THE MANAGEMENT OF GERIATRIC HYPERTENSION IN HEALTH MAINTENANCE ORGANIZATIONS

Objective: To evaluate the quality of medical care received by Medicare enrollees with hypertension in health maintenance organizations (HMOs) compared to that received by a similar group of elderly hypertensives in a fee-for-service (FFS) setting. Design: A quasi-experimental design was used to study an historical cohort of newly evaluated hypertensive patients over a 2-year period. Setting: Medicare HMO and FFS practice settings. Participants: Eight Medicare HMOs and 87 FFS primary care physicians in the same communities were selected. A sample of 685 elderly hypertensive patients was studied, 336 in FFS settings and 349 in HMOs. Measurements and Main Results: An expert panel of physicians selected standards of care for the management of geriatric hypertension, and medical records were reviewed. The results showed significant differences (P < 0.01) in recording medications (94.5% HMO versus 88% FFS) and smoking histories (75.8% HMO versus 64.7% FFS), checking orthostatic blood pressures (9.5% HMO versus 3.3% FFS), performing funduscopy (44.4% HMO versus 27% FFS), completing cardiac examinations (90.8% HMO versus 79.8% FFS), and obtaining chest x-rays (72.8% HMO versus 64.3% FFS, P < 0.05). Treatment and follow-up were similar between the two groups, except that FFS hypertensives were more likely to have medications adjusted and electrolytes ordered. Conclusions: The results suggest that elderly hypertensives in HMOs receive equal or better quality of care for most criteria compared to elderly hypertensives in FFS settings.