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The utility of HMO data for the surveillance of chronic diseases
D L Nordstrom1, P L Remington, P M Layde
1Marshfield Medical Research Foundation, Wis. 54449-5790.
Insights
Health maintenance organization (HMO) data alone may inaccurately estimate chronic disease prevalence. Comparing HMO and fee-for-service records revealed significant variations, highlighting the need for comprehensive data sources.
Area of Science:
- Epidemiology
- Health Services Research
Background:
- Health maintenance organizations (HMOs) and fee-for-service (FFS) models represent different healthcare delivery and reimbursement systems.
- Accurate disease prevalence estimation is crucial for public health planning and resource allocation.
Purpose of the Study:
- To compare the estimated prevalence of 11 chronic diseases between patients within an HMO and those in a fee-for-service (FFS) system.
- To assess the validity of using solely HMO data for disease prevalence studies.
Main Methods:
- A retrospective review of computerized medical records was conducted.
- Prevalence ratios were calculated by comparing annual disease prevalence between the HMO and FFS patient groups within a single medical center.
Main Results:
- Significant variations in prevalence ratios were observed across 11 diseases, ranging from 1.38 for rheumatoid arthritis to 0.60 for liver cirrhosis.
- These discrepancies suggest that HMO data alone may not fully capture disease prevalence.
Conclusions:
- Relying exclusively on HMO data can lead to inaccurate estimates of chronic disease prevalence.
- Supplementing HMO data with information from hospitals, physicians, and other sources is essential for valid prevalence studies.
Abstract:
In an area served by a single medical center that operates as both health maintenance organization (HMO) and fee-for-service clinic, we reviewed existing computerized medical records to determine the prevalence of 11 diseases. Standardized medical care utilization prevalence ratios, comparing the annual prevalences in the two groups, varied from 1.38 for rheumatoid arthritis to 0.60 for liver cirrhosis. Unless supplemented by data from hospitals, physicians, and other sources, HMO data may result in invalid estimates of the prevalence of chronic disease.