The effect of managed care on ICU length of stay: Implications for Medicare

JAMA

Volumn 276, Issue 13, 1996, Pages 1075-1082

  Angus, Derek C ^a   Linde Zwirble, Walter T ^c   Sirio, Carl A ^a   Rotondi, Armando J ^a   Chelluri, Lakshmipathi ^a   Newbold III, Richard C ^c   Lave, Judith R ^b   Pinsky, Michael R ^a  

^a UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH   (United States)

^c Health Process Management Inc   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; EMERGENCY MEDICINE; HEALTH CARE UTILIZATION; HEALTH INSURANCE; HOSPITALIZATION; INTENSIVE CARE; MEDICAL FEE; MEDICARE; PRIORITY JOURNAL; STATISTICAL ANALYSIS;

EID: 0029785311     PISSN: 00987484     EISSN: None     Source Type: Journal    
DOI: 10.1001/jama.276.13.1075     Document Type: Article

References (68)

1. Rapoport J, Gehlbach S, Lemeshow S, Teres D. Resource utilization among intensive care patients: managed care vs traditional insurance. Arch Intern Med. 1992;152:2207-2212.
2. Zinner MJ. Surgical research in a capitated system. Arch Surg. 1995;130:937-938.
3. Massachusetts Association of HMOs. HMO Enrollment of Massachusetts Residents, 1990-1995. Boston, Mass: Massachusetts Division of Insurance, Massachusetts Association of HMOs;1996:1.
4. State of Florida - Agency for Health Care Administration. 1994 Patient Data Tapes. Tallahassee, Fla: Agency for Health Care Administration; 1994.
5. International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, US Dept of Health and Human Services; 1988.
6. Fetter RB, Thompson JD, Averill RA. The New ICD-9-CM Diagnosis Related Groups Classification Scheme: Users Manual. New Haven, Conn: Health Systems Management Group, School of Organization and Management, Yale University; 1981.
7. Gonnella JS, Hornbrook MC, Louis DZ. Staging of disease: a case-mix measurement. JAMA. 1984; 251:637-644.
8. Iezzoni LI, Shwartz M, Moskowitz MA, Ash AS, Sawitz E, Burnside S. Illness severity and costs of admissions at teaching and nonteaching hospitals. JAMA. 1990;264:1426-1431.
9. SysteMetrics Inc. Disease Staging: A Clinically Based Approach to Measurement of Disease Severity. Springfield, Va: US Dept of Commerce, National Technical Information Service; 1983.
10. Naessens JM, Leibson CL, Krishan I, Ballard DJ. Contribution of a measure of disease complexity (COMPLEX) to prediction of outcome and charges among hospitalized patients. Mayo Clin Proc. 1992;67:1140-1149.
11. Angus DC, Linde Zwirble WT, Sirio CA, Newbold R III. Separation of patient variability from process of care variability by mathematical analysis of hospital length of stay. In: Proceedings of the Association for Health Services Research & Foundation for Health Services Research; June 12, 1994:7; Washington, DC. Abstract.
12. Angus DC, Linde-Zwirble WT, Sirio CA, et al. The effect of managed care on resource consumption in the ICU. Am J Respir Crit Care Med. 1995; 151:A492. Abstract.
13. Angus DC, Linde-Zwirble WT, Sirio CA, et al. Post-discharge resource consumption after prolonged mechanical ventilation. Am J Respir Crit Care Med. 1995;151:A492. Abstract.
14. Daley J. Validity of risk-adjustment methods. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes. Ann Arbor, Mich: Health Administration Press; 1994:239-262.
15. Hilbe J. Generalized linear models. Am Stat. 1994;48:255-265.
16. Hilbe J, Turlach BA. Generalized linear models. In: Hardle W, Klink S, Turlach BA, eds. XploRe: An Interactive Statistical Computing Environment. New York, NY: Springer-Verlag NY Inc; 1995:195-222.
17. McCullagh P; Neider JA. Generalized Linear Models. London, England: Chapman & Hall; 1989.
18. Generalized logit link. In: Proceedings of the International Conference on Health Policy Research; December 3, 1995; Boston, Mass. Abstract.
19. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29-36.
20. Hanley JA. Alternative approaches to receiver operating characteristic analyses. Radiology. 1988; 168:568-570.
21. Halpern NA, Bettes L, Greenstein R. Federal and nationwide intensive care units and healthcare costs: 1986-1992. Crit Care Med. 1994;22:2001-2007.
22. State of Maryland. Non-confidential Version of the Maryland State In-Patient Data Base. St Paul, Md: St Paul Computer Center; 1993.
23. Spraggins EE. HMO's pitches. Newsweek. June 19, 1995:55-58.
24. US Dept of Health and Human Services. Medicare and Medicaid statistical supplement. Health Care Financ Rev. 1995; February (suppl):24-25.
25. Beck M, Thomas R, Hager M. The new fine print: what will Congress do about your Medicare? Newsweek. September 18, 1995:42-43.
26. Luft HS. Health Maintenance Organizations: Dimensions of Performance. New York, NY: John Wiley & Sons Inc; 1981.
27. Johnson AN, Dowd B, Morris NE, Lurie N. Differences in inpatient resource use by type of health plan. Inquiry. 1989;26:388-98.
28. Arnould RJ, Debrock LW, Pollard JW. Do HMOs produce specific services more efficiently? Inquiry. 1984;21:243-253.
29. Bradbury RC, Golec JH, Stearns FE. Comparing hospital length of stay in independent practice association HMOs and traditional insurance programs. Inquiry. 1991;28:87-93.
30. Martin DP, Diehr P, Price KF, Richardson WC. Effect of a gatekeeper plan on health services use and charges: a randomized trial. Am J Public Health. 1989;79:1628-1632.
31. Yelin EH, Shearn MA, Epstein WV. Health outcomes for a chronic disease in prepaid group practice and fee for service settings: the case of rheumatoid arthritis. Med Care. 1986;24:36-247.
32. Stern RS, Juhn PI, Gertler PJ, Epstein AM. A comparison of length of stay and costs for health maintenance organization and fee-for-service patients. Arch Intern Med. 1989;149:1185-1188.
33. Agency for Health Care Policy and Research. Cost and Financing Issues in Health Care Reform. Washington, DC: US Government Printing Office; 1992. National Institutes of Health publication PA-93-45.
34. Health Care Financing Administration. Health Care Financing Research and Demonstration Cooperative agreements and grants for fiscal years 1994 through 1996. Federal Register. 1994;59:1961-1968.
35. Lave JR, Pashos CL, Anderson GF, et al. Costing medical care: using Medicare administrative data. Med Care. 1994;32(suppl 7):JS77-JS89.
36. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993;270:2478-2486.
37. Knaus WA, Wagner DP, Zimmerman JE, Draper EA. Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993; 118:753-761.
38. Dowd BE, Johnson AN, Madson RA. Inpatient length of stay in Twin Cities health plans. Med Care. 1986;24:694-710.
39. Potential resource savings in intensive care in tertiary care hospitals. In: The ICU: A Cost Benefit Analysis. New York, NY: Elsevier Science Inc; February 5, 1986:101.
40. Rapoport J, Teres D, Lemeshow S, Avrunin JS, Haber R. Explaining variability of cost using a severity-of-illness measure for ICU patients. Med Care. 1990;28:338-348.
41. Rapoport J, Teres D, Lemeshow S, Gehlbach S. A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med. 1994;22:1385-1391.
42. Wagner DP. Economics of prolonged mechanical ventilation. Am Rev Respir Dis. 1989;140:S14-S18.
43. Shortell SM, Zimmerman JE, Rousseau DM, et al. The performance of intensive care units: does good management make a difference. Med Care. 1994;32:508-525.
44. Zimmerman JE, Shortell SM, Knaue WA, et al. Value and cost of teaching hospitals: a prospective, multicenter, inception cohort study. Crit Care Med. 1993;21:1432-1442.
45. Zimmerman JE, Wagner DP, Draper EA, Knaus WA. Improving intensive care unit discharge decisions: supplementing physician judgment with predictions of next day risk for life support. Crit Care Med. 1994;22:1373-1384.
46. Zimmerman JE, Shortell SM, Rousseau DM, et al. Improving intensive care: observations based on organizational case studies in nine intensive care units: a prospective, multicenter study. Crit Care Med. 1993;21:1443-1451.
47. Clermont G, Angus DC, Linde-Zwirble WT, et al. Alternative measures of ICU resource use: do they compare? Crit Care Med. 1996;24(suppl 1): A52. Abstract.
48. Clermont G, Angus DC, Linde-Zwirble WT. Comparison of different indices of resource use in intensive care. In: Proceedings of the International Conference on Health Policy Research; December 3, 1995; Boston, Mass. Abstract.
49. Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA. 1994;271:1512-1519.
50. Carlisle DM, Siu AL, Keeler EB, et al. HMO vs fee-for-service care of older persons with acute myocardial infarction. Am J Public Health. 1992;82: 1626-1630.
51. Braveman P, Schaaf VM, Egerter S, Bennett T, Schecter W. Insurance-related differences in the risk of ruptured appendix. N Engl J Med. 1994; 331:444-449.
52. Sirio CA, Tajimi K, Tase C, et al. An initial comparison of intensive care in Japan and the United States. Crit Care Med. 1992;20:1207-1215.
53. Jacobs P, Noseworthy TW. National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med. 1990;18:1282-1286.
54. Zimmerman JE, Knaus WA, Judson JA, et al. Patient selection for intensive care: a comparison of New Zealand and United States hospitals. Crit Care Med. 1988;16:318-326.
55. Knaus WA, Le Gall JR, Wagner DP, et al. A comparison of intensive care in the USA and France. Lancet. 1982;2:642-646.
56. Angus DC, Linde-Zwirble WT, Sirio CA, et al. Rural-urban differences in ICU use in Florida. Chest. 1995;108:105S.
57. Rapoport J, Teres D, Barnett R, et al. A comparison of intensive care unit utilization in Alberta and western Massachusetts. Crit Care Med. 1995; 23:1336-1346.
58. Maklan CW, Greene R, Cummings MA. Methodological challenges and innovations in patient outcomes research. Med Care. 1994;32(suppl 7)JS13-JS21.
59. Mitchell JB, Bubolz T, Paul JE, et al. Using Medicare claims for outcomes research. Med Care. 1994;32(suppl 7)JS38-JS51.
60. McClellan M, McNeil BJ, Newhouse JP. Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? analysis using instrumental variables. JAMA. 1994;272:859-866.
61. Wennberg JE, Roos N, Sola L, Schon A, Jaffe R. Use of claims data systems to evaluate health care outcomes: mortality and reoperation following prostatectomy. JAMA. 1987;257:933-936.
62. Udvarhelyi IS, Gatsonis C, Epstein AM, Pashos CL, Newhouse JP, McNeil BJ. Acute myocardial infarction in the Medicare population: process of care and clinical outcomes. JAMA. 1992; 268:2530-2536.
63. Iezzoni L, Schwartz M, Ash A, MacKiernan Y. Risk adjustment methods for examining in-hospital mortality. In: Proceedings of the Association for Health Services Research and Foundation for Health Services Research; June 13, 1994:21; Washington, DC. Abstract.
64. Iezzoni LI, Shwartz M, Ash AS, Mackiernan Y, Hotchkin EK. Risk adjustment methods can affect perceptions of outcomes. Am J Med Q. 1994;9:43-48.
65. Iezzoni LI, Ash AS, Coffman GA, Moskowitz MA. Predicting in-hospital mortality: a comparison of severity measurement approaches. Med Care. 1992;30:347-359.
66. Iezzoni LI, Ash AS, Shwartz M, Daley J, Hughes JS, Mackiernan YD. Predicting who dies depends on how severity is measured: implications for evaluating patient outcomes. Ann Intern Med. 1995;123:763-770.
67. Linde-Zwirble WT. The effects of DRG assignment on hospital ICD-9 coding. In: Proceedings of the 155th annual joint statistical meeting of the American Statistical Association; August 16, 1995; Orlando, Fla. Abstract.
68. Iezzoni LI. Data sources and implications: administrative data bases. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes. Ann Arbor, Mich: Health Administration Press; 1994;119-176.