MANAGED CARE AND OUTCOMES OF HOSPITALIZATION AMONG ELDERLY PATIENTS WITH CONGESTIVE-HEART-FAILURE

Background: Little was known about the impact of the health maintenanc e organization-managed care on patients hospitalized for congestive he art failure. Understanding this issue is important with regards to the increasing prevalence of congestive heart failure among the elderly p opulation as well as the growing enrollment of Medicare beneficiaries in managed care. Objective: To examine the impact of the health mainte nance organization-managed care on the outcomes of hospitalization amo ng patients with congestive heart failure. Patients and Methods: We an alyzed the Oregon hospital discharge data set. Study subjects were all patients with congestive heart failure aged 65 years or older (N=5821 ) discharged from hospitals in 1995 and classified into 6 insurance gr oups: managed care, Medicare, Medicaid, commercial or private insuranc e, self-pay, and other. Results: The percentage of patients admitted t o hospitals via emergency departments was significantly higher in the managed care patients (69%) than in other health insurance coverage gr oups (29.0%-58.5%; P<.001). After adjusting for age, sex, and comorbid ity, the managed care patients experienced a similar length of hospita l stay (3.6 days) as the commercial or private insurance patients (3.7 days; P = .67), but a shorter length of hospital stay than the Medica re patients (4.0 days; P<.001), self-pay patients (4.5 days; P<.001), and other patients (4.8 days; P<.001). No difference in the in-hospita l mortality rate was seen among the insurance groups (P = .37). The re admission rate was slightly higher in managed care patients (9.1%) tha n in commercial insurance patients (6.8%) and Medicare patients (7.5%) . The differences, however, were not statistically significant after a djusting for the confounding factors (P = .59). Conclusions: Our resul ts suggest no association between managed care and poor short-term out comes of hospitalization in patients with congestive heart failure. At tention, however, needs to be paid to the increased use of emergency d epartments by managed care patients.