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Care for elderly heart attack patients is at least as good in HMOs as in fee-for-service plans

Elderly heart attack patients in Minnesota who were covered by health maintenance organizations (HMOs) received life-saving thrombolytic treatments at least as often as those covered by traditional fee-for-service (FFS) plans. In addition, they were slightly more likely to have received emergency transportation and aspirin therapy, according to a recent study funded by the Agency for Health Care Policy and Research (HS07357).

The research team, headed by Stephen B. Soumerai, Sc.D., of Harvard Medical School and Harvard Pilgrim Health Care, reviewed the medical records of 2,304 elderly Medicare patients who were admitted with acute myocardial infarction (AMI) to 20 hospitals in Minnesota from October 1992 through July 1993, and from July 1995 through April 1996. They found that the speed with which patients received care and the quality of that care were of equal or slightly higher quality under HMO coverage versus FFS coverage.

The researchers also looked at other dimensions of care for patients with AMI, including their use of emergency transportation and whether they received aspirin therapy in addition to thrombolytic medication. Patients with HMO coverage were slightly more likely to have used an ambulance to get to the hospital.

The researchers attributed this to HMOs' around-the-clock telephone triage systems that encourage patients with acute symptoms to use emergency transportation. Patients with HMO coverage also were slightly more likely to have received aspirin therapy, which researchers believe is because HMOs employ a larger percentage of younger physicians who may be more aware of newer drug treatments.

Dr. Soumerai and his colleagues show that objective quality standards need to be developed in all settings and for all insurers, not only for HMOs. This paper provides evidence that substantial opportunities exist to decrease preventable deaths, for example, by increasing use of beta blockers and aspirin and reducing delays to the hospital.

The researchers note that all of Minnesota's HMOs are nonprofit; they do not know if HMO performance would be as high in a for-profit setting.

For more details, see "Timeliness and quality of care for elderly patients with acute myocardial infarction under health maintenance organization vs. fee-for-service insurance," by Dr. Soumerai, Thomas J. McLaughlin, Sc.D., Jerry H. Gurwitz, M.D., and others, in the September 27, 1999, issue of Archives of Internal Medicine 159, pp. 2013-2020.

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