Changing Health Care Systems and Rheumatic Disease (1996) / Chapter Skim
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6: Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Diseases
6: Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Diseases
Pages 95-114
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From page 95... ...
6 Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Disease 95
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From page 97... ...
Issues such as these are given particular attention because of the patterns of lower service use- particularly hospitals, home health care, and specialist referrals found among managed care members. A fundamental concern is whether reduced access to care (and the presumed lower expenditures)
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From page 98... ...
One implication from these findings is that the formulas for reimbursing managed health care may have to be more sensitive to differences in historical patterns of utilization (and the marginal gains from this utilization) between the general population and those from more vulnerable segments of the population.
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From page 99... ...
Journal of the American Medical Association, 262: 925-930. Wells, KB, RD Hays, MA Burnam, W Rogers, S Greenfield, JE Ware (1989)
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From page 100... ...
Journal of the American Medical Association, 262: 907-913. Kravitz RL, S Greenf~eld, WH Rogers, WG Manning, Jr., M Zubkoff, EC Nelson, AR Tarlov, JE Ware, Jr.
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From page 101... ...
The power of the Medical Outcomes Study is such that a change from 1 to 1.5 points, on either the physical or the mental health scale, is significant statistically and clinically. To put these scores in perspective, a patient whose SF-36 physical functioning score increases by 6.5 points, has had an improvement in function equivalent to a patient who received an aortic valve replacement to relieve congestive heart failure or a total hip arthroplasty.
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From page 102... ...
This is essentially what Shelly Greenfield and colleagues reported in the Journal of the American Medical Association in 1995, with patients in HMO and FFS systems who have either hypertension or adult onset diabetes showing equivalent changes over time. The data from the 2,235 patients were separated into elderly and nonelderly groups (Table 6-11.
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From page 103... ...
According to the physical health scores and categorical changes of poor patients, 18 percent of patients in the FFS system improved over the four-year period, whereas only 9 percent improved in the HMO system (Table 6-39. This was significant at the .05 level.
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From page 104... ...
I think that the MOS data are telling us that although for the average American, decreases in health care services will not be detrimental to health, elderly and poor people with chronic disease should be monitored separately to ensure that their health is not being jeopardized by cost-restraining mechanisms.
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From page 105... ...
MEASURING MEDICAL OUTCOMES Ct ~. ~% Health Care Expenditures FIGURE 6-1 Hypothesized relationship between health care expenditures and health in the United States (see text for explanation of E, P
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From page 107... ...
For the past couple of years, an effort that grew out of health care reform to actually have a list of conditions and performance measures has grown into a database that we will make publicly available soon. Clinicians, health care organizations, and others can use this database to identify tools and even create their own measures for assessing quality.
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From page 108... ...
As many of you are probably aware, the Agency for Health Care Policy and Research (AHCPR) has had sort of a politically disastrous year this past year, but we are still here.
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. Sensitivity to change of 3 systemic lupus erythmatosus disease activity indices: international validation.
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From page 110... ...
· Functional Status Index (FSI) MACTAR Questionnaire Lee Functional Status Instrument Toronto Functional Capacity Questionnaire · Convery Polyarticular Disability Index · Modified Health Assessment Questionnaire Shortened Arthritis Impact Measurement Scale The best measures we have, however, are frequently insensitive at the patient level.
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From page 111... ...
AHCPR actually has a fairly large investment in trying to understand how consumers make choices about health care plans, which I agree is an enormously difficult problem. Right now in some markets the big problem is that even if you had perfect measures and tools, with the turnover in plans it is very difficult to actually assess care for the very small population that stays in one place long enough to be measured twice.
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From page 112... ...
For most of the measures that exist in rheumatology now, you would have a very hard time going to most health care systems and actually being able to get the data that you need. MATTHEW LIANG: Could I just add one comment about the Health Plan Employer Data and Information Set (HEDIS)
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From page 113... ...
Now I think managed care has become the normative system, we are stuck with it, and it is going to take a couple of decades to work out the problems with it and to arrive at a health services state in which we are confident that we are working for quality and improved health outcomes. Will risk-adjusted reimbursement do that?
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