当前位置： SCI文献检索 > JOURNAL OF GENERAL INTERNAL MEDICINE期刊下所有文献 > Primary care experiences of medicare beneficiaries, 1998 to 2000.

Primary care experiences of medicare beneficiaries, 1998 to 2000.

Abstract：

OBJECTIVE:To examine changes in the quality of primary care experienced and reported by Medicare beneficiaries from 1998 to 2000. DESIGN:Longitudinal observational study. SETTING:Thirteen states with large, mature Medicare HMO markets. PARTICIPANTS:Probability sample of noninstitutionalized Medicare beneficiaries aged 65 and older enrolled in traditional Medicare (FFS) or a Medicare HMO. MEASUREMENTS AND MAIN RESULTS:We examined 2-year changes in 9 measures derived from the Primary Care Assessment Survey (PCAS). The measures covered 2 broad areas of primary care performance: quality of physician-patient interactions (5 measures) and structural/organizational features of care (4 measures). For each measure, we computed the change in each beneficiary's score (1998 vs 2000) and standardized effect sizes (ES). Results revealed significant declines in 3 measures of physician-patient interaction quality (communication, interpersonal treatment, and thoroughness of physical exams; P < or = .0001). Physicians' knowledge of patients increased significantly over the 2-year period (P < or = .001). Patient trust did not change (P = .10). With regard to structural/organizational features of care, there were significant declines in financial access (P < or = .001), visit-based continuity (P < .001), and integration of care (P < or = .05), while organizational access increased (P < or = .05). With the exception of financial access, observed changes did not differ by system (FFS, HMO). CONCLUSIONS:Over a 2-year period, the quality of seniors' interactions with their primary physicians declined significantly, as did other hallmarks of primary care such as continuity, integration of care, and financial access. This decline is in sharp contrast to the marked improvements in technical quality that have been measured over this period. In an era marked by substantial national investment in quality monitoring, measures of these elements of care are notably absent from the nation's portfolio of quality indicators.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Montgomery JE,Irish JT,Wilson IB,Chang H,Li AC,Rogers WH,Safran DG

doi

10.1111/j.1525-1497.2004.30381.x

subject

Has Abstract

pub_date

2004-10-01 00:00:00

pages

991-8

issue

eissn

0884-8734

issn

1525-1497

pii

JGI30381

journal_volume

pub_type

杂志文章

在线工具

Primary care experiences of medicare beneficiaries, 1998 to 2000.