TAILIEUCHUNG - Differences in 4-Year Health Outcomes for Elderly and Poor, Chronically III Patients Treated in HMO and Fee-for-Service Systems

Height and weight of the subjects were measured using standard procedures. The weight was measured using SECA balance with minimum of cloths to the nearest of 100 gms and height was measured using an anthropometric rod to the minimum of cm. Body mass index (BMI : weight in kg/height in meters2 ) was calculated from heights and weights. A value ≤ is considered as a cut-off point for chronic energy deficiency (CED) or undernutrition (thinness), while BMI ≥ 25 is considered as overweight or obese. Prevalence of diseases in both groups separately was calculated. Logistic regression [exp (b)] analysis was performed controlling the effect of other potential risk factors to detect the. | Reprinted from JAMA @ The Journal of the American Medical Association October 2 1996 Volume 276 Copyright 1996 American Medical Association Original Contributions Differences in 4-Year Health Outcomes for Elderly and Poor Chronically III Patients Treated in HMO and Fee-for-Service Systems Results From the Medical Outcomes Study John E. Ware Jr PhD Martha S. Bayliss MSc William H. Rogers PhD Mark Kosinski MA Alvin R. Tarlov MD compare physical and mental health outcomes of chronically Hl adults including elderly and poor subgroups treated in health maintenance organization HMO and fee-for-service FFS systems. Study 4-year observational study of 2235 patients 18 to 97 years of age with hypertension non-insulin-dependent diabetes mellitus NIDDM recent acute myocardial infarction congestive heart failure and depressive disorder sampled from HMO and FFS systems in 1986 and followed up through 1990. Those aged 65 years and older covered under Medicare and low-income patients 200 of poverty were analyzed separately. Setting and of physicians practicing family medicine internal medicine endocrinology cardiology and psychiatry in HMO and FFS systems of care. Types of practices included both prepaid group 72 of patients and independent practice association 28 types of HMOs large multispecialty groups and solo or small single-specialty practices in Boston Mass Chicago III and Los Angeles Calif. Outcome between initial and 4-year follow-up scores of summary physical and mental health scales from the Medical Outcomes Study 36-Item Short-Form Health Survey SF-36 for all patients and practice settings. average physical health declined and mental health remained stable during the 4-year follow-up period with physical declines larger for the elderly than for the nonelderly P .001 . In comparisons between HMO and FFS systems physical and mental health outcomes did not differ for the average patient .

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