Bronstein J M, Johnson V A, Fargason C A
Department of Pediatrics, School of Medicine, University of Alabama at Birmingham 35294-2010, USA.
J Health Care Poor Underserved. 1997 May;8(2):202-13. doi: 10.1353/hpu.2010.0393.
Medicaid claims data were used to compare the costs and care quality of ambulatory visits for two childhood illnesses, urinary tract infection (UTI) and suppurative otitis media (OM), in the fee-for-service Medicaid program in Alabama across three care settings: offices where patients had been seen before, offices where patients had not been seen before, and outpatient hospital departments. Forty percent of UTI visits and 46 percent of OM visits occurred in return office settings. Visits to outpatient hospital and first-time office settings were more expensive than those to return office settings, due to the billing of facility fees and the provision of additional services. Adherence to common measures of quality of care for both types of visits was low; 52 percent of UTI visits included urine cultures and 40 percent of OM visits included recheck visits. Adherence to these quality measures was significantly lower in visits occurring in hospital settings.
在阿拉巴马州按服务收费的医疗补助计划中，利用医疗补助索赔数据，比较了三种护理环境下两种儿童疾病（尿路感染[UTI]和化脓性中耳炎[OM]）门诊就诊的成本和护理质量：患者之前就诊过的诊所、患者之前未就诊过的诊所，以及门诊医院科室。40%的尿路感染就诊和46%的中耳炎就诊发生在回访诊所环境中。由于收取设施费和提供额外服务，门诊医院和首次就诊诊所的就诊费用高于回访诊所。两种就诊类型对常见护理质量指标的依从性较低；52%的尿路感染就诊包括尿液培养，40%的中耳炎就诊包括复查。在医院环境中的就诊对这些质量指标的依从性明显较低。
