Key result
Managed care did not significantly affect risk-adjusted rates of death or stroke within 30 days of carotid endarterectomy compared to fee-for-service (OR 0.97; 95% CI 0.69-1.37).
Why the study?
Does managed care insurance improve appropriateness, referral patterns, and 30-day outcomes of carotid endarterectomy compared to fee-for-service in Medicare beneficiaries?
Observational (n=9,308)
Yes
Does managed care insurance improve appropriateness, referral patterns, and 30-day outcomes of carotid endarterectomy compared to fee-for-service in Medicare beneficiaries?
Medicare managed care plans did not improve appropriateness, referral patterns, or 30-day outcomes of carotid endarterectomy compared to fee-for-service.
Answers are grounded in this paper and cite their sources.
No outcome difference by insurance type in this cohort; leaves open managed care effects on CEA appropriateness and referrals.
This was a population-based observational study to assess the impact of managed care (MC) on several dimensions of quality of surgical care among Medicare beneficiaries undergoing carotid endarterectomies (CEAs) (N = 9308) in New York. Clinical data were abstracted from medical charts to assess appropriateness and deaths or strokes within 30 days of surgery. Differences in patients, appropriateness, and outcomes were compared using chi-square tests; risk-adjusted outcomes were compared using regression. Fee-For-Service (FFS, N = 8691) and MC (N = 897) CEA patients had similar indications for surgery, perioperative risk, and comorbidities. There were no differences in inappropriateness between FFS and MC (8.6% vs 8.4%). MC patients were less likely to use a high-volume surgeon (20.1% vs 13.5%) or hospital (20.5% vs 13.0%, P < .05). There were no differences in risk-adjusted rates of death or stroke (OR = 0.97; 95% CI = 0.69-1.37). Medicare MC plans did not have a positive impact on inappropriateness, referral patterns, or outcomes of CEA.
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Halm et al. (2008) conducted an observational in Carotid endarterectomy (n=9,308). Managed care (MC) vs. Fee-For-Service (FFS) was evaluated on Risk-adjusted rates of death or stroke within 30 days of surgery (OR 0.97, 95% CI 0.69-1.37). Managed care did not significantly affect risk-adjusted rates of death or stroke within 30 days of carotid endarterectomy compared to fee-for-service (OR 0.97; 95% CI 0.69-1.37).
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