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- Title
The Quality of Ambulatory Care in Medicare Health Maintenance Organizations.
- Authors
Retchin, Sheldon M.; Brown, Barbara
- Abstract
Abstract: The quality of ambulatory care received by Medicare recipients who enrolled in health maintenance organizations (HMOs) was compared to the care received by fee-for-service (FFS) Medicare recipients, in a quasi-experimental, non-randomized design. Both samples were drawn from the four major geographic areas in the country, and included two types of HMO practices: staff/group models, and independent practice associations (IPAs). A panel of expert physicians developed criteria for evaluating ambulatory care, and medical record abstractions using these criteria were performed on 1,590 outpatient records: 777 FFS and 813 HMO (441 staff/group, 372 IPA). While individual items of medical histories and physical examinations were performed most often for staff/group HMO patients and least often in FFS patients, odds ratios (OR) for performance in staff/group HMO patients were particularly large for health maintenance items: tonometry (OR = 8.4), mammography (OR = 2.7), pelvic examination (OR = 5.3), rectal examination (OR = 2.9), fecal occult blood test (OR = 3.3). The results suggest that recommended elements of routine and preventive care are more likely to be performed for Medicare enrollees in staff/group HMOs than in FFS settings. (Am J Public Health 1990; 80:411-415.)
- Subjects
UNITED States; MEDICARE; OUTPATIENT medical care; HEALTH Maintenance Organization (Organization); INDEPENDENT practice associations (Medical care); HEALTH insurance; HEALTH policy; MEDICAL care costs; PHYSICIANS; MEDICAL records; PUBLIC health
- Publication
American Journal of Public Health, 1990, Vol 80, Issue 4, p411
- ISSN
0090-0036
- Publication type
Article
- DOI
10.2105/AJPH.80.4.411