 |
|
Health Care Utilization and Outcomes Among Persons With Rheumatoid Arthritis in Fee-for-Service and Prepaid Group Practice Settings
Edward H. Yelin, PhD;
Lindsey A. Criswell, MD, MPH;
Paul G. Feigenbaum, MD
JAMA. 1996;276(13):1048-1053.
Abstract
| |
Objective.
—To compare health care utilization and outcomes over an 11-year period among persons with rheumatoid arthritis (RA) in fee-for-service and prepaid group practice settings.
Design.
—Cohort of persons with RA followed up for as long as 11 years. The principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker.
Setting.
—Persons with RA presenting to a random sample of community rheumatologists in northern California.
Patients.
—Patients were enrolled in 2 cycles: in 1982 and 1983 and in 1989. Study rheumatologists listed all persons meeting criteria for RA presenting to their offices over a 1-month period. Of the 1062 so listed, we enrolled 1025, or 96.5%. Of the 1025 persons with RA, 227 (22.2%) reported receiving care in prepaid group practice settings.
Main Outcome Measures.
—As of the end of 1994, 5295 person-years of observation were available for the analysis of the annual level of the utilization and outcome measures; 341 persons had been followed up for all 11 years of the study. The main utilization outcomes measured included office visits, outpatient surgeries, hospital admissions, and painful joints.
Results.
—The persons with RA in fee-for-service and prepaid group practice settings did not differ in the quantity of health care used in any 1 year for either RA or non-RA reasons. Among those followed up for all 11 years, the persons in feefor-service and prepaid group practice settings did not differ in the cumulative quantity of health care used over the entire period of study. The 2 groups did not differ on any outcome measure on either an annual or long-term basis. The results of mortality analyses were inconsistent: using Kaplan-Meier estimates, the persons with RA in prepaid group practice settings survived significantly longer (P<.05 by log-rank test); using Cox proportional hazards methods, the proportion dying each year did not differ significantly.
Conclusions.
—We could find no evidence that persons with RA in fee-forservice and prepaid group practice settings received different quantities of health care or experienced different outcomes on either an annual or long-term basis.
Author Affiliations
From the Rosalind Russell Medical Research Center for Arthritis (Drs Yelin and Criswell), and the Institute for Health Policy Studies (Dr Yelin), the University of California, San Francisco; and Kaiser-Permanente, San Francisco, Calif (Dr Feigenbaum).
Footnotes
Reprints: Edward H. Yelin, PhD, Arthritis Research Group, 1388 Sutter St, Suite 700, San Francisco, CA 94143-0920 (e-mail: yelin2@itsa.ucsf.edu).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Health-care use by rheumatoid arthritis patients compared with non-arthritic subjects
Girard et al.
Rheumatology (Oxford) 2002;41:167-175.
ABSTRACT
| FULL TEXT
Disease-modifying anti-rheumatic drug use according to the `sawtooth' treatment strategy improves the functional outcome in rheumatoid arthritis: results of a long-term follow-up study with review of the literature
Sokka et al.
Rheumatology (Oxford) 2000;39:34-42.
ABSTRACT
| FULL TEXT
Quality of Care in Investor-Owned vs Not-for-Profit HMOs
Himmelstein et al.
JAMA 1999;282:159-163.
ABSTRACT
| FULL TEXT
Effects of Managed Care on Physician-Patient Relationships, Quality of Care, and the Ethical Practice of Medicine: A Physician Survey
Feldman et al.
Arch Intern Med 1998;158:1626-1632.
ABSTRACT
| FULL TEXT
The Effect of Managed Care on Quality: A Review of Recent Evidence
Hellinger
Arch Intern Med 1998;158:833-841.
ABSTRACT
| FULL TEXT
Managed Care Regulation: In the Laboratory of the States
Miller
JAMA 1997;278:1102-1109.
ABSTRACT
Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care
Retchin et al.
JAMA 1997;278:119-124.
ABSTRACT
Quality of Care
Palmer
JAMA 1997;277:1896-1897.
Managed Care: A Work in Progress
Ellwood and Lundberg
JAMA 1996;276:1083-1086.
ABSTRACT
|
