HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Related articles in AJPH Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Retchin, S M Articles by Brown, B Search for Related Content PubMed PubMed Citation Articles by Retchin, S M Articles by Brown, B

The quality of ambulatory care in Medicare health maintenance organizations.

S M Retchin and B Brown

Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.

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.

Related articles in AJPH:

On quality of ambulatory care.

J T Ashley
AJPH 1990 80: 1136-1137. [PDF]  

This article has been cited by other articles:

				R. L. Kane, S. Flood, B. Bershadsky, and G. Keckhafer Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents Gerontologist, February 1, 2004; 44(1): 95 - 103. [Abstract] [Full Text] [PDF]

				R. L. Kane, P. Homyak, B. Bershadsky, Y.-S. Lum, and M. S. Siadaty Outcomes of Managed Care of Dually Eligible Older Persons Gerontologist, April 1, 2003; 43(2): 165 - 174. [Abstract] [Full Text] [PDF]

				D. G. Safran, I. B. Wilson, W. H. Rogers, J. E. Montgomery, and H. Chang Primary Care Quality in the Medicare Program: Comparing the Performance of Medicare Health Maintenance Organizations and Traditional Fee-for-Service Medicare Arch Intern Med, April 8, 2002; 162(7): 757 - 765. [Abstract] [Full Text] [PDF]

				R. M. Merrill, M. L. Brown, A. L. Potosky, G. Riley, S. H. Taplin, W. Barlow, and B. H. Fireman Survival and Treatment for Colorectal Cancer Medicare Patients in Two Group/Staff Health Maintenance Organizations and the Fee-for-Service Setting Med Care Res Rev, June 1, 1999; 56(2): 177 - 196. [Abstract] [PDF]

				S. M. Retchin Variations in Medicare Health Maintenance Organizations JAMA, February 24, 1999; 281(8): 755 - 756. [Full Text] [PDF]

				E. A. Miller, W. G. Weissert, and M. Chernew Managed Care for Elderly People: A Compendium of Findings American Journal of Medical Quality, September 1, 1998; 13(3): 127 - 140. [Abstract] [PDF]

				A. P. Legorreta, J. Christian-Herman, R. D. O'Connor, M. M. Hasan, R. Evans, and K.-M. Leung Compliance With National Asthma Management Guidelines and Specialty Care: A Health Maintenance Organization Experience Arch Intern Med, March 9, 1998; 158(5): 457 - 464. [Abstract] [Full Text] [PDF]

				S. M. Retchin, R. S. Brown, S.-C. J. Yeh, D. Chu, and L. Moreno Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care JAMA, July 9, 1997; 278(2): 119 - 124. [Abstract] [PDF]

				S. Asch, C. L. Goldzweig, and P. Lee Do We Understand the Effects of 'Managed Care' in Ophthalmology? A Review and Analysis Arch Ophthalmol, April 1, 1997; 115(4): 531 - 536. [Abstract] [PDF]

				J. B. Oberlander Managed Care and Medicare Reform Journal of Health Politics Policy and Law, January 1, 1997; 22(2): 595 - 631. [Abstract] [PDF]

				D. M. Berwick Payment by Capitation and the Quality of Care- Part Five of Six N. Engl. J. Med., October 17, 1996; 335(16): 1227 - 1231. [Full Text] [PDF]

				E. J. Emanuel and N. N. Dubler Preserving the Physician-Patient Relationship in the Era of Managed Care JAMA, January 25, 1995; 273(4): 323 - 329. [Abstract] [PDF]

				D. G. Clement, S. M. Retchin, R. S. Brown, and M. H. Stegall Access and Outcomes of Elderly Patients Enrolled in Managed Care JAMA, May 18, 1994; 271(19): 1487 - 1492. [Abstract] [PDF]

				R. H. Miller and H. S. Luft Managed Care Plan Performance Since 1980: A Literature Analysis JAMA, May 18, 1994; 271(19): 1512 - 1519. [Abstract] [PDF]

				S. M. Retchin and J. Preston Effects of Cost Containment on the Care of Elderly Diabetics Arch Intern Med, November 1, 1991; 151(11): 2244 - 2248. [Abstract] [PDF]