Landon Bruce E, O'Malley A James, McKellar M Richard, Hadley Jack, Reschovsky James D
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, USA,
J Gen Intern Med. 2014 Aug;29(8):1188-94. doi: 10.1007/s11606-014-2840-y. Epub 2014 Apr 17.
The relationship between practice intensity and the quality and outcomes of care has not been studied.
To examine the relationship between primary care physicians' costliness both for defined episodes of care and for defined patients and the quality and outcomes of care delivered to Medicare beneficiaries.
Cross sectional analysis of physician survey data linked to Medicare claims. Physician costliness measures were calculated by comparing the episode specific and overall costs of care for their patients with the care delivered by other physicians.
We studied physicians participating in the 2004-2005 Community Tracking Study Physician Survey linked with administrative claims from the Medicare program for the years 2004-2006.
Proportion of eligible beneficiaries receiving each of seven preventive services and rates of preventable admissions for acute and chronic conditions.
The 2,211 primary care physician respondents included 937 internists and 1,274 family or general physicians who were linked to more than 250,000 Medicare enrollees. Patients treated by more costly physicians (whether measured by the overall costliness index or the episode-level index) were more likely to receive recommended preventive services, but were also more likely to experience preventable admissions. For instance, physicians in the lowest quartile of costliness performed appropriate monitoring for hemoglobin A1C for diabetics 72.8% of the time, as compared with 81.9% for physicians in the highest quartile of costliness (p < 0.01). In contrast, patients treated by the physicians in the lowest quartile of episode costliness were admitted at a rate of 1.8/100 for both acute and chronic Prevention Quality Indicators (PQIs), as compared with 2.9/100 for both acute and chronic PQIs for those treated by physicians in the highest quartile of costliness (p < 0.001).
Physician practice patterns are associated with the quality of preventive services delivered to Medicare patients. Ongoing efforts to influence physician practice patterns may have differential effects on different aspects of quality.
医疗服务强度与医疗质量及结果之间的关系尚未得到研究。
研究初级保健医生针对特定诊疗阶段和特定患者的诊疗成本与为医疗保险受益人提供的医疗质量及结果之间的关系。
对与医疗保险理赔数据相关联的医生调查数据进行横断面分析。通过将医生患者的特定诊疗阶段及总体诊疗成本与其他医生提供的诊疗进行比较，计算医生诊疗成本指标。
我们研究了参与2004 - 2005年社区追踪研究医生调查的医生，这些医生与2004 - 2006年医疗保险计划的行政理赔数据相关联。
接受七种预防性服务中每项服务的合格受益人的比例，以及急性和慢性疾病的可预防住院率。
2211名初级保健医生受访者包括937名内科医生和1274名家庭医生或全科医生，他们与超过25万名医疗保险参保人相关联。由诊疗成本较高的医生治疗的患者（无论以总体成本指标还是特定诊疗阶段指标衡量）更有可能接受推荐的预防性服务，但也更有可能经历可预防的住院。例如，成本最低四分位数的医生对糖尿病患者进行糖化血红蛋白（A1C）适当监测的时间比例为72.8%，而成本最高四分位数的医生为81.9%（p < 0.01）。相比之下，特定诊疗阶段成本最低四分位数的医生治疗的患者，急性和慢性预防质量指标（PQIs）的住院率均为1.8/100，而成本最高四分位数的医生治疗的患者急性和慢性PQIs的住院率均为2.9/100（p < 0.001）。
医生的诊疗模式与为医疗保险患者提供的预防性服务质量相关。影响医生诊疗模式的持续努力可能会对质量的不同方面产生不同影响。
