PERIOPERATIVE MANAGEMENT OF COLON-CANCER UNDER MEDICARE RISK PROGRAMS

Objective: To determine differences in perioperative care and outcomes for patients with colon cancer enrolled in Medicare health maintenanc e organizations compared with similar fee-for-service nonenrollees. Me thods: Cross-sectional evaluation of hospital care and posthospital ou tcomes with data obtained from medical records. Nineteen health mainte nance organizations representing all model types were selected from 12 stales. The nonenrollee sample was drawn from the same areas. The sam ple included 412 enrollees and 401 nonenrollees, representing 65 hospi tals for health maintenance organizations and 61 hospitals for fee-for -service. Results: Nonenrollees were slightly older and had higher pre operative risk. Enrollees had shorter intervals between admission and surgery (enrollees, 1.55 days sis nonenrollees, 2.85 days). Difference s in length of stay (enrollees, 10.9 days vs nonenrollees, 14.2 days) persisted even after controlling far preoperative health status. Diffe rences in admissions to intensive care units (enrollees, 36.4% vs none nrollees, 44.4%) were highly influenced by preoperative health status. Nonenrollees were more significantly likely to receive preoperative a ntibiotics, postoperative testing (eg, postoperative chest radiographs and electrocardiograms), and postoperative patient-controlled analges ia. Tumor staging was similar for both groups. Enrollees were more lik ely to be discharged home, while nonenrollees were more likely to be d ischarged to a nursing home. There were no significant differences in hospital deaths or postdischarge readmissions. Conclusions: Health mai ntenance organization enrollees with colon cancer received less clinic al services of several types than similar patients in fee-for-service settings, had shorter hospital stays, and were less likely to be disch arged to nursing homes. However, there was no evidence that they exper ienced different outcomes.