Does managed care affect quality? Appropriateness, referral patterns, and outcomes of carotid endarterectomy

Ethan A. Halm, Matthew J. Press, Stanley Tuhrim, Jason Wang, Mary Rojas, Mark R. Chassin

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


This was a population-based observational study to assess the impact of managed care (MC) on several dimensions of quality of surgical care among Medicare beneficiaries undergoing carotid endarterectomies (CEAs) (N = 9308) in New York. Clinical data were abstracted from medical charts to assess appropriateness and deaths or strokes within 30 days of surgery. Differences in patients, appropriateness, and outcomes were compared using chi-square tests; risk-adjusted outcomes were compared using regression. Fee-For-Service (FFS, N = 8691) and MC (N = 897) CEA patients had similar indications for surgery, perioperative risk, and comorbidities. There were no differences in inappropriateness between FFS and MC (8.6% vs 8.4%). MC patients were less likely to use a high-volume surgeon (20.1% vs 13.5%) or hospital (20.5% vs 13.0%, P <.05). There were no differences in risk-adjusted rates of death or stroke (OR = 0.97; 95% CI = 0.69-1.37). Medicare MC plans did not have a positive impact on inappropriateness, referral patterns, or outcomes of CEA. (Am J Med Qual 2008;23:448-456).

Original languageEnglish (US)
Pages (from-to)448-456
Number of pages9
JournalAmerican Journal of Medical Quality
Issue number6
StatePublished - Dec 2008


  • Appropriateness
  • Carotid endarterectomy
  • Fee-for-service
  • Health services overuse
  • Managed care
  • Medicare
  • Outcomes
  • Referral patterns
  • Volume

ASJC Scopus subject areas

  • Health Policy


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