Table 3. Effects of the Medicare Coordinated Care Demonstration on Patient's Quality of Care During First Year After Enrollment.
| Outcome | Number of Programs | Programs with Impacts | ||
|---|---|---|---|---|
|
| ||||
| With Data1 | With Moderate Improvements2 | With Large Improvements2 | ||
| Knowledge and Behavior3 | ||||
| Understands Diet | 12 | 1 | 0 | CenVaNet |
| Follows Healthful Diet | 12 | 0 | 1 | Washington University |
| Understands Exercise | 12 | 1 | 0 | Medical Care Development |
| Exercises Regularly | 12 | 1 | 0 | Health Quality Partners (HQP) |
| Misses Doses of Medication | 12 | 0 | 0 | — |
| Visits Physician with List of Questions | 12 | 0 | 0 | — |
| Tried to Quit Smoking (Smokers Only) | 12 | 0 | 1 | QMed |
| Tried to Cut Down on Drinking (Drinkers Only) | 12 | 0 | 1 | HQP |
| Preventative Care All Patients | ||||
| Flu Vaccine3 | 12 | 1 | 0 | CenVaNet |
| Pneumonia Vaccine3 | 12 | 1 | 0 | HQP |
| Colon Cancer Screening4,5 | 14 | 0 | 0 | — |
| Screening Mammography4,7 | 14 | 0 | 1 | HQP |
| Diabetes Patients4 | ||||
| Diabetes Education | 14 | 0 | 0 | — |
| Eye Examination | 14 | 0 | 0 | — |
| Cholesterol or Lipid Test | 14 | 1 | 1 | Carle, HQP |
| Hemoglobin A1c Test | 14 | 1 | 0 | Carle |
| Urine Test for Protein | 14 | 0 | 1 | Carle |
| Congestive Heart Failure (CHF) Patients4,7 | ||||
| LV Function Test | 14 | 0 | 0 | — |
| Coronary Artery Disease (CAD) Patients5 | ||||
| Cholesterol or Lipid Test | 14 | 1 | 1 | Carle, HQP |
| Preventable Hospitalizations4 | 14 | 2 | 1 | CenVaNet, Georgetown, Hospice of the Valley |
| Health Status and Weil-Being3 | ||||
| Emotional Distress | 12 | 3 | 0 | CorSolutions, HQP, Mercy |
| Depression | 12 | 0 | 0 | — |
| Poor Sleep | 12 | 2 | 0 | Avera, Jewish Home and Hospital |
| Pain | 12 | 2 | 0 | Hospice of the Valley, QMed |
| Effect of Primary Condition on Life | 12 | 1 | 0 | CenVaNet |
| Physical Health Summary Score | 12 | 1 | 0 | CorSolutions |
| Mental Health Summary Score | 12 | 0 | 0 | — |
Measures for which 12 sites have data were obtained from the patient survey. The claims-based measures excluded quality oncology because the program's focus on beneficiaries with cancer makes measures of general preventative care and preventative care for diabetes, CHF, and CAD irrelevant for the program.
Moderate=a statistically significant treatment-control difference (p<= 0.10) that favors the treatment group and is less than 10 percentage points and less than one-half the control group proportion (pc) or its complement (1-pc). Large=a statistically significant treatment-control difference (p<= 0.10) that favors the treatment group and is more than 10 percentage points or at least one-half the control group proportion [pc] or its complement (1-pc).
Sample sizes for the survey ranged from 395 to 684 per site across the 12 sites in which surveys were conducted. The survey sample was evenly split between treatment and control groups; response rates (from 84.9 to 97.6 percent) were similar for the treatment and control groups in each site.
Sample sizes for the claims-based measures ranged from 55 to 2,042 per site across 14 sites.
Colon cancer screening is fecal occult blood testing, screening colonoscopy, sigmoidoscopy, or barium enema.
Screening mammography is only assessed for females.
Enrollees were defined as having diabetes, CHF, or CAD if they had a Medicare claim with such a diagnosis in the 2 years prior to enrollment; diagnosis categories are not mutually exclusive.
SOURCE: Brown, R., Peikes, D., Chen, A., and Schore, J., Mathematica Policy Research, Inc., 2008.