Selim Alfredo J, Kazis Lewis E, Rogers William, Qian Shirley X, Rothendler James A, Spiro Avron, Ren Xinhua S, Miller Donald, Selim Bernardo J, Fincke Benjamin G
Center for Health Quality, Outcomes, and Economic Research, A Health Services Research and Development Field Program, VA Medical Center, Bedford, MA, USA.
Qual Life Res. 2007 Sep;16(7):1179-91. doi: 10.1007/s11136-007-9216-2. Epub 2007 May 25.
Comparing health outcomes with adequate methodology is central to performance assessments of health care systems. We compared the Medicare Advantage Program (MAP) and the Veterans Health Administration (VHA) with regard to changes in health status and mortality.
We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2 years. We compared the probability of being alive with the same or better (than would be expected by chance) PCS (or MCS) at 2 years and mortality, while adjusting for case-mix. Given the geographic variations in MAP enrollment, we did a regional sub-analysis.
There were no significant differences in the probability of being alive with the same or better PCS except for the South (VHA 65.8% vs. MAP 62.5%, P = .0014). VHA patients had a slightly higher probability than MAP patients of being alive with the same or better MCS (71.8% vs. 70.1%, P = .002) but no significant regional variations. The hazard ratios for mortality in the MAP were higher than in the VHA across all regions.
With the use of appropriate methodology, we found small differences in 2-year health outcomes that favor the VHA.
运用适当的方法比较健康结局是医疗保健系统绩效评估的核心。我们比较了医疗保险优势计划（MAP）和退伍军人健康管理局（VHA）在健康状况变化和死亡率方面的情况。
我们使用死亡主文件来确定生命状态，并使用简明健康调查问卷36项简表来确定基线时和2年后的身体（PCS）和精神（MCS）健康状况。我们比较了在2年时存活且PCS（或MCS）与基线相同或更好（高于随机预期）的概率以及死亡率，同时对病例组合进行了调整。鉴于MAP参保情况存在地理差异，我们进行了区域亚组分析。
除南部地区外，存活且PCS与基线相同或更好的概率没有显著差异（VHA为65.8%，MAP为62.5%，P = 0.0014）。VHA患者存活且MCS与基线相同或更好的概率略高于MAP患者（71.8%对70.1%，P = 0.002），但无显著区域差异。在所有地区，MAP的死亡率风险比均高于VHA。
通过使用适当的方法，我们发现2年健康结局存在细微差异，这些差异有利于VHA。
