The growth of managed care has profoundly changed medical care in the US and the impact of the changes is uncertain. Building on our group's extensive experience in cardiovascular quality assessment, we propose to describe the impact of key aspects of managed care on evidence-based quality of care markers and on health outcomes in coronary disease. By focusing on coronary disease, this project addresses a high prevalence chronic disorder with well-defined quality of care and health outcome measures. We will specifically evaluate process and outcome measures in both the transitional phase following cardiac hospitalization and the longer term maintenance phase in order to determine those features of managed care organizations (MCOs) that influence these measures. We will specifically evaluate process and outcome measures in both the transitional phase following hospitalization and the longer term health maintenance phase in order to determine those features of managed care organizations (MCOs) that influence these measures. We will also address methodological issues of non-response bias and confounding, because they have direct relevance to these evaluations. To achieve the overall objective of this project, we will address 6 Specific Aims: We will (1) Assemble the relevant disease-specific process and health outcomes measures into a patient survey; (2) Collect information on these measures at two points in time in a large cohort of CAD patients drawn from 3 MCOs; (3) Determine the specific MCO organizational features and initiatives that are associated with higher quality of care and with better health outcomes in the post-hospitalization period; (4) Determine the specific MCO organizational features and initiatives that are associated with better long term health maintenance and secondary prevention; (5) Examine methodological issues of confounding and endogeneity as they affect these relationships; and (6) Examine how non- response bias affects these relationships.
