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October 22, 1997

Outcomes for Patients With Stroke in Managed Care vs Fee-for-Service-Reply

Author Affiliations

Northwestern University Medical School Chicago, Ill

JAMA. 1997;278(16):1316. doi:10.1001/jama.1997.03550160036022

In Reply.  —We agree with Dr Barber, as we stated in our Editorial, that more studies are needed relating appropriate outcomes of care (for example, differences in functional status related to discharge destination for stroke patients) and optimal resource allocation. We vigorously disagree with his characterizations of the study since best practices with respect to stroke management are well established.1 While the study by Retchin et al2 is indeed limited by lack of functional outcomes data, it is consistent with findings of inferior outcomes for elderly HMO patients from the largest, most comprehensive functional outcomes study to date.3 We still, therefore, are very concerned with regard to how those who are unable to easily and effectively navigate the current health care delivery system fare under corporate medical plans. We do not consider ourselves "anti-managed care." As we pointed out in our Editorial, prepaid delivery systems have the potential to