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October 2, 1996

Health Care Utilization and Outcomes Among Persons With Rheumatoid Arthritis in Fee-for-Service and Prepaid Group Practice Settings

Author Affiliations

From the Rosalind Russell Medical Research Center for Arthritis (Drs Yelin and Criswell), and the Institute for Health Policy Studies (Dr Yelin), the University of California, San Francisco; and Kaiser-Permanente, San Francisco, Calif (Dr Feigenbaum).

JAMA. 1996;276(13):1048-1053. doi:10.1001/jama.1996.03540130046028

Objective.  —To compare health care utilization and outcomes over an 11-year period among persons with rheumatoid arthritis (RA) in fee-for-service and prepaid group practice settings.

Design.  —Cohort of persons with RA followed up for as long as 11 years. The principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker.

Setting.  —Persons with RA presenting to a random sample of community rheumatologists in northern California.

Patients.  —Patients were enrolled in 2 cycles: in 1982 and 1983 and in 1989. Study rheumatologists listed all persons meeting criteria for RA presenting to their offices over a 1-month period. Of the 1062 so listed, we enrolled 1025, or 96.5%. Of the 1025 persons with RA, 227 (22.2%) reported receiving care in prepaid group practice settings.

Main Outcome Measures.  —As of the end of 1994, 5295 person-years of observation were available for the analysis of the annual level of the utilization and outcome measures; 341 persons had been followed up for all 11 years of the study. The main utilization outcomes measured included office visits, outpatient surgeries, hospital admissions, and painful joints.

Results.  —The persons with RA in fee-for-service and prepaid group practice settings did not differ in the quantity of health care used in any 1 year for either RA or non-RA reasons. Among those followed up for all 11 years, the persons in feefor-service and prepaid group practice settings did not differ in the cumulative quantity of health care used over the entire period of study. The 2 groups did not differ on any outcome measure on either an annual or long-term basis. The results of mortality analyses were inconsistent: using Kaplan-Meier estimates, the persons with RA in prepaid group practice settings survived significantly longer (P<.05 by log-rank test); using Cox proportional hazards methods, the proportion dying each year did not differ significantly.

Conclusions.  —We could find no evidence that persons with RA in fee-forservice and prepaid group practice settings received different quantities of health care or experienced different outcomes on either an annual or long-term basis.