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Medicare HMO penetration and mortality outcomes of ischemic stroke.

Publication ,  Journal Article
Bian, J; Dow, WH; Matchar, DB
Published in: Am J Manag Care
January 2006

OBJECTIVE: To examine associations between Medicare health maintenance organization (HMO) penetration and stroke mortality outcomes among older persons. STUDY DESIGN: Panel analysis of nationally representative secondary data from 1993 to 1998. METHODS: The first analysis sample included ischemic stroke hospitalizations among older persons in the Nationwide Inpatient Sample; the second included county-level ischemic stroke deaths in the National Vital Statistics System. The 2 samples were merged with the HMO enrollment data and the 2001 Area Resource File. The 2 outcomes were in hospital death status and county-level population ischemic stroke death rates among older persons; the 2 utilization variables were length of hospital stay for ischemic stroke and proportion of ischemic stroke deaths occurring in hospitals. The 3 key explanatory variables were county-level Medicare total, independent practice association, and nonindependent practice association HMO penetration. Ordinary least squares analysis with hospital or county fixed effects was used in estimation. RESULTS: Medicare HMO penetration was not associated with the 2 ischemic stroke mortality outcomes (P > .05). Increases in Medicare total and independent practice association HMO penetration were associated with a significant shift in a higher proportion of stroke deaths from hospitals to nursing homes or residences (P < .05). Medicare HMO penetration was negatively associated with length of stay, although this was not statistically significant (P > .05). CONCLUSIONS: Increased Medicare HMO penetration was associated with a shift in ischemic stroke deaths from hospitals to nonhospital settings. The effect of Medicare HMO penetration on quality of stroke care needs further research.

Duke Scholars

Published In

Am J Manag Care

ISSN

1088-0224

Publication Date

January 2006

Volume

12

Issue

1

Start / End Page

58 / 64

Location

United States

Related Subject Headings

  • Workforce
  • United States
  • Stroke
  • Risk Adjustment
  • Population Surveillance
  • Outcome Assessment, Health Care
  • Nursing Homes
  • Neurology
  • Multivariate Analysis
  • Medicare
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bian, J., Dow, W. H., & Matchar, D. B. (2006). Medicare HMO penetration and mortality outcomes of ischemic stroke. Am J Manag Care, 12(1), 58–64.
Bian, John, William H. Dow, and David B. Matchar. “Medicare HMO penetration and mortality outcomes of ischemic stroke.Am J Manag Care 12, no. 1 (January 2006): 58–64.
Bian J, Dow WH, Matchar DB. Medicare HMO penetration and mortality outcomes of ischemic stroke. Am J Manag Care. 2006 Jan;12(1):58–64.
Bian, John, et al. “Medicare HMO penetration and mortality outcomes of ischemic stroke.Am J Manag Care, vol. 12, no. 1, Jan. 2006, pp. 58–64.
Bian J, Dow WH, Matchar DB. Medicare HMO penetration and mortality outcomes of ischemic stroke. Am J Manag Care. 2006 Jan;12(1):58–64.

Published In

Am J Manag Care

ISSN

1088-0224

Publication Date

January 2006

Volume

12

Issue

1

Start / End Page

58 / 64

Location

United States

Related Subject Headings

  • Workforce
  • United States
  • Stroke
  • Risk Adjustment
  • Population Surveillance
  • Outcome Assessment, Health Care
  • Nursing Homes
  • Neurology
  • Multivariate Analysis
  • Medicare