ENROLLMENT IN THE HEALTH ALLIANCE PLAN HMO IS NOT AN INDEPENDENT RISKFACTOR FOR CORONARY-ARTERY BYPASS GRAFT-SURGERY

Citation
G. Paone et al., ENROLLMENT IN THE HEALTH ALLIANCE PLAN HMO IS NOT AN INDEPENDENT RISKFACTOR FOR CORONARY-ARTERY BYPASS GRAFT-SURGERY, Circulation, 92(9), 1995, pp. 69-72
Citations number
9
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
Circulation → ACNP
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
69 - 72
Database
ISI
SICI code
0009-7322(1995)92:9<69:EITHAP>2.0.ZU;2-H
Abstract
Background Henry Ford Hospital is the sole provider of cardiac surgica l services for the Health Alliance Plan, a health maintenance organiza tion (HMO) that presently serves 450 000 enrollees. Methods and Result s To determine the effect of managed care referral patterns on the out come of coronary artery bypass graft (CABG) surgery, we retrospectivel y reviewed two concurrent groups of patients, 569 HMO patients and 225 patients with fee-for-service (FFS) insurance, who had undergone isol ated primary CABG surgery between January 1, 1990 and January 31, 1994 . The 605 patients with Medicare operated on during the same time fram e were excluded to obviate age bias. Age, sex, use of cardiac medicati ons, history of prior percutaneous transluminal coronary angioplasty o r thrombolytic therapy, history of recent and remote myocardial infarc tion, extent of coronary disease, presence of preexisting comorbid con ditions, and incidence of unstable clinical syndromes and left ventric ular dysfunction (ejection fraction <40%) were comparable for both gro ups. Inhospital mortality (HMO group, 1.9%; FFS group, 2.2%), mean ICU stay (HMO, 2.6+/-0.3 days; FFS, 2.3+/-0.3 days), and total hospital l ength of stay (HMO, 9.8+/-0.8 days; FFS, 8.6+/-0.6 days) were likewise similar. Conclusions These data refute the notion that the gale-keepe r mentality often associated with managed-care health insurance vehicl es results in delayed referral of patients with coronary artery diseas e and results in suboptimal outcome.