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Sheldon M. Retchin, MD, MSPH; Lynne Penberthy, MD, MPH; Chris Desch, MD; Randall Brown, PhD; Bonnie Jerome-D'Emilia, MS; Dolores Clement, DrPH

Arch Intern Med. 1997;157(16):1878-1884.

Abstract
Objective
To determine differences in perioperative care and outcomes for patients with colon cancer enrolled in Medicare health maintenance organizations compared with similar fee-for-service nonenrollees.

Methods
Cross-sectional evaluation of hospital care and posthospital outcomes with data obtained from medical records. Nineteen health maintenance organizations representing all model types were selected from 12 states. The nonenrollee sample was drawn from the same areas. The sample included 412 enrollees and 401 nonenrollees, representing 65 hospitals for health maintenance organizations and 61 hospitals for fee-for-service.

Results
Nonenrollees were slightly older and had higher preoperative risk. Enrollees had shorter intervals between admission and surgery (enrollees, 1.55 days vs nonenrollees, 2.85 days). Differences in length of stay (enrollees, 10.9 days vs nonenrollees, 14.2 days) persisted even after controlling for preoperative health status. Differences in admissions to intensive care units (enrollees, 36.4% vs nonenrollees, 44.4%) were highly influenced by preoperative health status. Nonenrollees were more significantly likely to receive preoperative antibiotics, postoperative testing (eg, postoperative chest radiographs and electrocardiograms), and postoperative patient-controlled analgesia. Tumor staging was similar for both groups. Enrollees were more likely to be discharged home, while nonenrollees were more likely to be discharged to a nursing home. There were no significant differences in hospital deaths or postdischarge readmissions.

Conclusions
Health maintenance organization enrollees with colon cancer received less clinical services of several types than similar patients in fee-for-service settings, had shorter hospital stays, and were less likely to be discharged to nursing homes. However, there was no evidence that they experienced different outcomes.

Arch Intern Med. 1997;157:1878-1884

Author Affiliations
From the Departments of Internal Medicine (Drs Retchin and Desch), Health Administration (Ms Jerome-D'Emilia and Dr Clement), and Massey Cancer Center (Drs Penberthy and Desch), Virginia Commonwealth University, Richmond, and Mathematica Policy Research Inc, Princeton, NJ (Dr Brown).

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