The "Boston model" of managed care and spinal cord injury: a cross-sectional study of the outcomes of risk-based, prepaid, managed care.
OBJECTIVE
To present preliminary data on the health-related consequences for people with spinal cord injury (SCI) of participation in a prepaid, risk-based, managed care plan.


METHODS
Baseline data from a longitudinal interview survey.


METHODS
Massachusetts.


METHODS
Subjects were 114 independently living adults with SCI recruited from 6 independent living centers and 2 managed care plans; 45 received care from a risk-based prepaid managed care plan and 69 from other sources.


RESULTS
Self-reports of use of health services; self-assessments of health, health at interview versus 12 months earlier; hospital admissions; numbers of secondary conditions, and experiences of specific secondary conditions (eg, pressure ulcers, depression, fatigue, and chronic pain).


RESULTS
Persons in the managed care plan do not differ from their counterparts in terms of age, gender, education, level of SCI, number of comorbid conditions, activity of daily living profiles, household composition, and reliance upon health maintenance programs and routines (eg, bowel and bladder care). In terms of processes of care, they appear generally better-served. There also are a few differences in outcome that are statistically significant, or approach significance, and generally favor the managed care plan.


CONCLUSIONS
Preliminary data suggest that thoughtfully and sensitively designed and implemented risk-based managed care may improve both access and outcomes.
Meyers
A R
AR
Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Boston Medical Center, MA, USA.
Bisbee
A
A
Winter
M
M
D000203:Activities of Daily Living; D000328:Adult; D001900:Boston; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D017061:Prepaid Health Plans; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000145:classification / Q000150:complications*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome