Bian John, Dow William H, Matchar David B
Division of Preventive Medicine, University of Alabama at Birmingham, Deep South Center on Effectiveness at Birmingham VA Medical Center, 35295-4410, USA.
Am J Manag Care. 2006 Jan;12(1):58-64.
To examine associations between Medicare health maintenance organization (HMO) penetration and stroke mortality outcomes among older persons.
Panel analysis of nationally representative secondary data from 1993 to 1998.
The first analysis sample included ischemic stroke hospitalizations among older persons in the Nationwide Inpatient Sample; the second included county-level ischemic stroke deaths in the National Vital Statistics System. The 2 samples were merged with the HMO enrollment data and the 2001 Area Resource File. The 2 outcomes were in hospital death status and county-level population ischemic stroke death rates among older persons; the 2 utilization variables were length of hospital stay for ischemic stroke and proportion of ischemic stroke deaths occurring in hospitals. The 3 key explanatory variables were county-level Medicare total, independent practice association, and nonindependent practice association HMO penetration. Ordinary least squares analysis with hospital or county fixed effects was used in estimation.
Medicare HMO penetration was not associated with the 2 ischemic stroke mortality outcomes (P > .05). Increases in Medicare total and independent practice association HMO penetration were associated with a significant shift in a higher proportion of stroke deaths from hospitals to nursing homes or residences (P < .05). Medicare HMO penetration was negatively associated with length of stay, although this was not statistically significant (P > .05).
Increased Medicare HMO penetration was associated with a shift in ischemic stroke deaths from hospitals to nonhospital settings. The effect of Medicare HMO penetration on quality of stroke care needs further research.
研究医疗保险健康维护组织（HMO）的普及程度与老年人中风死亡率之间的关联。
对1993年至1998年具有全国代表性的二手数据进行面板分析。
第一个分析样本包括全国住院患者样本中老年人的缺血性中风住院病例；第二个样本包括国家生命统计系统中县级缺血性中风死亡病例。这两个样本与HMO注册数据和2001年地区资源文件合并。两个结果分别是住院死亡状态和老年人县级人群缺血性中风死亡率；两个利用变量分别是缺血性中风的住院时间和在医院发生的缺血性中风死亡比例。三个关键解释变量分别是县级医疗保险总HMO普及率、独立执业协会HMO普及率和非独立执业协会HMO普及率。估计采用具有医院或县固定效应的普通最小二乘法分析。
医疗保险HMO普及率与两个缺血性中风死亡率结果均无关联（P > 0.05）。医疗保险总HMO普及率和独立执业协会HMO普及率的增加与中风死亡比例从医院显著转移到疗养院或住所显著相关（P < 0.05）。医疗保险HMO普及率与住院时间呈负相关，尽管这在统计学上不显著（P > 0.05）。
医疗保险HMO普及率的提高与缺血性中风死亡从医院向非医院环境的转移有关。医疗保险HMO普及率对中风护理质量的影响需要进一步研究。
