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Managed care and outcomes of hospitalization among elderly patients with congestive heart failure

H Ni1, D J Nauman, R E Hershberger

  • 1Oregon Heart Failure Project, Heart Failure Treatment Program, Oregon Health Sciences University, Portland 97201-3098, USA.

Archives of Internal Medicine
|June 13, 1998
PubMed

Insights

Managed care for congestive heart failure patients did not worsen hospitalization outcomes like mortality or length of stay. However, managed care enrollees used emergency departments more frequently.

Area of Science:

  • Health Services Research
  • Cardiology
  • Public Health

Background:

  • Limited understanding of health maintenance organization (HMO)-managed care impact on congestive heart failure (CHF) hospitalizations.
  • Increasing CHF prevalence in the elderly and rising Medicare enrollment in managed care necessitate this research.

Purpose of the Study:

  • To evaluate the effect of HMO-managed care on hospitalization outcomes for CHF patients.

Main Methods:

  • Analysis of Oregon hospital discharge data from 1995.
  • Inclusion of 5821 CHF patients aged 65+.
  • Categorization into six insurance groups: managed care, Medicare, Medicaid, commercial/private, self-pay, and other.

Main Results:

  • Managed care patients had significantly higher emergency department admission rates (69%) compared to other groups (29.0%-58.5%).
  • Hospital length of stay was similar for managed care (3.6 days) and commercial insurance (3.7 days) patients, but shorter than Medicare, self-pay, and other groups.
  • No significant differences in in-hospital mortality rates were observed across insurance groups (P = .37). Readmission rates were not statistically different after adjustments.

Conclusions:

  • No association found between managed care and adverse short-term hospitalization outcomes for CHF patients.
  • Increased emergency department utilization by managed care patients warrants further attention.
Abstract

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