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    A longitudinal study of hospitalization rates for patients with chronic disease: results from the Medical Outcomes Study

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    Authors
    Nelson, Eugene C.
    McHorney, Colleen A.
    Manning, Willard G. Jr.
    Rogers, William H.
    Zubkoff, Michael
    Greenfield, Sheldon
    Ware, John E. Jr.
    Tarlov, Alvin R.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    1998-02-14
    Keywords
    Adult
    Aged
    Boston
    Chicago
    Chronic Disease
    Fee-for-Service Plans
    Female
    Health Resources
    Health Services Research
    Hospitalization
    Humans
    Longitudinal Studies
    Los Angeles
    Male
    Middle Aged
    Prepaid Health Plans
    Prospective Studies
    Socioeconomic Factors
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070232/pdf/hsresearch00038-0038.pdf
    Abstract
    OBJECTIVE: To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. DATA SOURCE/STUDY SETTING: Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles. STUDY DESIGN: A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians. DATA COLLECTION/EXTRACTION METHODS: Insurance payment system (PPD or FFS), hospitalizations, and office visits were obtained from patient reports. Disease and severity indicators, sociodemographics, and self-reported functional status were used to adjust for patient mix and to compute expected utilization rates. PRINCIPAL FINDINGS: Compared to FFS, PPD patients had 31 percent fewer observed hospitalizations before adjustment for patient differences (p = .005) and 15 percent fewer hospitalizations than expected after adjustment (p = .078). The observed rate of FFS hospitalizations exceeded the expected rate by 9 percent. These results are not explained by system differences in patient mix or trends in hospital use over four years. Half of the PPD/FFS difference in hospitalization rate is due to intrinsic characteristics of the payment system itself. CONCLUSIONS: PPD patients with chronic medical conditions followed prospectively over four years, after extensive patient-mix adjustment, had 15 percent fewer hospitalizations than their FFS counterparts owing to differences intrinsic to the insurance reimbursement system.
    Source
    Health Serv Res. 1998 Feb;32(6):759-74. Link to article on publisher's site
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47414
    PubMed ID
    9460485
    Related Resources
    Link to Article in PubMed
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    Population and Quantitative Health Sciences Publications

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