title: Longterm health outcomes of patients with rheumatoid arthritis treated in managed care and fee-for-service practice settings.
abstract: OBJECTIVE
  To compare health care utilization and longterm health outcomes among patients with rheumatoid arthritis (RA) treated in managed care and fee-for-service practice settings.
  
  
  METHODS
  We compared levels of health care utilization, treatments, and health outcomes between 57 patients with RA treated predominantly in managed care settings and 125 patients with RA treated predominantly in fee-for-service practice settings. These patients were participants in a community based cohort study of health outcomes in RA, and had been followed prospectively for up to 13 years (mean followup 10.3 yrs). Information on physician visits, hospitalizations, diagnostic testing, treatments, and 3 measures of health status (global arthritis status, pain, functional disability measures of the Health Assessment Questionnaire) was collected using biannual mailed questionnaires.
  
  
  RESULTS
  All measures of health care utilization were similar between the managed care and fee-for-service groups, as was the use of the major types of arthritis treatments. Average global arthritis status scores, pain scores, and functional disability scores were closely comparable in the 2 groups. Over time, global arthritis status scores and disability scores worsened in both groups, but the rates of worsening did not differ between groups.
  
  
  CONCLUSIONS
  In this cohort, longterm health outcomes, as well as treatments and health care utilization, were similar among persons with RA who were treated in managed care and fee-for-service practice settings.
authors.affiliation: Medical Service, Veterans Affairs, Palo Alto Health Care System, CA 94304, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Ward
authors.forename: D
authors.initials: D
authors.lastname: Lubeck
authors.forename: J P
authors.initials: JP
authors.lastname: Leigh
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D016896:Treatment Outcome