What question did this study set out to answer?

To determine whether patients with managed care insurance undergo coronary artery bypass graft (CABG) surgery at lower-mortality hospitals less frequently than those with fee-for-service insurance.

April 19, 2000JAMA

The Relationship Between Managed Care Insurance and Use of Lower-Mortality Hospitals for CABG Surgery

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Why the study?

Does managed care insurance reduce the probability of receiving CABG surgery at a lower-mortality hospital compared to fee-for-service insurance in adults undergoing CABG?

Population

58,902 adults older than 17 years hospitalized for CABG surgery in New York State. Excluded: CABG combined…

Comparison

Managed care insurance vs Fee-for-service insurance

Design

Cohort

Authors

LELars C. EricksonHarvard University

Discussion

Member takes

Implication

May limit access to lower-mortality CABG hospitals under managed care; leaves open whether insurance design drives hospital selection.

Key Points

To determine whether patients with managed care insurance undergo coronary artery bypass graft (CABG) surgery at lower-mortality hospitals less frequently than those with fee-for-service insurance.
Retrospective cohort study of 58,902 adults aged >17 years undergoing CABG surgery from 1993 to 1996 using New York Department of Health databases.
Classified surgical centers into 14 lower-mortality (mean 2.1%) and 17 higher-mortality (mean 3.2%) hospitals, assessing outcomes with multivariate analysis adjusted for confounding factors.
Compared with private fee-for-service (FFS; n=18,905), patients with private managed care (n=7,169; RR, 0.77; 95% CI, 0.74–0.81; P<.001) and Medicare managed care (n=880; RR, 0.61; 95% CI, 0.54–0.70; P<.001) were significantly less likely to receive surgery at lower-mortality hospitals.
Patients with Medicare FFS (n=31,948) utilized lower-mortality hospitals at rates closer to private FFS, though still statistically lower (RR, 0.95; 95% CI, 0.91–0.98; P=.004).

Structured PICO

Does managed care insurance reduce the probability of receiving CABG surgery at a lower-mortality hospital compared to fee-for-service insurance in adults undergoing CABG?

Population

58,902 adults older than 17 years hospitalized for CABG surgery in New York State. Excluded: CABG combined with any valve procedure or left ventricular aneurysm resection, or patients younger than 65 years enrolled in Medicare FFS or Medicare managed care.

Intervention

Managed care insurance (private managed care or Medicare managed care)

Comparator

Fee-for-service (FFS) insurance (private FFS or Medicare FFS)

Outcome

Probability of a patient receiving CABG surgery at a lower-mortality hospital

Patients with managed care insurance are significantly less likely to undergo CABG surgery at lower-mortality hospitals compared to those with fee-for-service insurance.

Cite This Study

Lars C. Erickson (2000) studied this question.

synapsesocial.com/papers/6a910ffb5730a89ab2caf4b0 https://doi.org/10.1001/jama.283.15.1976

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The Relationship Between Managed Care Insurance and Use of Lower-Mortality Hospitals for CABG Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

The Relationship Between Managed Care Insurance and Use of Lower-Mortality Hospitals for CABG Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider