Outcomes of Patients with Hypertension and Non-Insulin-Dependent Diabetes Mellitus Treated by Different Systems and Specialties

Compares outcomes of MOS patients with hypertension and non-insulin-dependent diabetes mellitus who were cared for in three different systems of care and by generalist and subspecialist physicians. Patients were sampled from HMOs, large multispecialty groups, and solo or single-group practices in Boston, Los Angeles, and Chicago. Functional outcomes were assessed using the SF-36; mortality was determined for the seven years following the entrance examination. No system of care or physician specialty achieved consistently better two- or four-year outcomes for patients with either hypertension or diabetes. The only specialist-related difference identified was that endocrinologists appeared to achieve better foot ulcer and infection outcomes for patients with diabetes mellitus, particularly when compared with family practitioners. Moreover, no adjusted mortality difference among systems or among physician specialties were observed in the 7-year follow-up period. The authors conclude that although prepaid medicine relies more heavily on generalist physicians than does fee-for-service medicine, there is no evidence from these analyses that the quality of care of moderately ill patients with these two common diseases is adversely affected. These findings must be viewed in the light of historically higher costs of fee-for-service and subspecialty physician practice.