More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations
More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations
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DOI：
10.1370/afm.1787
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发表时间：
2015-05-01
影响因子：
4.4
通讯作者：
Phillips, Robert L., Jr.
中科院分区：
文献类型：
--
作者：
Bazemore, Andrew;Petterson, Stephen;Phillips, Robert L., Jr.
全面性被誉为初级保健的5个核心美德之一，但其与结果的关系尚不清楚。我们测量了家庭医生之间的实践和医疗保健利用和成本的综合性变化之间的关联，为他们的Medicare beneficiaries.METHODS我们合并了2011年Medicare Part A和B索赔文件的数据，这些文件是一个复杂的随机样本，家庭医生从事直接的病人护理，包括100%的Medicare受益人声称的护理，这些数据来自同一批医生在2007年至2011年期间参加家庭医生认证维持（MC-FP）期间报告的数据。我们从强制性自我报告的调查项目中创建了一个全面性措施，作为MC-FP考试注册的一部分。我们将此措施与来自医疗保险Berenson-Eggers服务类型（BETOS）代码的另一项措施进行了比较。然后，我们研究了2项措施的全面性和住院治疗，部分B支付，并结合部分A和B payment.Results我们的完整的家庭医生样本包括3,652名医生提供的多种护理555,165医疗保险受益人之间的关联。其中，1 133人在2007年至2011年期间重新获得认证，照顾了185 044名受益人。有一个适度的相关性（0.30）之间的BETOS和自我报告的全面性措施。在调整受益人和医生特征后，增加综合性与较低的医疗保险A部分和B部分总成本以及单独的B部分成本相关，但与住院无关; BETOS测量与支出的相关性比自我报告测量更强;更高的BETOS评分显著降低了住院的可能性。结论增加家庭医生全面的护理，特别是通过索赔措施来衡量，与医疗保险费用和住院费用的减少有关。增强初级保健全面性的支付和实践政策可能有助于“弯曲成本曲线”。"
PURPOSE Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries.METHODS We merged data from 2011 Medicare Part A and B claims files for a complex random sample of family physicians engaged in direct patient care, including 100% of their claimed care of Medicare beneficiaries, with data reported by the same physicians during their participation in Maintenance of Certification for Family Physicians (MC-FP) between the years 2007 and 2011. We created a measure of comprehensiveness from mandatory self-reported survey items as part of MC-FP examination registration. We compared this measure to another derived from Medicare's Berenson-Eggers Type of Service (BETOS) codes. We then examined the association between the 2 measures of comprehensiveness and hospitalizations, Part B payments, and combined Part A and B payments.RESULTS Our full family physician sample consists of 3,652 physicians providing the plurality of care to 555,165 Medicare beneficiaries. Of these, 1,133 recertified between 2007 and 2011 and cared for 185,044 beneficiaries. There was a modest correlation (0.30) between the BETOS and self-reported comprehensiveness measures. After adjusting for beneficiary and physician characteristics, increasing comprehensiveness was associated with lower total Medicare Part A and B costs and Part B costs alone, but not with hospitalizations; the association with spending was stronger for the BETOS measure than for the self-reported measure; higher BETOS scores significantly reduced the likelihood of a hospitalization.CONCLUSIONS Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance primary care comprehensiveness may help "bend the cost curve."