Kane Robert L, Homyak Patricia, Bershadsky Boris, Lum Terry, Flood Shannon, Zhang Hui
University of Minnesota School of Public Health, D351 Mayo (MMC 197), 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Gerontologist. 2005 Aug;45(4):496-504. doi: 10.1093/geront/45.4.496.
Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care.
Two control groups were used; one was drawn from nonenrollees living in the same area (Control-In) and another from comparable individuals living in another urban area where the program was not available (Control-Out). Cohorts living in the community and in nursing homes were included. Quality measures for both groups included mortality rates, preventable hospital admissions, and preventable emergency room (ER) visits. For the community group, nursing home admission rates were also tracked. For nursing home residents, quality measures included quality indicators derived from the Minimum Data Set.
There were no differences in mortality rates for either cohort. MSHO had fewer short-stay nursing home admissions but no difference for stays 90 days or longer. MSHO community and nursing home residents had fewer preventable hospital and ER visits compared to Control-In. There were no major differences in nursing home quality indicator rates.
The cost of changing the model of care for dual eligibles from a mixture of fee-for-service and managed care to a merged managed-care approach cannot be readily justified by the improvements in quality observed.
本研究的目的是比较明尼苏达高级健康选择计划（MSHO）（一项旨在为双重资格老年人提供服务的特殊计划）所提供的护理质量与接受按服务收费的医疗保险和医疗补助管理式护理的对照组所接受的护理质量。
使用了两个对照组；一个来自居住在同一地区的未参保者（对照组-内部），另一个来自居住在该计划未实施的另一个城市地区的可比个体（对照组-外部）。纳入了居住在社区和养老院的队列。两组的质量指标包括死亡率、可预防的住院次数和可预防的急诊室就诊次数。对于社区组，还跟踪了养老院入住率。对于养老院居民，质量指标包括从最低数据集得出的质量指标。
两个队列的死亡率均无差异。MSHO的短期养老院入住率较低，但90天及以上的入住率无差异。与对照组-内部相比，MSHO的社区和养老院居民的可预防住院和急诊室就诊次数较少。养老院质量指标率没有重大差异。
将双重资格者的护理模式从按服务收费和管理式护理的混合模式转变为合并的管理式护理方法所带来的成本，不能轻易地通过所观察到的质量改善来证明是合理的。
