The proposed 3-year project is an observational study of the impact of varying organizational and financing arrangements under managed care on the quality of eye care for working age patients with diabetic retinopathy (DR) or primary open-angle glaucoma (POAG), the 2 leading causes of blindness in the U.S. The project represents a collaborative effort between investigators at RAND and the Center for Health Care Policy and Evaluation at United HealthCare (UHC), a leading managed care organization. The project will collect data from patients in 7 geographically dispersed health plans to examine the impact of managed care features on: 1. process of care; 2. intermediate outcomes of care (e.g., control of intraocular pressure in glaucoma); 3. changes over time in visual performance-based measures (e.g., visual acuity); 4. changes over time in general health status and in vision-specific and generic health-related quality of life; 5. patient satisfaction; 6. utilization of eye care services. The managed care features assessed by the project will include patient cost sharing, type of eye care provider, provider payment method and practice arrangement, and utilization and quality management systems. Study patients and eye care providers will be identified using administrative data from UHC. Explicit quality criteria for process of care will be adapted from the American Academy of Ophthalmology's Preferred Practice Patterns for DR and POAG. Care process, intermediate care outcomes, and changes over time in visual performance-based measures will be assessed using data from a retrospective abstraction of eye care charts conducted during the project's second year. Changes over time in general health status and in vision-specific and generic health-related quality of life will be evaluated using data from a baseline patient interview conducted during the project's first year and a follow-up interview conducted 18 months later. Patient satisfaction will be assessed using data from the baseline patient interview. Utilization of eye care services will be measured using UHC administrative data. Managed care features will be assessed using information from the study plans and from a survey of providers that will be conducted during the project's second year. The main statistical analyses will consist of multivariate regression modeling to estimate the impact of managed care features on quality of care controlling for patient clinical and sociodemographic variables that may affect quality. The proposed project will enhance our understanding of the effect of varying organizational and financing arrangements under managed care on the quality of care provided to patients with chronic eye diseases. The results of the project will inform policy debates about the merits of alternative ways to deliver care under managed care.
