title: Outcomes of hospital-based managed care: a multivariate analysis of cost and quality.
abstract: OBJECTIVE
  To determine the effects a hospital-based managed care intervention has on the cost and quality of care.
  
  
  METHODS
  The intervention consisted of a CareMap and a nurse case manager. The CareMap contained both a critical path and a set of expected patient outcomes. The study population comprised all women who delivered by cesarean during the 18 months of the study and who were cared for in the maternity unit at a tertiary-level university hospital. The effects of the intervention were determined by comparing the after group with the before group in regard to length of stay and costs of care post-cesarean delivery, patient ratings of quality of care, and the physical recovery of the patients by discharge and 1 month later.
  
  
  RESULTS
  After the implementation of hospital-based managed care, the average length of stay decreased 13.5% (0.7 days) and the average costs decreased 13.1% ($518). These decreases were statistically significant and remained so after controlling for co-morbid and complicating conditions. Patients perception of the quality of care increased from 4.26 to 4.41 on a 1-5 scale, a statistically significant increase. In particular, patients believed that they had an increased level of participation in their care. The physical recovery scores obtained at discharge did not change.
  
  
  CONCLUSIONS
  Hospital-based managed care can reduce resource use, length of stay, and cost associated with hospital care while maintaining or improving the quality of care. Whether these effects are reproducible and generalizable to other conditions should be addressed in future studies; the duration of these effects should also be examined.
authors.affiliation: College of Nursing, University of Iowa, Iowa City, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Blegen
authors.forename: R C
authors.initials: RC
authors.lastname: Reiter
authors.forename: C J
authors.initials: CJ
authors.lastname: Goode
authors.forename: R R
authors.initials: RR
authors.lastname: Murphy
mesh_terms: D000328:Adult; D019090:Case Management; D002585:Cesarean Section / Q000191:economics*; D019091:Critical Pathways; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008329:Managed Care Programs / Q000191:economics*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000628:therapy; D011787:Quality of Health Care