• Login
    View Item 
    •   Home
    • UMass Chan Departments, Programs and Centers
    • Population and Quantitative Health Sciences
    • Population and Quantitative Health Sciences Publications
    • View Item
    •   Home
    • UMass Chan Departments, Programs and Centers
    • Population and Quantitative Health Sciences
    • Population and Quantitative Health Sciences Publications
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of eScholarship@UMassChanCommunitiesPublication DateAuthorsUMass Chan AffiliationsTitlesDocument TypesKeywordsThis CollectionPublication DateAuthorsUMass Chan AffiliationsTitlesDocument TypesKeywordsProfilesView

    My Account

    LoginRegister

    Help

    AboutSubmission GuidelinesData Deposit PolicySearchingUsage StatisticsAccessibilityTerms of UseWebsite Migration FAQ

    Statistics

    Most Popular ItemsStatistics by CountryMost Popular Authors

    Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Authors
    Ware, John E. Jr.
    Bayliss, Martha S.
    Rogers, William H.
    Kosinski, Mark
    Tarlov, Alvin R.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    1996-10-02
    Keywords
    Adult
    Age Factors
    Aged
    *Chronic Disease
    *Fee-for-Service Plans
    *Health Maintenance Organizations
    Health Policy
    *Health Status
    Health Surveys
    Humans
    Independent Practice Associations
    Longitudinal Studies
    Mental Health
    Middle Aged
    Multivariate Analysis
    *Outcome and Process Assessment (Health Care)
    Policy Making
    Poverty
    Regression Analysis
    Socioeconomic Factors
    United States
    Biostatistics
    Epidemiology
    Health Services Research
    Show allShow less
    
    Metadata
    Show full item record
    Link to Full Text
    http://jama.ama-assn.org/cgi/reprint/276/13/1039
    Abstract
    OBJECTIVE: To compare physical and mental health outcomes of chronically ill adults, including elderly and poor subgroups, treated in health maintenance organization (HMO) and fee-for-service (FFS) systems. STUDY DESIGN: A 4-year observational study of 2235 patients (18 to 97 years of age) with hypertension, non-insulin-dependent diabetes mellitus (NIDDM), recent acute myocardial infarction, congestive heart failure, and depressive disorder sampled from HMO and FFS systems in 1986 and followed up through 1990. Those aged 65 years and older covered under Medicare and low-income patients (200% of poverty) were analyzed separately. SETTING AND PARTICIPANTS: Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry, in HMO and FFS systems of care. Types of practices included both prepaid group (72% of patients) and independent practice association (28%) types of HMOs, large multispecialty groups, and solo or small, single-specialty practices in Boston, Mass, Chicago, Ill, and Los Angeles, Calif. OUTCOME MEASURES: Differences between initial and 4-year follow-up scores of summary physical and mental health scales from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) for all patients and practice settings. RESULTS: On average, physical health declined and mental health remained stable during the 4-year follow-up period, with physical declines larger for the elderly than for the nonelderly (P<.001). In comparisons between HMO and FFS systems, physical and mental health outcomes did not differ for the average patient; however, they did differ for subgroups of the population differing in age and poverty status. For elderly patients (those aged 65 years and older) treated under Medicare, declines in physical health were more common in HMOs than in FFS plans (54% vs 28%; P<.001). In 1 site, mental health outcomes were better (P<.05) for elderly patients in HMOs relative to FFS but not in 2 other sites. For patients differing in poverty status, opposite patterns of physical health (P<.05) and for mental health (P<.001) outcomes were observed across systems; outcomes favored FFS over HMOs for the poverty group and favored HMOs over FFS for the nonpoverty group. CONCLUSIONS: During the study period, elderly and poor chronically ill patients had worse physical health outcomes in HMOs than in FFS systems; mental health outcomes varied by study site and patient characteristics. Current health care plans should carefully monitor the health outcomes of these vulnerable subgroups.
    Source
    JAMA. 1996 Oct 2;276(13):1039-47. Link to article on publisher's site
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47394
    PubMed ID
    8847764
    Related Resources
    Link to Article in PubMed
    Collections
    Population and Quantitative Health Sciences Publications

    entitlement

    Related items

    Showing items related by title, author, creator and subject.

    • Thumbnail

      Policy Brief: Addressing Social Determinants of Health through Community Health Workers: A Call to Action

      London, Katharine; Damio, Grace; Ferrazo, Meredith; Perez-Escamalla, Rafael; Wiggins, Noelle (2018-01-30)
      This technical report was compiled by the Hispanic Health Council in partnership with Southwestern AHEC and a panel of Community Health Worker Policy Research Experts which included our Katharine London from the Center for Health Law and Economics. The report offers a number of policy recommendations for community health workers for communities that might benefit from community-based services. The report offers recommendations on; payment of community health workers; community health worker caseloads; community health worker recruitment; community health worker training; reflective and trauma-informed mentoring and supportive supervision of community health workers; integration of community health workers into care teams; documenting the effect of community heal worker services on social determination of health. The Hispanic Health Council believes a service design that effectively supports community health workers would incorporate the seven areas of policy recommendation included in this report.
    • Thumbnail

      A Public Health Framework for the State Mental Health Authority: A Call for Action by Massachusetts Consumers and Family Members

      Delman, Jonathan (2006-01-01)
      During the Spring of 2006, Consumer Quality Initiatives (CQI) conducted 20 focus groups across the state, 12 with adults with mental illness, 3 with parents of youth with serious emotional disorder, 2 with youth with SED, 1 with family members of adult consumers, and 2 with youth in transition. Supported by a contract with Massachusetts Department of Mental Health (DMH), the goal was to assist DMH in framing the criteria for its upcoming reprocurement. Our findings reveal a frustration with an approach to health care delivery that focuses primarily on the provision of psychiatric care (egs, medication, therapy, hospitalization). We reviewed the focus group reports to identify the most significant themes, which clustered within eight broad categories.
    • Thumbnail

      Making the Case for Sustainable Funding for Community Health Worker Services: Talking to Payers and Providers

      London, Katharine (2018-01-27)
      In this presentation, Katharine London of the Center for Health Law and Economics makes her case for offering sustainable funding for community health worker services. Research has shown community health workers can have a distinct impact on health systems, helping them improve population health and contain costs, while also promoting health equity and community engagement. This presentation was designed to assist CHWs and other advocates in engaging with policymakers and payers to support CHW sustainability and develop a financial plan for their CHW work. It was presented as part of a CHW Sustainability event held at the Families USA’s annual conference, Health Action 2018: Staying Strong for America’s Families, in Washington, DC. See Katharine London's blog post on payment delivery methods for community health workers here.
    DSpace software (copyright © 2002 - 2023)  DuraSpace
    Lamar Soutter Library, UMass Chan Medical School | 55 Lake Avenue North | Worcester, MA 01655 USA
    Quick Guide | escholarship@umassmed.edu
    Works found in eScholarship@UMassChan are protected by copyright unless otherwise indicated.
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.