title: The quality of ambulatory care in Medicare health maintenance organizations.
abstract: The quality of ambulatory care received by Medicare recipients who enrolled in health maintenance organizations (HMOs) was compared to the care received by fee-for-service (FFS) Medicare recipients, in a quasi-experimental, non-randomized design. Both samples were drawn from the four major geographic areas in the country, and included two types of HMO practices: staff/group models, and independent practice associations (IPAs). A panel of expert physicians developed criteria for evaluating ambulatory care, and medical record abstractions using these criteria were performed on 1,590 outpatient records: 777 FFS and 813 HMO (441 staff/group, 372 IPA). While individual items of medical histories and physical examinations were performed most often for staff/group HMO patients and least often in FFS patients, odds ratios (OR) for performance in staff/group HMO patients were particularly large for health maintenance items: tonometry (OR = 8.4), mammography (OR = 2.7), pelvic examination (OR = 5.3), rectal examination (OR = 2.9), fecal occult blood test (OR = 3.3). The results suggest that recommended elements of routine and preventive care are more likely to be performed for Medicare enrollees in staff/group HMOs than in FFS settings.
authors.affiliation: Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
authors.forename: S M
authors.initials: SM
authors.lastname: Retchin
authors.forename: B
authors.initials: B
authors.lastname: Brown
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D005251:Fees, Medical; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D007193:Independent Practice Associations / Q000592:standards*; D008485:Medical Audit; D006278:Medicare; D016017:Odds Ratio; D011314:Preventive Health Services; D011331:Private Practice / Q000592:standards*; D012044:Regression Analysis; D014481:United States