Document Detail

How does managed care manage the frail elderly? The case of hospital readmissions in fee-for-service versus HMO systems.
MedLine Citation:
PMID:  10198653     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study examined whether hospital readmissions varied among the frail elderly in managed care versus fee-for-service (FFS) systems. SETTING AND PARTICIPANTS: Random sample of 450 patients, aged 65 and over, from a large vertically integrated health care system in San Diego, California. Participants were receiving physician-authorized home health and survived and 18-month follow-up period. MAIN OUTCOME MEASURES: Multiple logistic regression analyses were used to conduct comparisons of readmissions and preventable readmissions by plan type. Two methods to identify preventable readmissions were developed, one based on a computerized algorithm of service use patterns, and another based on blind clinical review. RESULTS: The odds of having a preventable hospital readmission within 90 days of an index admission were 3.51 (P = 0.06) to 5.82 (P = 0.02) times as high for Medicare HMO enrollees compared to Medicare FFS participants, depending on the method used to assess preventability. Readmission patterns were similar for Medicare HMO enrollees and FFS study participants dually enrolled in Medicare and Medicaid. CONCLUSION: In this group of frail elderly Medicare beneficiaries, those enrolled in an HMO were more likely to have a preventable hospital readmission than those receiving care under FFS. These results suggest that policies promoting stringent approaches to utilization control (e.g., early hospital discharge, reduced levels of post-acute care, and restricted use of home health services) may be problematic for the frail elderly.
B Experton; R J Ozminkowski; D N Pearlman; Z Li; S Thompson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of preventive medicine     Volume:  16     ISSN:  0749-3797     ISO Abbreviation:  Am J Prev Med     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-06-23     Completed Date:  1999-06-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8704773     Medline TA:  Am J Prev Med     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  163-72     Citation Subset:  IM    
HUMETRIX, Inc., San Diego, California, USA.
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MeSH Terms
Aged, 80 and over
Fee-for-Service Plans / economics,  statistics & numerical data*,  trends
Frail Elderly / statistics & numerical data*
Health Maintenance Organizations / economics,  statistics & numerical data*,  trends
Logistic Models
Medicare / economics,  statistics & numerical data,  trends
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care) / economics,  statistics & numerical data*,  trends
Patient Readmission / economics,  statistics & numerical data*
Retrospective Studies
Sampling Studies
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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