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A HEALTH SYSTEM ANALYSIS APPROACH TO HEALTH OUTCOMES IN MEDICARE CLIENTS WITH CHRONIC ILLNESSES Christine A. Elnitsky Old Dominion University, 2001 Director: Dr. Betty B. Alexy Since 1863, outcomes measurement efforts have provided information to health care consumers, administrators, and policymakers in assessing concerns about access, quality and costs. With a growing population of older adults with chronic illnesses, costcutting strategies in health delivery systems, and federal endorsement o f managed care systems, researchers have begun to evaluate the impact o f different delivery system organizations on health. The current study combines two areas o f health services research to provide the first published hierarchical analysis o f the influence of delivery system factors, and a profile of population and community characteristics and utilization factors, on perceived health outcomes o f a nationally representative sample o f older adult Medicare beneficiaries with various chronic illnesses. This study was designed to analyze the difference in health status outcomes across Medicare fee-for-service and health maintenance organization systems nationwide, and to explain health delivery system factors’ effects on outcomes. Using a recently developed health outcomes classification scheme, a newly expanded Andersen and Aday Health System Model, and hierarchical multiple regression analysis methodology, health delivery system factors were found to have a significant impact on three o f four clientcentered outcome measures. The results o f this study suggest there are health delivery system factors affecting health outcomes of older adults with chronic illnesses. In addition, the findings imply that hierarchical regression analysis is a useful tool for explaining the unique contribution o f several individual variables as well as several blocks o f variables on perceived health permission of the copyright owner. Further reproduction prohibited without permission. outcomes. Information from this study can be used to monitor outcomes of health care in this vulnerable population, inform development o f chronic illness related health policy, and encourage use of high quality public data resources available for health services research. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Copyright. 1997, by Christine A. Elnitsky. All Rights Reserved Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

A Health System Analysis Approach to Health Outcomes in Medicare Clients With Chronic Illnesses