OUTCOMES OF HOSPITAL-BASED MANAGED CARE - A MULTIVARIATE-ANALYSIS OF COST AND QUALITY

Objective: To determine the effects a hospital-based managed care inte rvention has on the cost and quality of care. Methods: The interventio n consisted of a CareMap and a nurse case manager. The CareMap contain ed both a critical path and a set of expected patient outcomes. The st udy population comprised all women who delivered by cesarean during th e 18 months of the study and who were cared for in the maternity unit at a tertiary-level university hospital. The effects of the interventi on were determined by comparing the after group with the before group in regard to length of stay and costs of care post-cesarean delivery, patient ratings of quality of care, and the physical recovery of the p atients by discharge and 1 month later. Results: After the implementat ion of hospital-based managed care, the average length of stay decreas ed 13.5% (0.7 days) and the average costs decreased 13.1% ($518). Thes e decreases were statistically significant and remained so after contr olling for co-morbid and complicating conditions. Patients perception of the quality of care increased from 4.26 to 4.41 on a 1-5 scale, a s tatistically significant increase. In particular, patients believed th at they had an increased level of participation in their care. The phy sical recovery scores obtained at discharge did not change. Conclusion : Hospital-based managed care can reduce resource use, length of stay, and cost associated with hospital care while maintaining or improving the quality of care. Whether these effects are reproducible and gener alizable to other conditions should be addressed in future studies; th e duration of these effects should also be examined.