Experton B, Ozminkowski R J, Pearlman D N, Li Z, Thompson S
HUMETRIX, Inc., San Diego, California, USA.
Am J Prev Med. 1999 Apr;16(3):163-72. doi: 10.1016/s0749-3797(98)00098-1.
This study examined whether hospital readmissions varied among the frail elderly in managed care versus fee-for-service (FFS) systems.
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.
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.
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.
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.
本研究探讨了在管理式医疗与按服务收费（FFS）系统中，体弱老年人的医院再入院情况是否存在差异。
从加利福尼亚州圣地亚哥一个大型垂直整合医疗系统中随机抽取450名65岁及以上的患者。参与者正在接受医生授权的家庭保健服务，并且在18个月的随访期内存活。
采用多元逻辑回归分析按计划类型对再入院和可预防再入院情况进行比较。开发了两种识别可预防再入院的方法，一种基于服务使用模式的计算机算法，另一种基于盲法临床评估。
根据评估可预防性的方法不同，医疗保险健康维护组织（HMO）参保者在首次入院后90天内发生可预防医院再入院的几率是医疗保险FFS参与者的3.51倍（P = 0.06）至5.82倍（P = 0.02）。同时参加医疗保险和医疗补助的医疗保险HMO参保者和FFS研究参与者的再入院模式相似。
在这组体弱的老年医疗保险受益人中，参加健康维护组织的人比接受FFS治疗的人更有可能发生可预防的医院再入院。这些结果表明，推广严格利用控制方法（如早期出院、降低急性后期护理水平和限制家庭保健服务使用）的政策可能对体弱老年人存在问题。
