Show simple item record

dc.creatorWare, John E.en
dc.creatorBayliss, Martha S.en
dc.creatorRogers, William H.en
dc.creatorKosinski, Marken
dc.creatorTarlov, Alvin R.en
dc.date.accessioned2015-05-05T19:00:25Zen
dc.date.available2015-05-05T19:00:25Zen
dc.date.created1996-10-02en
dc.date.issued1996-10-02en
dc.identifier10.1001/jama.276.13.1039ben
dc.identifier.bibliographicCitationJAMA. 1996 Oct 2; 276(13): 1039-1047.en
dc.identifier.issn0098-7484en
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Differences+in+4-Year+Health+Outcomes+for+Elderly+and+Poor,+chronically+Ill+Patients+Treated+in+Hmo+and+Fee-for-Service+Systems:+Results+from+the+Medical+Outcomes+Study&title=JAMA.++&volume=276&issue=13&pages=1039-1047&date=1996&au=Ware,+John+E.en
dc.identifier.urihttp://dx.doi.org/10.1001/jama.276.13.1039ben
dc.identifier.urihttp://hdl.handle.net/10822/751699en
dc.description.abstractOBJECTIVE: To compare physical and mental health outcomes of chronically ill adults, including elderly and poor subgroups, treated in health maintenance organization (HMO) and fee-for-service (FFS) systems. STUDY DESIGN: A 4-year observational study of 2235 patients (18 to 97 years of age) with hypertension, non-insulin-dependent diabetes mellitus (NIDDM), recent acute myocardial infarction, congestive heart failure, and depressive disorder sampled from HMO and FFS systems in 1986 and followed up through 1990. Those aged 65 years and older covered under Medicare and low-income patients (200% of poverty) were analyzed separately. SETTING AND PARTICIPANTS: Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry, in HMO and FFS systems of care. Types of practices included both prepaid group (72% of patients) and independent practice association (28%) types of HMOs, large multispecialty groups, and solo or small, single-specialty practices in Boston, Mass, Chicago, Ill, and Los Angeles, Calif. OUTCOME MEASURES: Differences between initial and 4-year follow-up scores of summary physical and mental health scales from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) for all patients and practice settings. RESULTS: On average, physical health declined and mental health remained stable during the 4-year follow-up period, with physical declines larger for the elderly than for the nonelderly (P less than .001). In comparisons between HMO and FFS systems, physical and mental health outcomes did not differ for the average patient; however, they did differ for subgroups of the population differing in age and poverty status. For elderly patients (those aged 65 years and older) treated under Medicare, declines in physical health were more common in HMOs than in FFS plans (54% vs 28%; P less than .001). In 1 site, mental health outcomes were better (P less than .05) for elderly patients in HMOs relative to FFS but not in 2 other sites. For patients differing in poverty status, opposite patterns of physical health (P less than .05) and for mental health (P less than .001) outcomes were observed across systems; outcomes favored FFS over HMOs for the poverty group and favored HMOs over FFS for the nonpoverty group. CONCLUSIONS: During the study period, elderly and poor chronically ill patients had worse physical health outcomes in HMOs than in FFS systems; mental health outcomes varied by study site and patient characteristics. Current health care plans should carefully monitor the health outcomes of these vulnerable subgroups.en
dc.formatArticleen
dc.languageenen
dc.sourceBRL:MEDKIE/96404325en
dc.subjectAdultsen
dc.subjectAgeden
dc.subjectChronically Illen
dc.subjectComparative Studiesen
dc.subjectDepressive Disorderen
dc.subjectDiabetesen
dc.subjectEconomicsen
dc.subjectEvaluationen
dc.subjectGovernmenten
dc.subjectGovernment Financingen
dc.subjectHealthen
dc.subjectHealth Careen
dc.subjectHealth Maintenance Organizationsen
dc.subjectHeart Diseasesen
dc.subjectHypertensionen
dc.subjectIndigentsen
dc.subjectInsulinen
dc.subjectInternal Medicineen
dc.subjectMedicineen
dc.subjectMental Healthen
dc.subjectMorbidityen
dc.subjectOrganizationsen
dc.subjectPatient Careen
dc.subjectPatientsen
dc.subjectPhysiciansen
dc.subjectPsychiatryen
dc.subjectPovertyen
dc.subjectQuality of Health Careen
dc.subjectSurveyen
dc.subjectTime Factorsen
dc.subjectTreatment Outcomeen
dc.titleDifferences in 4-Year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee-for-Service Systems: Results From the Medical Outcomes Studyen
dc.provenanceDigital citation created by the National Reference Center for Bioethics Literature at Georgetown University for the BIOETHICSLINE database, part of the Kennedy Institute of Ethics' Bioethics Information Retrieval Project funded by the United States National Library of Medicine.en
dc.provenanceDigital citation migrated from OpenText LiveLink Discovery Server database named NBIO hosted by the Bioethics Research Library to the DSpace collection BioethicsLine hosted by Georgetown University.en


This item appears in the following Collection(s)

Show simple item record


Georgetown University Seal
©2009—2019 Bioethics Research Library
Box 571212 Washington DC 20057-1212
202.687.3885