Ni H, Nauman D J, Hershberger R E
Oregon Heart Failure Project, Heart Failure Treatment Program, Oregon Health Sciences University, Portland 97201-3098, USA.
Arch Intern Med. 1998 Jun 8;158(11):1231-6. doi: 10.1001/archinte.158.11.1231.
Little was known about the impact of the health maintenance organization-managed care on patients hospitalized for congestive heart failure. Understanding this issue is important with regards to the increasing prevalence of congestive heart failure among the elderly population as well as the growing enrollment of Medicare beneficiaries in managed care.
To examine the impact of the health maintenance organization-managed care on the outcomes of hospitalization among patients with congestive heart failure.
We analyzed the Oregon hospital discharge data set. Study subjects were all patients with congestive heart failure aged 65 years or older (N=5821) discharged from hospitals in 1995 and classified into 6 insurance groups: managed care, Medicare, Medicaid, commercial or private insurance, self-pay, and other.
The percentage of patients admitted to hospitals via emergency departments was significantly higher in the managed care patients (69%) than in other health insurance coverage groups (29.0%-58.5%; P<.001). After adjusting for age, sex, and comorbidity, the managed care patients experienced a similar length of hospital stay (3.6 days) as the commercial or private insurance patients (3.7 days; P = .67), but a shorter length of hospital stay than the Medicare patients (4.0 days; P<.001), self-pay patients (4.5 days; P<.001), and other patients (4.8 days; P<.001). No difference in the in-hospital mortality rate was seen among the insurance groups (P = .37). The readmission rate was slightly higher in managed care patients (9.1%) than in commercial insurance patients (6.8%) and Medicare patients (7.5%). The differences, however, were not statistically significant after adjusting for the confounding factors (P = .59).
Our results suggest no association between managed care and poor short-term outcomes of hospitalization in patients with congestive heart failure. Attention, however, needs to be paid to the increased use of emergency departments by managed care patients.
关于健康维护组织管理式医疗对因充血性心力衰竭住院患者的影响，人们了解甚少。鉴于充血性心力衰竭在老年人群中的患病率不断上升，以及医疗保险受益人在管理式医疗中的参保人数不断增加，了解这一问题很重要。
探讨健康维护组织管理式医疗对充血性心力衰竭患者住院结局的影响。
我们分析了俄勒冈州医院出院数据集。研究对象为1995年从医院出院的所有65岁及以上的充血性心力衰竭患者（N = 5821），并分为6个保险组：管理式医疗、医疗保险、医疗补助、商业或私人保险、自费和其他。
管理式医疗患者通过急诊科入院的百分比（69%）显著高于其他医疗保险覆盖组（29.0% - 58.5%；P <.001）。在调整年龄、性别和合并症后，管理式医疗患者的住院时间（3.6天）与商业或私人保险患者（3.7天；P =.67）相似，但比医疗保险患者（4.0天；P <.001）、自费患者（4.5天；P <.001）和其他患者（4.8天；P <.001）的住院时间短。各保险组的院内死亡率无差异（P =.37）。管理式医疗患者的再入院率（9.1%）略高于商业保险患者（6.8%）和医疗保险患者（7.5%）。然而，在调整混杂因素后，差异无统计学意义（P =.59）。
我们的结果表明，管理式医疗与充血性心力衰竭患者住院的短期不良结局之间无关联。然而，需要注意管理式医疗患者对急诊科的使用增加。
