Barreto Tyler W, Chung Yoonkyung, Wingrove Peter, Young Richard A, Petterson Stephen, Bazemore Andrew, Liaw Winston
From Robert Graham Center, Washington, DC (TWB, YC, SP, AB, WL); Department of Family and Community Medicine, UT Health San Antonio, San Antonio, TX (TWB); University of Pittsburgh School of Medicine, Pittsburgh, PA (PW) John Peter Smith Hospital Family Medicine Residency Program, Fort Worth (RAY); Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston, Houston (WL).
J Am Board Fam Med. 2019 Mar-Apr;32(2):218-225. doi: 10.3122/jabfm.2019.02.180111.
Previous work has shown that $210 billion may be spent annually on unnecessary medical services and has identified patient and hospital characteristics associated with low value care (LVC). However, little is known about the association between primary care physician (PCP) characteristics and LVC spending. The objective of this study was to assess this association.
We performed a retrospective analysis by using Medicare claims data to identify LVC and American Medical Association Masterfile data for PCP characteristics. We included PCPs of adults aged 65 years and older who were enrolled in Medicare in 2011. We measured Medicare spending per attributed patient on 8 low value services.
Our final sample contained 6,873 PCPs with 1,078,840 attributed patients. Lower per-patient LVC Medicare spending was associated with the following PCP characteristics: allopathic training, smaller Medicare patient panel, practiced family medicine, practiced in the Midwest region, were a recent graduate, or practiced in rural areas. The largest associations were seen in Medicare patient panel size and geographic region. The average per-patient LVC spending was $14.67. LVC spending among PCPs with small patient panels was $3.98 less per patient relative to those with larger panels. PCPs in the Midwest had $2.80 less per patient LVC spending than those in the Northeast.
Our analysis suggests that LVC services are associated with specific PCP characteristics. Further research should assess the strength of these associations, and future policy efforts should focus on systemic interventions to reduce LVC spending.
此前的研究表明，每年可能有2100亿美元花在了不必要的医疗服务上，并且已经确定了与低价值医疗（LVC）相关的患者和医院特征。然而，对于初级保健医生（PCP）特征与低价值医疗支出之间的关联却知之甚少。本研究的目的是评估这种关联。
我们通过使用医疗保险索赔数据来识别低价值医疗，并利用美国医学协会主文件数据获取初级保健医生的特征，进行了一项回顾性分析。我们纳入了2011年参加医疗保险的65岁及以上成年人的初级保健医生。我们衡量了每位归属患者在8项低价值服务上的医疗保险支出。
我们的最终样本包含6873名初级保健医生和1078840名归属患者。每位患者较低的低价值医疗医疗保险支出与以下初级保健医生特征相关：接受过全科医学培训、医疗保险患者群体较小、从事家庭医学、在中西部地区执业、是刚毕业的医生或在农村地区执业。在医疗保险患者群体规模和地理区域方面观察到的关联最为显著。每位患者的低价值医疗平均支出为14.67美元。患者群体较小的初级保健医生的每位患者低价值医疗支出比患者群体较大的医生少3.98美元。中西部地区的初级保健医生每位患者的低价值医疗支出比东北部地区的医生少2.80美元。
我们的分析表明，低价值医疗服务与特定的初级保健医生特征相关。进一步的研究应评估这些关联的强度，未来的政策努力应侧重于系统性干预措施以减少低价值医疗支出。
