Quality of life and patient satisfaction: ESRD managed care demonstration

Health Care Financing Review, Summer, 2003 by Trinh B. Pifer, Jennifer L. Bragg-Gresham, Dawn M. Dykstra, Jennifer R. Shapiro, Caitlin Carroll Oppenheimer, Daniel S. Gaylin, Nancy Beronja, Robert J. Rubin, Philip J. Held

A significantly smaller percentage of demonstration patients reported financial burdens for copayments and medications as compared with the FFS and NDMC patients (p<0.0001), while a significantly larger percentage of demonstration patients reported ease in obtaining nutritional supplements (p<0.0001).

QUALITY OF LIFE

DOPPS Comparison to Demonstration

Managed care demonstration patients comprise a healthier group than most dialysis patients. Compared with a nationally representative sample (DOPPS), demonstration patients have fewer comorbidities, better mobility, and higher albumin, on average. This better health is also reflected in their baseline quality of life. Crude baseline physical and mental component summary scores show the two demonstration sites having significantly higher scores than the State-specific DOPPS comparisons (Table 6).

After taking into account the variation due to differences in health factors between the demonstration and DOPPS, the statistically significant differences at baseline disappeared. Table 6 also shows the baseline scores after adjustments were made.

Matched FFS and NDMC Comparisons

The demonstration patients reported similar quality of life to the matched NDMC and FFS patients. Table 7 shows the samples had generally similar unadjusted physical and mental component summary scores at baseline. No differences were seen in the mental component summary score for either comparison group, but the NDMC sample showed higher physical component summary scores.

Pre-Managed Versus Managed Care

One year following their enrollment in the demonstration, patients were asked to report their quality of life a second time. Table 8 shows that quality of life scores either stayed the same or increased for demonstration patients after 1 year of enrollment in the demonstration. Several of the physical and mental subscales showed statistically significant, and clinically meaningful increases as determined by a criterion of a [greater than or equal to] 3-point difference (Samsa et al., 1999; Hays and Woolley, 2000). In addition, the mental component summary score showed a significant increase (D=l.9, p<0.001) at the 1 year followup. Although results are shown for both sites combined, the effect of improved mental scores was seen in both demonstration populations independently.

In contrast to the demonstration quality of life scores increasing, Table 9 illustrates that 1 year change in quality of life for the nationally representative DOPPS sample showed some small, but statistically significant, decreases.

DISCUSSION

Patient Satisfaction

Health Plan Benefits

We found significant differences in patient satisfaction with the financial incentives provided by the demonstration plan. After 1 year of coverage, significantly fewer demonstration patients reported financial burdens due to the benefit of free medications and no copayments provided under the demonstration MCP. These financial incentives were also the most important reasons listed by the demonstration patients for enrolling and/or staying in the plan. It is not surprising that these are major incentives for ESRD patients given the high costs that they may incur for medications and copayments if they do not have supplemental insurance. Furthermore, demonstration patients tended to have lower incomes than the comparison groups; therefore, these financial benefits would certainly be important incentives for enrolling and staying in the demonstration.