Center for Studying Health System Change, 600 Maryland Avenue SW Suite 550, Washington, DC 20024, USA.
J Gen Intern Med. 2011 Sep;26(9):987-94. doi: 10.1007/s11606-011-1740-7. Epub 2011 May 10.
Pay-for-performance programs could worsen health disparities if providers who care for disadvantaged patients face systematic barriers to providing high-quality care. Risk adjustment that includes sociodemographic factors could mitigate the financial incentive to avoid disadvantaged patients.
To test for associations between quality of care and the composition of a physician's patient panel.
Repeat cross-sectional analysis
Nationally representative sample of US primary care physicians responding to a panel telephone survey in 2000-2001 and 2004-2005
Quality of primary care as measured by provision of eight recommended preventive services (diabetic monitoring [hemoglobin A1c testing, eye examinations, cholesterol testing and urine protein analysis], cancer screening [screening colonoscopy/sigmoidoscopy and mammography], and vaccinations against influenza and pneumococcus) documented in Medicare claims data and the association between quality and the sociodemographic composition of physicians' patient panels.
Across eight quality measures, physicians' quality of care was not consistently associated with the composition of their patient panel either in a single year or between time periods. For example, a substantial number (seven) of the eighteen significant associations seen between sociodemographic characteristics and the delivery of preventive services in the first time period were no longer seen in the second time period. Among sociodemographic characteristics, panel Medicaid eligibility was most consistently associated with differences in the delivery of preventive services between time points; among preventive services, the delivery of influenza vaccine was most likely to demonstrate disparities in both time points.
In a Medicare pay-for-performance program, a better understanding of the effect of effect of patient panel composition on physicians' quality of care may be necessary before implementing routine statistical adjustment, since the association of quality and sociodemographic composition is small and inconsistent. In addition, we observed improvements between time periods among physicians with varying panel composition.
如果为弱势患者提供治疗的医生面临提供高质量医疗服务的系统性障碍，那么按服务付费项目可能会加剧健康差距。包含社会人口因素的风险调整可以减轻避免弱势患者的经济激励。
检验医疗服务质量与医生患者群体构成之间的关联。
重复横断面分析。
2000-2001 年和 2004-2005 年期间参与全国代表性样本的美国初级保健医生对小组电话调查的回应。
使用 Medicare 理赔数据记录的八项推荐预防服务（糖尿病监测[糖化血红蛋白检测、眼部检查、胆固醇检测和尿液蛋白分析]、癌症筛查[结肠镜检查/乙状结肠镜检查和乳房 X 光检查]和流感及肺炎球菌疫苗接种）衡量的初级保健质量，以及质量与医生患者群体社会人口构成之间的关联。
在八项质量措施中，医生的医疗服务质量与他们的患者群体构成之间的关联并不一致，无论是在单一年份还是在时间段之间。例如，在第一个时间段内，社会人口特征与预防服务提供之间存在大量（七个）显著关联，但在第二个时间段内不再存在。在社会人口特征中，患者群体的 Medicaid 资格是预防服务提供方面两个时间点之间差异最一致的关联因素；在预防服务中，流感疫苗接种最有可能在两个时间点都显示出差异。
在 Medicare 按服务付费计划中，在实施常规统计调整之前，可能需要更好地了解患者群体构成对医生医疗服务质量的影响，因为质量与社会人口构成的关联较小且不一致。此外，我们观察到不同患者群体构成的医生在两个时间段之间都有所改善。
