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The merits of open versus closed healthcare systems regarding quality of care and costs are uncertain. In this retrospective cohort study, we compared healthcare utilization and costs among Geisinger Health Plan (GHP) enrolees with newly diagnosed atrial fibrillation/flutter (AF/AFL) who received medical care from employed physicians within the Geisinger Health System (GHS) (closed system) versus outside the GHS (open system).
Adults with ≥1 inpatient or ≥2 outpatient claims for AF/AFL and continuous GHP enrolment for 12 months before and after their index AF/AFL diagnosis were identified in the GHP claims database (6/04-6 /11). Patients with a GHS-employed primary care physician (PCP; GHP/GHS group) were matched by age and gender to patients with a non-Geisinger PCP (GHP/non-GHS group).
In total, 14,726 patients (5,632 GHP/GHS and 9,094 GHP/non-GHS) were included. The GHP/GHS group were older (mean 72.9 vs 70.5 years) and had more baseline comorbidity (Charlson Comorbidity Index 1.34 vs 1.12) than the GHP/non-GHS group. Over 12 months after the index diagnosis, the GHP/GHS group had more all-cause and cardiovascular (CV)-related outpatient primary care visits (median 5.0 vs 4.0; 5.0 vs 3.0, respectively) and specialist visits (median 7.0 vs 6.0; 6.0 vs 5.0, respectively) than the GHP/non-GHS group (all P<0.001), but a similar number of ED visits (median 2.0 vs 2.0) and hospital admissions (median 0 vs 0). After adjustment for baseline differences, the GHP/GHS was more likely to have outpatient primary care visits (OR=1.58, 95% CI 1.42-1.75), and specialist visits (OR=1.32, 95% CI 1.18-1.48). Perhaps as a result of the more frequent outpatient visits, we observed trends towards a lower frequency of ED visits (OR=0.98, 95% CI 0.91-1.06 and hospitalizations (OR=0.96, 95% CI 0.90-1.03). There was a significantly lower risk of hospitalization for heart failure (OR=0.91, 95% 0.84-0.995), and 8.8% lower total charges (p<0.0001) in the GHP/GHS group.
For patients with AF/AFL, a closed system healthcare model appears to offer a superior clinical outcome at lower cost than an open system model.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmia Outcomes and Quality Assessment
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1245-109
- 2013 American College of Cardiology Foundation