Older Adults and Specialty Care Use in Managed Care

管理式医疗组织（MCOs）是对医疗保健成本控制困境的一种回应。最近对急性脑卒中患者的研究表明，管理式护理患者接受院内专科护理的可能性低于按服务收费（FFS）的患者，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：mco中基于年龄的配给的可能性。随着对管理式医疗资源管理策略的讨论日益两极化，对这些发现的后续研究至关重要。随着卫生保健市场的发展，重要的是更新我们对mco如何管理保健的理解，特别是对最弱势群体。然而，对于急性中风患者，大部分的管理是在医院层面进行的。该项目的长期目标是检验MCO激励和医院特征在解释急性中风住院的老年患者专科护理使用（包括年龄梯度）、结果和成本变化方面的贡献。拟议的研究将确定1997-2000年期间65岁及65岁以上因急性缺血性中风出院的医疗保险受益人，使用的数据来自一个大型国家MCO的一部分健康计划，以及来自同一大都市地区的FFS医疗保险受益人的比较样本。行政数据将用于获取具体的MCO激励措施的信息，包括医院和医生的支付政策、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。有关本地环境的信息将从区域资源文件中获得。多层建模技术将用于分离MCOs、医院和患者在解释专科护理使用、成本和结果变化方面的影响。拟议的研究将为临床医生、政策制定者和对管理式护理和卫生保健提供者（即医院）对急病老年患者的影响感兴趣的研究人员提供有价值的信息。

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.