This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Sheldon M. Retchin, MD; Jeanette Preston, MD

Arch Intern Med. 1991;151(11):2244-2248.

Abstract
Objective. —
Because of rising costs in the Medicare program, the elderly have been encouraged to enroll in health maintenance organizations (HMOs). To evaluate the quality of care in these HMOs, detailed criteria on the treatment of elderly diabetics were established by an expert panel.

Design.— —
Approximately 20 months of care for elderly diabetics was reviewed by medical record abstractions with a historical cohort design.

Setting.—
The care of elderly diabetics in eight HMOs was compared with the care received in fee-for-service (FFS) settings located in similar geographic areas.

Patients. —
Elderly diabetics enrolled in HMOs (n = 158) were compared with similar diabetics (n = 134) in FFS settings.

Results. —
Diabetic HMO enrollees were more likely to have funduscopic examinations (48% in HMOs vs 30% FFS) and urinalyses (89% in HMOs vs 74% FFS) performed. Enrollees with poor diabetic control were also more likely than FFS diabetics to be referred to an ophthalmologist (45% in HMOs vs 11% FFS). However, influenza vaccinations were administered to diabetics more often in FFS settings than to diabetic enrollees (19% in HMOs vs 62% FFS). One fifth of diabetics in both groups were treated with insulin and two thirds were treated with oral hypoglycemic agents, though HMO enrollees were more likely to have medication changes.

Conclusions.——
We conclude that most aspects of the quality of diabetic care were similar in HMO and FFS settings and were unaffected by this effort at cost containment.

(Arch Intern Med. 1991;151:2244-2248)

Author Affiliations
From the Division of Geriatric Medicine, Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond (Drs Retchin and Preston); Project HOPE Center for Health Affairs, Chevy Chase, Md (Dr Retchin); and McGuire Veterans Affairs Hospital, Richmond (Dr Preston).

Footnotes
Accepted for publication April 22, 1991.

Reprint requests to Box 287, MCV Station, Richmond, VA 23298 (Dr Retchin).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Need for Eye Care Among Older Adults With Diabetes Mellitus in Fee-for-Service and Managed Medicare
Brown et al.
Arch Ophthalmol 2005;123:669-675.
ABSTRACT | FULL TEXT  

Managed Care for Elderly People: A Compendium of Findings
Miller et al.
American Journal of Medical Quality 1998;13:127-140.
ABSTRACT  

Perioperative Management of Colon Cancer Under Medicare Risk Programs
Retchin et al.
Arch Intern Med 1997;157:1878-1884.
ABSTRACT  

Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care
Retchin et al.
JAMA 1997;278:119-124.
ABSTRACT  

Do We Understand the Effects of 'Managed Care' in Ophthalmology? A Review and Analysis
Asch et al.
Arch Ophthalmol 1997;115:531-536.
ABSTRACT  

Managed Care and Medicare Reform
Oberlander
Journal of Health Politics, Policy and Law 1997;22:595-631.
ABSTRACT  

Diabetes in a Managed Care System
Quickel
ANN INTERN MED 1996;124:160-163.
ABSTRACT | FULL TEXT  

Managed Care Plan Performance Since 1980: A Literature Analysis
Miller and Luft
JAMA 1994;271:1512-1519.
ABSTRACT  

The Effects of Cost Containment on the Care of Elderly Diabetics
Warren and Nugent
Arch Intern Med 1991;151:2146-2147.
ABSTRACT