Health care utilization and outcomes among persons with rheumatoid arthritis in fee-for-service and prepaid group practice settings
E. H. Yelin, L. A. Criswell and P. G. Feigenbaum
Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco 94143-0920, USA. yelin2@itsa.ucsf.edu
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 fee-for-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 long-rank test); using Cox proportional hazards
methods, the proportion dying each year did not differ signficantly.
CONCLUSIONS: We could find no evidence that persons with RA in
fee-for-service and prepaid group practice settings received different
quantities of health care or experienced different outcomes on either an
annual or long-term basis.
