A comparison of Medicare fee-for-service and a group-model HMO in the inpatient management and long-term survival of elderly individuals with syncope

William S. Getchell, Greg C. Larsen, Cynthia Morris, John H. McAnulty

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To compare the management and survival of elderly patients hospitalized with syncope in 2 healthcare delivery systems. Study design: Retrospective cohort. Patients and methods: Using hospitalization records from Medicare and a group-model health maintenance organization (HMO) in Oregon, we identified individuals with an admission or discharge diagnosis of syncope between 1992 and 1994. Among patients 65 years or older (median age = 79 years), we randomly selected a sample of the standard Medicare patients (primarily fee-for-service; n = 473) and all of the group-model HMO patients (n = 583). Use of inpatient testing and consultation was ascertained by chart review; all-cause mortality was obtained from the National Death Index. Results: Median diagnostic testing and consultation costs were the same (P = .35) in the standard Medicare population ($643) and the HMO population ($619), although the use of specific tests differed. More cardiovascular syncope was identified in the Medicare population (23% vs 18%; P = .02). Inpatient, 30-day, 1-year, and 4-year mortality rates were higher in the Medicare population (1.7%, 3.8%, 16.7%, and 50.6% respectively) than in the HMO population (0.7%, 1.5%, 13.2%, and 41.8%). After adjusting for age, gender, comorbidity, diagnostic testing, and administrative factors, the relative risk (RR) of dying was lower for group-model HMO patients (RR = 0.74; 95% confidence interval = 0.60, 0.91) than for standard Medicare patients (RR = 1.0). Conclusions: The inpatient management of these elderly patients with syncope was similar in the group-model HMO and standard Medicare settings, but survival was better for the individuals in the HMO. The reason for the differential survival is not obvious and warrants additional study.

Original languageEnglish (US)
Pages (from-to)1089-1098
Number of pages10
JournalAmerican Journal of Managed Care
Volume6
Issue number10
StatePublished - 2000

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Fee-for-Service Plans
Health Maintenance Organizations
Syncope
Medicare
fee
Inpatients
organization
Survival
health
management
Group
Population
diagnostic
mortality
Referral and Consultation
Delivery of Health Care
comorbidity
Mortality
dying
hospitalization

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health(social science)
  • Health Professions(all)

Cite this

A comparison of Medicare fee-for-service and a group-model HMO in the inpatient management and long-term survival of elderly individuals with syncope. / Getchell, William S.; Larsen, Greg C.; Morris, Cynthia; McAnulty, John H.

In: American Journal of Managed Care, Vol. 6, No. 10, 2000, p. 1089-1098.

Research output: Contribution to journalArticle

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abstract = "Objective: To compare the management and survival of elderly patients hospitalized with syncope in 2 healthcare delivery systems. Study design: Retrospective cohort. Patients and methods: Using hospitalization records from Medicare and a group-model health maintenance organization (HMO) in Oregon, we identified individuals with an admission or discharge diagnosis of syncope between 1992 and 1994. Among patients 65 years or older (median age = 79 years), we randomly selected a sample of the standard Medicare patients (primarily fee-for-service; n = 473) and all of the group-model HMO patients (n = 583). Use of inpatient testing and consultation was ascertained by chart review; all-cause mortality was obtained from the National Death Index. Results: Median diagnostic testing and consultation costs were the same (P = .35) in the standard Medicare population ($643) and the HMO population ($619), although the use of specific tests differed. More cardiovascular syncope was identified in the Medicare population (23{\%} vs 18{\%}; P = .02). Inpatient, 30-day, 1-year, and 4-year mortality rates were higher in the Medicare population (1.7{\%}, 3.8{\%}, 16.7{\%}, and 50.6{\%} respectively) than in the HMO population (0.7{\%}, 1.5{\%}, 13.2{\%}, and 41.8{\%}). After adjusting for age, gender, comorbidity, diagnostic testing, and administrative factors, the relative risk (RR) of dying was lower for group-model HMO patients (RR = 0.74; 95{\%} confidence interval = 0.60, 0.91) than for standard Medicare patients (RR = 1.0). Conclusions: The inpatient management of these elderly patients with syncope was similar in the group-model HMO and standard Medicare settings, but survival was better for the individuals in the HMO. The reason for the differential survival is not obvious and warrants additional study.",
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N2 - Objective: To compare the management and survival of elderly patients hospitalized with syncope in 2 healthcare delivery systems. Study design: Retrospective cohort. Patients and methods: Using hospitalization records from Medicare and a group-model health maintenance organization (HMO) in Oregon, we identified individuals with an admission or discharge diagnosis of syncope between 1992 and 1994. Among patients 65 years or older (median age = 79 years), we randomly selected a sample of the standard Medicare patients (primarily fee-for-service; n = 473) and all of the group-model HMO patients (n = 583). Use of inpatient testing and consultation was ascertained by chart review; all-cause mortality was obtained from the National Death Index. Results: Median diagnostic testing and consultation costs were the same (P = .35) in the standard Medicare population ($643) and the HMO population ($619), although the use of specific tests differed. More cardiovascular syncope was identified in the Medicare population (23% vs 18%; P = .02). Inpatient, 30-day, 1-year, and 4-year mortality rates were higher in the Medicare population (1.7%, 3.8%, 16.7%, and 50.6% respectively) than in the HMO population (0.7%, 1.5%, 13.2%, and 41.8%). After adjusting for age, gender, comorbidity, diagnostic testing, and administrative factors, the relative risk (RR) of dying was lower for group-model HMO patients (RR = 0.74; 95% confidence interval = 0.60, 0.91) than for standard Medicare patients (RR = 1.0). Conclusions: The inpatient management of these elderly patients with syncope was similar in the group-model HMO and standard Medicare settings, but survival was better for the individuals in the HMO. The reason for the differential survival is not obvious and warrants additional study.

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