Preston J A, Retchin S M
Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond.
J Am Geriatr Soc. 1991 Jul;39(7):683-90. doi: 10.1111/j.1532-5415.1991.tb03622.x.
To evaluate the quality of medical care received by Medicare enrollees with hypertension in health maintenance organizations (HMOs) compared to that received by a similar group of elderly hypertensives in a fee-for-service (FFS) setting.
A quasi-experimental design was used to study an historical cohort of newly evaluated hypertensive patients over a 2-year period.
Medicare HMO and FFS practice settings.
Eight Medicare HMOs and 87 FFS primary care physicians in the same communities were selected. A sample of 685 elderly hypertensive patients was studied, 336 in FFS settings and 349 in HMOs.
An expert panel of physicians selected standards of care for the management of geriatric hypertension, and medical records were reviewed. The results showed significant differences (P less than 0.01) in recording medications (94.5% HMO versus 88% FFS) and smoking histories (75.8% HMO versus 64.7% FFS), checking orthostatic blood pressures (9.5% HMO versus 3.3% FFS), performing funduscopy (44.4% HMO versus 27% FFS), completing cardiac examinations (90.8% HMO versus 79.8% FFS), and obtaining chest x-rays (72.8% HMO versus 64.3% FFS, P less than 0.05). Treatment and follow-up were similar between the two groups, except that FFS hypertensives were more likely to have medications adjusted and electrolytes ordered.
The results suggest that elderly hypertensives in HMOs received equal or better quality of care for most criteria compared to elderly hypertensives in FFS settings.
评估健康维护组织（HMO）中参加医疗保险的高血压患者所接受的医疗护理质量，并与按服务收费（FFS）模式下类似的老年高血压患者群体所接受的医疗护理质量进行比较。
采用准实验设计，对一组新评估的高血压患者进行为期2年的历史性队列研究。
医疗保险HMO和FFS医疗机构。
选取了同一社区的8家医疗保险HMO和87名FFS初级保健医生。对685名老年高血压患者进行了研究，其中336名在FFS模式下，349名在HMO模式下。
一个医生专家小组选定了老年高血压管理的护理标准，并对病历进行了审查。结果显示，在记录用药情况（HMO为94.5%，FFS为88%）、吸烟史（HMO为75.8%，FFS为64.7%）、检查直立位血压（HMO为9.5%，FFS为3.3%）、进行眼底镜检查（HMO为44.4%，FFS为27%）、完成心脏检查（HMO为90.8%，FFS为79.8%）以及进行胸部X光检查（HMO为72.8%，FFS为64.3%，P<0.05）方面存在显著差异（P<0.01）。两组之间的治疗和随访情况相似，但FFS模式下的高血压患者更有可能调整用药并安排电解质检查。
结果表明，与FFS模式下的老年高血压患者相比，HMO模式下的老年高血压患者在大多数标准下接受了同等或更好质量的护理。
