Health Maintenance Organization Members Research Articles

Case-control study of 10 years of comprehensive diabetes care.

To describe the long-term clinical impact of a comprehensive management program instituted throughout a health system for members with diabetes mellitus. 10 year case-control evaluation. Kaiser Permanente Northwest, Portland, OR. Members of the health maintenance organization between 1987 and 1996; members with diabetes were compared with equal numbers of members without diabetes. The number of participants with diabetes ranged from 5331 in 1987 to 13,099 in 1996. Number in diabetes register, mortality, change in comorbidity, rates of uptake of preventive health measures, use of pharmaceuticals, levels of risk factors, hospital days per thousand per year, emergency room visits per thousand per year. The prevalence of diabetes identified in this population rose from 2.54% (7,895/310,819) in 1987 to 3.66% (14,741/402,754) in 1996, and the mean (SEM) age of members at the time of diagnosis fell slightly from 62.9 (+/- 0.21) years to 62.0 (+/- 0.13) years (P < 0.05). By 1996, 10,885 of the 13,099 (83% +/- 0.3%) of members with diabetes had an annual laboratory test to assess glycemic control, the annual screening rate for retinopathy was 67.6% (+/- 0.4%), the rate of uptake of influenza immunizations was 60.2% (7,886/13,099) and the screening rate for nephropathy was 43% (5,698/13,099) (+/- 0.49%). The use of home glucose testing increased from 32.4% (1721/5331) of members with diabetes to 53.0% (6,942/12,099); the use of lipid lowering drugs increased from 3.5% (187/55,331) to 19.8% (2,594/13,099). The use of angiotensin converting enzyme inhibitors increased from 8.5% to 34.8% of members with diabetes. Mean blood pressure decreased from 144/82 mm Hg (+/- 0.8/0.4) to 138/79 mm Hg (+/- 0.3/0.15), and mean total cholesterol concentrations dropped from 243 mg/dL (+/- 4.2) to 215 mg/dL (+/- 0.6). By 1996, 56.4% (7,388/1,3099) (+/- 0.5%) of members on the diabetes register had good to excellent glycemic control (HbA1c < 8%). Mortality decreased from 4.8% (256/5331) (+/- 0.3%) to 3.6% (472/13,099) (+/- 0.2%) among members with diabetes, this was a more rapid decrease than was observed among those without diabetes (P < 0.01). The annual ratio of visits to the emergency room by members with diabetes to members without fell from 2.5 to 1.8, and the ratio for the number of days spent in acute care in the hospital dropped from 3.6 to 2.5. This centrally organized program based in a primary care setting and utilizing a register of patients with diabetes was associated with substantial improvements in the process and outcomes of care in a large population of health maintenance organization members with diabetes.

The Vaccine Safety Datalink: immunization research in health maintenance organizations in the USA.

The Vaccine Safety Datalink is a collaborative project involving the National Immunization Program of the Centers for Disease Control and Prevention and several large health maintenance organizations in the USA. The project began in 1990 with the primary purpose of rigorously evaluating concerns about the safety of vaccines. Computerized data on vaccination, medical outcome (e.g. outpatient visits, emergency room visits, hospitalizations, and deaths) and covariates (e.g. birth certificates, census data) are prospectively collected and linked under joint protocol at multiple health maintenance organizations for analysis. Approximately 6 million persons (2% of the population of the USA) are now members of health maintenance organizations participating in the Vaccine Safety Datalink, which has proved to be a valuable resource providing important information on a number of vaccine safety issues. The databases and infrastructure created for the Vaccine Safety Datalink have also provided opportunities to address vaccination coverage, cost-effectiveness and other matters connected with immunization as well as matters outside this field.

HMO membership and patient age and the use of specialty care for hospitalized patients with acute stroke: The Minnesota Stroke Survey.

The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. We investigated the relationship between membership in an HMO and the decision to consult with a neurologist or admit to a neurology ward for patients hospitalized with acute stroke. We then compared 1-year mortality of patients who received neurology care to the 1-year mortality of those who did not receive neurology care. Retrospective medical record review. A sample of hospitalized acute stroke patients (age range, 30-79 years) who were discharged from Minneapolis-St. Paul metropolitan hospitals with a diagnosis code of acute cerebrovascular disease from 1991 to 1993. Trained nurses abstracted the medical records. Stroke events (n = 2,320) were validated using clinical criteria and neuroimaging reports. Mortality data were obtained from the Minnesota Death Index. Among patients enrolled in HMOs, 30% of validated stroke patients did not receive neurology care in comparison with 19% of patients not enrolled in HMOs. After adjusting for patient mix and hospital characteristics, the odds of receiving neurology care were half as great for patients enrolled in HMOs as compared with patients not enrolled in HMOs (odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.36-0.74). The association of membership in HMOs with lower use of neurology care was concentrated in older patients. Within each age group, the odds ratios and 95% CI of receiving neurology care for patients enrolled in HMOs versus patients not enrolled in HMOs were: < 55 years (1.06, 0.42-2.67), 55 to 64 years (0.54, 0.34-0.87), 65 to 74 years (0.51, 0.36-0.71), and >75 years (0.40, 0.24-0.68). Using Cox regression, 30-day mortality did not differ between patients who received neurology care and those who did not. Among 30-day survivors, the mortality hazards ratio (HR) during the next 11 months for patients who received neurology care was 71% of the hazard for patients who did not receive neurology care (HR = 0.71, 95% CI = 0.55-0.91). These data suggest that membership in an HMO was associated with reduced access to neurology care for older patients with acute stroke and that patients who received neurology care had a lower risk of death during the year after their stroke. It remains to be determined if these differences in outcome are caused by true differences in stroke management or by unmeasured characteristics.

Physician Choice Directories

It is a generally held belief that enrolled members of a health maintenance organization (HMO) will be more satisfied with their HMO and physicians if those members have a relationship with a personal physician. Public relations and marketing managers, therefore, in an attempt to encourage the establishment of such relationships, spend significant resources producing physician choice directories for their HMO members. But to what extent do these directories impact members? Do the HMO members read them? If so, do they take advantage of the opportunity to choose a personal physician? And if they do choose, what affect does that choice behavior have on satisfaction levels? The experience of one large, group model HMO suggests that physician choice directories enhance members' confidence in their physicians and their satisfaction with personalized care.

Supplementing tuberculosis surveillance with automated data from health maintenance organizations.

Data collected by health maintenance organizations (HMOs), which provide care for an increasing number of persons with tuberculosis (TB), may be used to complement traditional TB surveillance. We evaluated the ability of HMO-based surveillance to contribute to overall TB reporting through the use of routinely collected automated data for approximately 350,000 HMO members. During approximately 1.5 million person-years, 45 incident cases were identified in either HMO or public health department records. Eight (18%) confirmed cases had not been identified by the public health department. The most useful screening criterion (sensitivity of 89% and predictive value positive of 30%) was dispensing of two or more TB drugs. Pharmacy dispensing information routinely collected by many HMOs appears to be a useful adjunct to traditional TB surveillance, particularly for identifying cases without positive microbiologic results that may be missed by traditional public health surveillance methods.

Using automated pharmacy records to assess the management of tuberculosis.

We used automated pharmacy dispensing data to characterize tuberculosis (TB) management for 45 health maintenance organization (HMO) members. Pharmacy records distinguished patients treated in HMOs from those treated elsewhere. For cases treated in HMOs, they provided useful information about appropriateness of prescribed regimens and adherence to therapy.

Use of and interest in alternative therapies among adult primary care clinicians and adult members in a large health maintenance organization: Gordon NP, Sobel DS, Tarazona EZ. Western Journal of Medicine 1998; 169: 153–161

During spring 1996, random samples of adult primary care physicians, obstetrics-gynecology physicians and nurse practitioners, and adult members of a large northern California group practice model health maintenance organization (HMO) were surveyed by mail to assess the use of alternative therapies and the extent of interest in having them incorporated into HMO-delivered care. Sixty-one percent (n = 624) of adult primary care physicians, 70% (n = 157) of obstetrics-gynecology clinicians, and 50% (2 surveys, n = 1,507 and n = 17,735) of adult HMO members responded. During the previous 12 months, 25% of adults reported using and nearly 90% of adult primary care physicians and obstetrics-gynecology clinicians reported recommending at least 1 alternative therapy, primarily for pain management. Chiropractic, acupuncture, massage, and behavioral medicine techniques such as meditation and relaxation training were most often cited. Obstetrics-gynecology clinicians used herbal and homeopathic medicines more often than adult primary care physicians, primarily for menopause and premenstrual syndrome. Two thirds of adult primary care physicians and three fourths of obstetrics-gynecology clinicians were at least moderately interested in using alternative therapies with patients, and nearly 70% of young and middle-aged adult and half of senior adult members were interested in having alternative therapies incorporated into their health care. Adult primary care physicians and members were more interested in having the HMO cover manipulative and behavioral medicine therapies than homeopathic or herbal medicines.

Stages of change across ten health risk behaviors for older adults.

Owing to the recent success of the Transtheoretical Model of behavior change and the possible relationships between health behaviors, this study investigated the stage distribution of 10 healthy behaviors (seatbelt use, avoidance of high fat food, eating a high-fiber diet, attempting to lose weight, exercising regularly, avoiding sun exposure, sunscreen use, attempting to reduce stress, stopping smoking, and conducting cancer self-exams) and their interrelationships in a representative sample of health maintenance organization (HMO) members. The majority of older adults were found to be in either precontemplation or maintenance, illustrating the need to target interventions to precontemplation. Most older individuals were in precontemplation for losing weight and/ or sunscreen use and exercise, making these behaviors a priority for intervention research. Possible gateway behaviors to general health could be identified; however, these results are preliminary and require longitudinal follow-up.

Type 2 diabetes: incremental medical care costs during the first 8 years after diagnosis.

To describe and analyze the time course of medical care costs caused by type 2 diabetes, from the time of diagnosis through the first 8 postdiagnostic years. From electronic health maintenance organization (HMO) records, we ascertained the ongoing medical care costs for all members with type 2 diabetes who were newly diagnosed between 1988 and 1995. To isolate incremental costs (costs caused by the diagnosis of diabetes), we subtracted the costs of individually matched HMO members without diabetes from costs of members with diabetes. The economic burden of diabetes is immediately apparent from the time of diagnosis. In year 1, total medical costs were 2.1 times higher for patients with diabetes compared with those without diabetes. Diabetes-associated incremental costs (type 2 diabetic costs minus matched costs for people without diabetes) averaged $2,257 per type 2 diabetic patient per year during the first 8 postdiagnostic years. Annual incremental costs varied relatively little over the period but were higher during years 1, 7, and 8 because of higher-cost hospitalizations for causes other than diabetes or its complications. For the first 8 years after diabetes diagnosis, patients with type 2 diabetes incurred substantially higher costs than matched nondiabetic patients, but those high costs remained largely flat. Once the growth in costs due to general aging is controlled for, it appears that diabetic complications do not increase incremental costs as early as is commonly believed. Additional research is needed to better understand how diabetes and its diagnosis affect medical care costs over longer periods of time.

Women's provider preferences for basic gynecology care in a large health maintenance organization.

To examine women's preferences for the type and sex of the provider of basic gynecological services and the correlates of these preferences, we mailed a cross-sectional survey to 8406 women in a large group model health maintenance organization (HMO) in northern California, with a response rate of 73.6%. Four questions asked women the type (obstetrician/gynecologist, nurse practitioner, or primary care physician) and sex of provider who performed their last pelvic examination and their preferences in type and sex of provider for these examinations. This was a random sample of female HMO members 35-85 years of age who were empaneled with a primary care physician from one of three categories: family practitioner, general internist, or subspecialist. Of the 5164 respondents who received their last pelvic examination at Kaiser Permanente, 56% had seen a gynecologist, 26% a nurse practitioner, and only 18% their own primary care physician for the examination. Of these women, 60.3% reported preferring a gynecologist for basic gynecology care, 12.6% preferred a nurse practitioner, 13.3% preferred their own primary care physician, and 13.8% had no preference. Patients of family practitioners were more likely to prefer their own primary care practitioner than patients of other types of doctors. The strongest independent predictor of preferring a gynecologist over the primary care physician was having seen a gynecologist for the last pelvic examination (OR = 28.3, p < 0.0001). Other independent predictors of preferring a gynecologist were younger age, higher education and income, and having a male primary care physician. Of respondents, 52.2% preferred a female provider for basic gynecological care, and 42.0% had no preference for the sex of the provider. Preferring a female provider was strongly and independently associated with lower income, higher education, nonwhite race, having a male primary care physician, having an older primary care, physician, and having seen a female provider at the last pelvic examination. In this HMO, a majority of women reported a preference for seeing an obstetrician/gynecologist for their routine gynecological care, despite having a primary care physician. This most likely reflects the strong influence of previous patient experience and that familiarity with a particular type of provider leads to preferences for that type. This medical group's structure probably also affects preferences, as in this HMO, primary care physicians can be discouraged from performing pelvic examinations. Many women do prefer female providers for pelvic examinations, but a large percentage have no preference. These women often see male providers for basic gynecological care. As managed care places increasing emphasis on providing integrated, comprehensive primary care, this apparent preference for specialty gynecological care will require further study.

Advance directives are more likely among seniors asked about end-of-life care preferences.

To estimate the proportion of seniors in a large health maintenance organization (HMO) who had been asked about their end-of-life care preferences (EOLCPs) by a clinician and who had completed an advance directive (AD). To examine the association of having had an EOLCP discussion and AD completion. A random sample of HMO members aged 65 years or older were asked to complete a mailed survey about health and health-related issues in 1996. Data provided by 5117 seniors (80% response rate) were used to estimate the prevalence of EOLCP and AD among seniors overall and in specific risk groups. Bivariate and multiple logistic regression models were used to identify predictors of AD completion, especially having been asked about EOLCP. One third of seniors reported having an AD on file with the HMO, but only 15% had talked with a clinician about EOLCP. Both having been asked about EOLCP and having an AD were positively associated with age, but not significantly associated with sex, race/ethnicity, marital status, or self-rated health status. Having been asked by a clinician about EOLCP was significantly associated with completion of an AD. Clinicians can play an important role in increasing AD completion rates among seniors by bringing up the subject of EOLCPs.

Mass Mailing and Staff Experience in a Total Recruitment Program for a Clinical Trial: The SHEP Experience

The Systolic Hypertension in the Elderly Program (SHEP) staff contacted 447,921 screenees, of whom 11,919 (2.7%) were originally eligible and 4,736 (1.1%) maintained eligibility and were randomized. The total number of participants enrolled at the 16 clinical centers ranged from 133 to 559. The low yield of screenees to randomizations resulted from the study design, not from low levels of agreement to participate, and required the employment of a variety of recruitment strategies in a prudent overall plan. SHEP was one of the first clinical trials to use mass mailing as a primary strategy of recruitment. The study used mailing lists from seven generic sources. More than 3.4 million letters of invitation were mailed; they yielded an overall response rate of 4.3%. Motor vehicle and voter registration lists provided the greatest numbers of names. Mailings to members of health maintenance organizations (HMOs) and registrants of the Health Care Finance Administration (HCFA) provided the greatest response rates. Considerable variability in response rates existed among clinical centers using generically similar mailing lists. Generally, the number of hours spent on recruitment showed a positive, but not statistically significant, association with randomization yields. The recruitment yield was statistically significantly higher in clinics with experienced recruitment coordinators than in clinics with inexperienced ones ( p = 0.0008). From these findings we conclude that mass mailing is an important strategy in an overall recruitment program, that the involvement of experienced recruitment staff is important, and that although the total time spent by staff on recruitment may also improve results, it matters less than the staff’s level of recruiting experience.

Hypertension, antihypertensive medication use, and risk of renal cell carcinoma.

To investigate whether diuretic medication use increases risk of renal cell carcinoma (RCC), the authors conducted a case-control study of health maintenance organization members in western Washington State. Cases (n = 238) diagnosed between January 1980 and June 1995 were compared with controls (n = 616) selected from health maintenance organization membership files. The computerized health maintenance organization pharmacy database provided information on medications prescribed after March 1977. Additional exposure information was collected from medical records. For women, use of diuretics was associated with increased risk of RCC (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.0-3.1), but the association was not independent of a diagnosis of hypertension (adjusted for hypertension, OR = 1.1, 95% CI 0.5-2.1). Similarly, nondiuretic antihypertensive use was associated with increased risk, but only when unadjusted for hypertension. For men, neither diuretic nor nondiuretic antihypertensive use was associated with risk of RCC. A diagnosis of hypertension was clearly associated with RCC risk for women (OR = 2.5, 95% CI 1.2-5.1), but not men (OR = 1.3, 95% CI 0.7-2.5). High systolic and diastolic blood pressures were associated with increased risk in both sexes. These results do not support the hypothesis that use of diuretic medication increases RCC risk; they are more consistent with an association between RCC and high blood pressure.

Associations of Smoking With Hospital-Based Care and Quality of Life in Patients With Obstructive Airway Disease

To investigate the relationship between direct or environmental tobacco smoke (ETS) exposure and both hospital-based care (HBC) and quality of life (QOL) among subjects with asthma. We report baseline cross-sectional data on 619 subjects with asthma, including direct or ETS exposure and QOL, and prospective longitudinal data on HBC using administrative databases for 30 months following baseline evaluation. Participants were health maintenance organization members with physician-diagnosed asthma involved in a longitudinal study of risk factors for hospital-based asthma care. Demographic characteristics and QOL were assessed with administered questionnaires, including the Marks Asthma Quality-of-Life (AQLQ) and SF-36 questionnaires. HBC was defined as episodes per person-year of hospital-based asthma care, which included emergency department and urgency care visits, and hospitalizations for asthma. Current smokers reported significantly worse QOL than never-smokers in two of five domains of the AQLQ (p < 0.05). Subjects with ETS exposure also reported significantly worse QOL than those without ETS exposure in two domains (p < 0.05). On the SF-36, current smokers reported significantly worse QOL than never-smokers in five of nine domains (p < 0.05). Subjects with ETS exposure reported significantly worse QOL than those without ETS exposure in three domains (p < 0.05). Current smokers used significantly more hospital-based asthma care than never-smokers (adjusted relative risk [RR], 1.40; 95% confidence interval [CI], 1.01 to 1.95) while ex-smokers did not exhibit increased risk compared with nonsmokers (adjusted RR, 0.94; 95% CI, 0.7 to 1.3). Also, subjects with ETS exposure used significantly more hospital-based asthma care than those without ETS exposure (RR, 2.34; 95% CI, 1.80 to 3.05). Direct or environmental tobacco exposure prospectively predicted increased health-care utilization for asthma and reduced QOL in patients with asthma. These findings add to our existing knowledge of the detrimental effects of tobacco smoke and are of relevance specifically to patients with asthma.

Women's Provider Preferences for Basic Gynecology Care in a Large Health Maintenance Organization

To examine women's preferences for the type and sex of the provider of basic gynecological services and the correlates of these preferences, we mailed a cross-sectional survey to 8406 women in a large group model health maintenance organization (HMO) in northern California, with a response rate of 73.6%. Four questions asked women the type (obstetrician/gynecologist, nurse practitioner, or primary care physician) and sex of provider who performed their last pelvic examination and their preferences in type and sex of provider for these examinations. This was a random sample of female HMO members 35-85 years of age who were empaneled with a primary care physician from one of three categories: family practitioner, general internist, or subspecialist. Of the 5164 respondents who received their last pelvic examination at Kaiser Permanente, 56% had seen a gynecologist, 26% a nurse practitioner, and only 18% their own primary care physician for the examination. Of these women, 60.3% reported preferring a gynecologist for basic gynecology care, 12.6% preferred a nurse practitioner, 13.3% preferred their own primary care physician, and 13.8% had no preference. Patients of family practitioners were more likely to prefer their own primary care practitioner than patients of other types of doctors. The strongest independent predictor of preferring a gynecologist over the primary care physician was having seen a gynecologist for the last pelvic examination (OR = 28.3, p < 0.0001). Other independent predictors of preferring a gynecologist were younger age, higher education and income, and having a male primary care physician. Of respondents, 52.2% preferred a female provider for basic gynecological care, and 42.0% had no preference for the sex of the provider. Preferring a female provider was strongly and independently associated with lower income, higher education, nonwhite race, having a male primary care physician, having an older primary care, physician, and having seen a female provider at the last pelvic examination. In this HMO, a majority of women reported a preference for seeing an obstetrician/gynecologist for their routine gynecological care, despite having a primary care physician. This most likely reflects the strong influence of previous patient experience and that familiarity with a particular type of provider leads to preferences for that type. This medical group's structure probably also affects preferences, as in this HMO, primary care physicians can be discouraged from performing pelvic examinations. Many women do prefer female providers for pelvic examinations, but a large percentage have no preference. These women often see male providers for basic gynecological care. As managed care places increasing emphasis on providing integrated, comprehensive primary care, this apparent preference for specialty gynecological care will require further study.

The member satisfaction survey as a measure of health plan accountability.

In its 1996 study of St. Louis area health maintenance organization members, Gateway Purchasers for Health closely analyzed member responses to the National Committee for Quality Assurance's annual member health care survey. The analysis of specific questions regarding overall satisfaction levels and member health status afforded insight into the factors that contribute to an individual's reported satisfaction with health care services and into variations by subgroups within the population. Ultimately, consumer information that allows choice of a health plan that best suits specific needs and preferences will drive accountability, quality, and value in the health care market.

Medicare managed care: consumers' perspectives

The 1997 CareData survey of members of Medicare risk health maintenance organizations (HMOs) measured the degree of satisfaction of Medicare managed care members with emphasis on pharmacy-related issues and specific disease treatment perceptions. The survey was a 12-page, self-administered questionnaire assessing more than 150 issues; it was distributed to 23,140 known enrollees of Medicare risk HMOs by their former employers between May and July 1997. A total of 12,265 Medicare beneficiaries enrolled in more than 70 major health plans in 23 US geographic markets completed and returned their questionnaires (response rate, 53%). The pharmacy benefit was cited by 75% of the respondents as the reason for joining their plan; 81% of the respondents reported being highly satisfied with the pharmacy benefit overall, with regional variations from a low of 60% to a high of 82%. The issues driving enrollees' satisfaction after being in their plan for a minimum of 6 months and a mean length of slightly more than 3 years were: satisfaction with customer service and plan administration (11.6% explained variance); the plan's concern for the member's well-being (10.6%); the belief that the care improved the member's health and well-being (9.2%); satisfaction with choice of specialists (5.3%); satisfaction with the pharmacy plan (5.1%); and satisfaction with the primary care physician (4.8%). Significant variations were seen among regions, plans, and the self-reported health status of the respondents.

The association between physical fitness and diagnosed chronic disease in health maintenance organization members.

The purpose of this investigation was to determine the relationship between predicted cardiorespiratory fitness (predicted VO2max) and diagnosed chronic disease. A stratified random sample of individuals was surveyed. Large Health Maintenance Organization (HMO) in the upper Midwest. HMO members (N = 8000), age 40 and over, with none, one, or two or more of the following diagnosed chronic conditions: hypertension, diabetes, dyslipidemia, and heart disease. Predicted VO2max was estimated for those respondents who completed the survey providing all critical data elements (n = 4121; representing 51.5% of total sample). Predicted VO2max was compared across chronic conditions using analysis of variance. The proportion of subjects across fitness quintiles by number of chronic conditions was tested using the chi 2 test. Subjects without chronic conditions showed higher predicted VO2max values (29.8 +/- 7.7 ml/kg/min) than those with one (25.9 +/- 7.8 ml/kg/min) or two or more conditions (25.7 +/- 7.9 ml/kg/min) (p < .0001). Subjects with diabetes, hypertension, and heart disease reported lower predicted VO2max than their healthier counterparts (p < .0001), but this was not the case for dyslipidemia subjects (27.6 +/- 7.6 vs. 27.4 +/- 8.2 ml/kg/min, respectively; p > .58). A larger proportion of diseased subjects was in the lowest fitness quintile for diabetes, hypertension, and heart disease, but not for dyslipidemia. As a group, chronic disease patients appear to have lower levels of physical fitness than subjects without chronic disease. Physical fitness improvement in diseased populations should be supported in the clinical setting.

A cost analysis of a Helicobacter pylori eradication strategy in a large health maintenance organization

Objectives: We sought to describe the effect of a Helicobacter pylori eradication strategy on health care costs among a cohort of health maintenance organization (HMO) members with peptic ulcer disease (PUD). Methods: Patients were identified from an outpatient diagnosis database and verified at chart review to have new-onset PUD by upper endoscopy or upper gastrointestinal radiographic series. Health plan registration and accounting databases were used to track costs over 12 months after initial diagnosis. Costs were analyzed separately for an initial 2-month interval and a 10-month follow-up period. Inpatient and pharmacy costs are those directly attributable to PUD (either a PUD-related discharge diagnosis or an antiulcer medication prescription). Outpatient costs are total costs. All cost differences were adjusted for age and gender. Results: Twenty-seven of 93 patients meeting selection criteria received H. pylori treatment. During the 2-month treatment window, adjusted PUD-related inpatient costs were higher for the H. pylori treated group (difference, $234.00/person), whereas total outpatient costs and PUD-related pharmacy costs were similar. During the 10-month follow-up period, PUD-related inpatient and pharmacy adjusted costs were similar, but adjusted outpatient costs in the H. pylori treated group were lower than in the untreated group (difference, $508.00/person). Total adjusted follow-up period costs were $555.00/person less in the H. pylori treated group ( p = 0.05). Total 12-month costs in the H. pylori treated group were $285.00/per person less than in untreated patients, ( p > 0.2); 30% of H. pylori treated patients were still receiving antisecretory therapy 1 yr after diagnosis, compared to 41.9% of untreated patients. Conclusions: H. pylori treatment is associated with a decreased cost of follow-up care for patients with PUD, primarily due to decreased outpatient utilization.

A cost analysis of a Helicobacter pylori eradication strategy in a large health maintenance organization.

We sought to describe the effect of a Helicobacter pylori eradication strategy on health care costs among a cohort of health maintenance organization (HMO) members with peptic ulcer disease (PUD). Patients were identified from an outpatient diagnosis database and verified at chart review to have new-onset PUD by upper endoscopy or upper gastrointestinal radiographic series. Health plan registration and accounting databases were used to track costs over 12 months after initial diagnosis. Costs were analyzed separately for an initial 2-month interval and a 10-month follow-up period. Inpatient and pharmacy costs are those directly attributable to PUD (either a PUD-related discharge diagnosis or an antiulcer medication prescription). Outpatient costs are total costs. All cost differences were adjusted for age and gender. Twenty-seven of 93 patients meeting selection criteria received H. pylori treatment. During the 2-month treatment window, adjusted PUD-related inpatient costs were higher for the H. pylori treated group (difference, $234.00/person), whereas total outpatient costs and PUD-related pharmacy costs were similar. During the 10-month follow-up period, PUD-related inpatient and pharmacy adjusted costs were similar, but adjusted outpatient costs in the H. pylori treated group were lower than in the untreated group (difference, $508.00/person). Total adjusted follow-up period costs were $555.00/person less in the H. pylori treated group (p = 0.05). Total 12-month costs in the H. pylori treated group were $285.00/per person less than in untreated patients, (p > 0.2); 30% of H. pylori treated patients were still receiving antisecretory therapy 1 yr after diagnosis, compared to 41.9% of untreated patients. H. pylori treatment is associated with a decreased cost of follow-up care for patients with PUD, primarily due to decreased outpatient utilization.