Onady G M
Wright State University School of Medicine, Department of Medicine, Dayton, Ohio, USA.
Am J Med. 1997 May;102(5):441-8. doi: 10.1016/S0002-9343(97)00005-3.
The medical literature has followed educational outcomes of Medicine-Pediatric (Med/Peds) physicians, but limited studies exist as to clinical outcomes for these combined specialty physicians. Although a variety of practice environments are available for a growing number of Med/Peds physicians, a collaborative practice setting with family physicians may optimize the Med/Peds practice potential. This study investigates clinical practice outcomes and utilization efficiencies of collaborative Med/Peds family practice physicians within a community, which should provide an effective model in a growing managed care environment.
Two collaborative practice settings in a moderate size Midwest community were analyzed with respect to patient demographics and utilization scores provided by a practice management group and a nationally based health care network. Current Procedural Terminology (CPT) coding was used to follow demographic trends for over 45,000 patient visits for 1 year. Efficiency ratings (Z-scores) were used over the same year for over 6,000 health care network patient visits to 10 collaborative practice-based physicians, which were then compared to 141,101 community family practice patient encounters, 26,617 general internist patient encounters, and 29,995 patient encounters to pediatricians for utilization trends.
Med/Peds and Family Practice patient care data reflected nearly identical patient demographics between specialties with only a few exceptions. Med/Peds physicians cared for three times the total number of children less than 2 years old. Med/Peds physicians experienced a higher complexity of illness, in part due to a 40% increase in internal referrals from family practice colleagues in the ambulatory care setting, while maintaining a third of the proportion of outpatient referrals. Cost-effective interoffice utilization was still maintained, supported by a more optimal efficiency rating for Med/Peds physicians compared to collaborative family practice colleagues. Inpatient efficiency was demonstrated for Med/Peds specialists even though a threefold increase in hospitalizations was observed, in part resulting from physicians within these collaborative practices arranging all newborn nursery and pediatric admissions be covered by Med/Peds physicians. Both collaborative primary care specialists demonstrated more cost-effective overall practice utilization scores when compared to community-based primary care specialists.
Med/Peds physicians in this study have been trained to provide cost-effective patient care in both outpatient and inpatient settings. Decreased outside referrals by collaborative family practice physicians through utilization of Med/Peds colleagues serves to optimize practice economy by eliminating the threat of competition that exists among community-based generalists. Such a model helps to control an overused referral system to subspecialists.
医学文献一直关注医学 - 儿科学（Med/Peds）医生的教育成果，但关于这些联合专科医生的临床结果的研究有限。尽管越来越多的Med/Peds医生有多种执业环境可供选择，但与家庭医生的协作执业环境可能会优化Med/Peds的执业潜力。本研究调查了社区内协作式Med/Peds家庭执业医生的临床执业结果和利用效率，这应该能在不断发展的管理式医疗环境中提供一个有效的模式。
对中西部一个中等规模社区的两个协作执业环境进行了分析，分析内容包括一个执业管理小组和一个全国性医疗保健网络提供的患者人口统计学数据和利用分数。使用当前程序编码术语（CPT）来跟踪1年中超过45,000次患者就诊的人口统计学趋势。在同一年，对超过6,000次医疗保健网络患者就诊10位基于协作执业的医生的情况使用效率评级（Z分数），然后将其与141,101次社区家庭执业患者诊疗、26,617次普通内科医生患者诊疗以及29,995次儿科医生患者诊疗的利用趋势进行比较。
Med/Peds和家庭执业的患者护理数据反映出各专科之间患者人口统计学情况几乎相同，只有少数例外。Med/Peds医生诊治的2岁以下儿童总数是其他医生的三倍。Med/Peds医生遇到的疾病复杂性更高，部分原因是在门诊环境中，来自家庭执业同事的内部转诊增加了40%，同时门诊转诊比例保持在三分之一。与协作式家庭执业同事相比，Med/Peds医生的效率评级更优，从而维持了具有成本效益的办公室间利用。尽管观察到住院人数增加了两倍，但Med/Peds专科医生仍显示出住院效率，部分原因是这些协作执业中的医生安排所有新生儿病房和儿科住院患者均由Med/Peds医生负责。与社区初级保健专科医生相比，两位协作式初级保健专科医生的总体执业利用分数均显示出更高的成本效益。
本研究中的Med/Peds医生接受过培训，能够在门诊和住院环境中提供具有成本效益的患者护理。协作式家庭执业医生通过利用Med/Peds同事减少外部转诊，消除了社区全科医生之间存在的竞争威胁，从而优化了执业经济性。这样的模式有助于控制过度使用的向专科医生的转诊系统。
