Titre :
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The relationship between managed care insurance and use of lower-mortality hospitals for CABG surgery. (2000)
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Auteurs :
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L.C. ERICKSON ;
E.L. HANNAN ;
J.W. NEWBURGER ;
E.C. Schneider ;
D.F. TORCHIANA ;
Department of Cardiology. Children's Hospital. Boston. MA. USA ;
Department of Pediatrics. Harvard Medical School. Boston. MA. USA
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Type de document :
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Article
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Dans :
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JAMA - Journal of the american medical association (vol. 283, n° 15, 2000)
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Pagination :
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1976-1982
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Langues:
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Anglais
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Mots-clés :
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Soins intégrés
;
Assurance maladie
;
Mortalité
;
Hôpital
;
Etats Unis
;
Amérique
;
Hospitalisation
;
Homme
;
Chirurgie
;
Amérique du Nord
;
Medicare
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Résumé :
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[BDSP. Notice produite par INIST U5R0xPll. Diffusion soumise à autorisation]. Context Explicit information about the quality of coronary artery bypass graft (CABG) surgery has been available for nearly a decade in New York State ; however, the extent to which managed care insurance plans direct enrollees to the lowest-mortality CABG surgery hospitals remains unknown. Objective To compare the proportion of patients with managed care insurance and fee-for-service (FFS) insurance who undergo CABG surgery at lower-mortality hospitals. Design A retrospective cohort study of CABG surgery discharges from 1993 to 1996, using New York Department of Health databases and multivariate analysis to estimate the use of lower-mortality hospitals by patients with different types of health insurance. Setting Cardiac surgical centers in New York, of which 14 were classified as lower-mortality hospitals (mean rate, 2.1%) and 17 were classified as higher-mortality hospitals (mean rate, 3.2%). Patients A total of 58 902 adults older than 17 years who were hospitalized for CABG surgery. Patients were excluded if their CABG surgery was combined with any valve procedure or left ventricular aneurysm resection or if they were younger than 65 years and enrolled in Medicare FFS or Medicare managed care. Main Outcome Measure Probability of a patient receiving CABG surgery at a lower-mortality hospital. (...)
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