Retchin S M, Brown B
Department of Internal Medicine, Medical College of Virginia, Commonwealth University, Richmond.
Am J Med. 1991 Feb;90(2):236-42.
Because of concern about the quality of care received by Medicare patients in health maintenance organizations (HMOs), the care of patients with congestive heart failure (CHF) in eight HMOs was compared with the care of fee-for-service (FFS) Medicare cases.
We compared the care of 170 patients with CHF enrolled in one of eight Medicare HMOs with the care of 191 similar FFS patients. Panels of expert physicians developed criteria for evaluating quality of care, and specially trained nurse clinicians abstracted medical records.
Outpatient evaluation and management were similar in both settings, although HMO patients were significantly more likely to be advised to restrict salt intake. However, FFS patients with uncontrolled hypertension were more likely to have their medication regimens changed (62% versus 36%, p less than 0.01). Ejection fractions were obtained equally as often, and inpatient management was similar for both groups. Nonetheless, HMO providers scheduled follow-up visits within 1 week of hospital discharge more often (42% versus 27%, p less than 0.01).
This study suggests that financial incentives of prepaid care are not detrimental to most aspects of care for CHF patients. More rapid follow-up after hospital discharge for patients with CHF suggests that HMOs may be more effective in delivering continuity of care for patients with chronic illness.
由于对医疗保险患者在健康维护组织（HMO）中接受的护理质量存在担忧，对8个HMO中充血性心力衰竭（CHF）患者的护理与按服务收费（FFS）的医疗保险病例的护理进行了比较。
我们将8个医疗保险HMO之一中登记的170例CHF患者的护理与191例类似的FFS患者的护理进行了比较。专家医生小组制定了评估护理质量的标准，经过专门培训的护士临床医生提取了医疗记录。
尽管HMO患者被建议限制盐摄入的可能性显著更高，但两种情况下的门诊评估和管理相似。然而，高血压未得到控制的FFS患者更有可能改变其药物治疗方案（62%对36%，p<0.01）。两组获取射血分数的频率相同，住院管理也相似。尽管如此，HMO提供者更常在出院后1周内安排随访（42%对27%，p<0.01）。
本研究表明，预付护理的经济激励措施对CHF患者护理的大多数方面并无不利影响。CHF患者出院后更快速的随访表明，HMO在为慢性病患者提供连续护理方面可能更有效。
