Bronstein J M, Johnson V A, Fargason C A
School of Public Health, University of Alabama at Birmingham 35294, USA.
J Rural Health. 1997 Spring;13(2):126-35. doi: 10.1111/j.1748-0361.1997.tb00942.x.
This study compares the costs and quality of episodes of care for two common childhood illnesses, urinary tract infections (UTI) and otitis media (OM), across providers practicing in rural, small town, and urban counties in Alabama in 1992. The data source is Medicaid claims data for children under age 8 who were treated for these conditions. The study found that episodes cared for by rural providers were less expensive than episodes cared for in other locations, both because fewer rural episodes included outpatient facility charges and because fewer ancillary services were provided in rural settings. Researchers also found that, even controlling for physician characteristics and patient demographic and utilization factors, rural episodes were significantly less likely to include two process measures of quality of care: fewer rural UTI episodes included urine cultures, and fewer rural OM episodes included follow-up visits. This study suggest that, as a group, rural physicians may have a favorable cost profile but a potentially unfavorable care content profile, compared with other physicians. Both practice profile data and explicit care recommendations need to be available to physicians so thy can monitor, defend, or alter their clinical practices.
本研究比较了1992年阿拉巴马州农村、小镇和城市县的医疗服务提供者对两种常见儿童疾病——尿路感染（UTI）和中耳炎（OM）——的护理成本和质量。数据来源是因这些疾病接受治疗的8岁以下儿童的医疗补助索赔数据。研究发现，农村医疗服务提供者护理的病例比其他地区护理的病例成本更低，这既是因为农村病例中较少包含门诊设施费用，也是因为农村地区提供的辅助服务较少。研究人员还发现，即使控制了医生特征、患者人口统计学和使用因素，农村病例包含两种护理质量过程指标的可能性也显著更低：农村尿路感染病例中进行尿培养的较少，农村中耳炎病例中进行随访的较少。这项研究表明，总体而言，与其他医生相比，农村医生可能具有有利的成本状况，但护理内容状况可能不利。医生需要同时掌握执业状况数据和明确的护理建议，以便他们能够监测、维护或改变自己的临床实践。
