Carlisle D M, Siu A L, Keeler E B, McGlynn E A, Kahn K L, Rubenstein L V, Brook R H
RAND Health Program, Santa Monica, Calif. 90407-2138.
Am J Public Health. 1992 Dec;82(12):1626-30. doi: 10.2105/ajph.82.12.1626.
Health maintenance organizations (HMOs) continue to grow in number and in their enrollment of Medicare recipients. They are also increasingly viewed as organizational structures that might contribute to control of health care costs. Yet little is known about the quality of care that elderly HMO enrollees receive.
We compared patients from three HMOs to a fee-for-service (FFS) sample that was national in scope. Sickness at admission, the quality of process of care, and mortality were assessed for patients aged 65 years and older who had been hospitalized with a diagnosis of acute myocardial infarction.
After adjustment for sickness at admission, there were no significant mortality differences between the HMO and FFS groups at either 30 (23.2% vs 23.5%) or 180 days (34.4% vs 34.5%) after admission. Compliance with process criteria was higher for the HMO group as a whole (P < .05). The HMOs had greater compliance with three of five scales measuring different aspects of care for patients with acute myocardial infarction.
We conclude that older patients from our participating HMOs who were hospitalized for acute myocardial infarction received hospital care that was generally better in terms of process than that received by patients in a national FFS sample.
健康维护组织（HMOs）的数量及其参保的医疗保险受益人的数量持续增长。它们也越来越被视为可能有助于控制医疗成本的组织结构。然而，对于老年HMO参保者所接受的医疗质量却知之甚少。
我们将来自三个HMOs的患者与一个全国范围的按服务收费（FFS）样本进行了比较。对65岁及以上因急性心肌梗死住院的患者的入院时疾病情况、医疗过程质量和死亡率进行了评估。
在对入院时疾病情况进行调整后，HMO组和FFS组在入院后30天（23.2%对23.5%）或180天（34.4%对34.5%）的死亡率没有显著差异。总体而言，HMO组对过程标准的依从性更高（P < .05）。HMOs在测量急性心肌梗死患者护理不同方面的五个量表中的三个量表上有更高的依从性。
我们得出结论，我们参与研究的HMOs中因急性心肌梗死住院的老年患者所接受的医院护理在过程方面总体上比全国FFS样本中的患者所接受的护理更好。
