在解释专科护理使用、成本和结局变化方面的影响。拟议的研究将为对管理式医疗和医疗保健提供者（即，医院）对急性病的老年患者。

Managed care organizations (MCOs) have been one response to the health care cost-containment dilemma. Recent research on acute stroke patients has shown that managed care patients had a lower probability of receiving in-hospital specialty care than patients in fee-for-service (FFS), but only among older patients. This age gradient raises a contentious issue: the possibility of age-based rationing in MCOs. Follow-up research on such findings is crucial as discussions of managed care resource management strategies become increasingly polarized. As the health care market evolves it is important to update our understanding of how MCOs manage care, especially for the most vulnerable populations. However, for acute stroke patients, much of the management goes on at the hospital level. The long-term objective of this project is to examine the contribution of both MCO incentives and hospital characteristics in explaining variation in specialty care use (including the age gradient), outcomes, and costs for older patients who are hospitalized with acute stroke. The proposed research will identify Medicare beneficiaries 65 years of age and older discharged with acute ischemic stroke during 1997-2000 using claims data from health plans that are part of a large national MCO, and a comparison sample of FFS Medicare beneficiaries from the same metropolitan areas. Administrative data will be used to obtain information on specific MCO incentives, including hospital and physician payment policies, hospital networks, and utilization review. This will be augmented by data on hospital characteristics from the American Hospital Association annual surveys, including the hospital's level of specialization and experience with managed care. Information on the local environment will be obtained from the Area Resource File. Multilevel modeling techniques will be used to separate the effects of MCOs, hospitals and patients in explaining variation in specialty care use, costs and outcomes. The proposed research will provide valuable information to clinicians, policymakers and researchers interested in the effects of managed care and health care providers (i.e., hospitals) on acutely-ill older patients.