Study Analyzes Managed Care's Impact On Congestive Heart Failure Treatment

June 12, 1998

Researchers at Oregon Health Sciences University have found that a higher percentage of Medicare managed care patients with congestive heart failure are admitted to Oregon hospitals through emergency rooms than patients with other kinds of insurance. The study also shows managed care apparently has no negative influence on short-term outcomes for those same patients. Results of this investigation are published in the June 8 edition of the Archives of Internal Medicine.

"We looked at hospital discharge data for nearly 6,000 elderly patients classified into six insurance groups, including managed care," said Hanyu Ni, Ph.D., research assistant professor for the Oregon Heart Failure Project in OHSU's division of cardiology. "Our investigation showed no significant difference in hospital stays, in-hospital mortality rates or readmission between managed-care patients and patients with other types of insurance."

However, 69 percent of congestive heart failure patients in managed care plans were admitted to hospitals through the emergency room. That's compared to a range of 29 to 58.5 percent for patients with other types of insurance. "This is a significant finding," said Ray Hershberger, M.D., associate professor of medicine in the division of cardiology and a co-author of the article. "Managed care emphasizes reducing hospitalization rates by offering fiscal incentives to HMO clinicians. Our research suggests that may be a barrier to outpatient care or timely hospital admission for some heart failure patients. Patients may have utilized the emergency room as primary care or may be showing up at the emergency room for urgent hospital admission, leading to more potential complications for the patients and more overall costs for insurers and health care systems."

The study analyzed hospital data on 5,821 congestive heart failure patients discharged from Oregon hospitals in 1995. The patients were classified into six insurance groups: managed care, Medicare, Medicaid, commercial or private insurance and self-pay. Deirdre Nauman, R.N., of the division of cardiology also contributed to the article.

Oregon Health & Science University

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