Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states
Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states
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DOI：
10.1111/1475-6773.13590
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发表时间：
2020-10-29
影响因子：
3.4
通讯作者：
Cutler, David
中科院分区：
文献类型：
--
作者：
Zhou, Ruohua Annetta;Beaulieu, Nancy D.;Cutler, David
目的描述2012至2016年间四个州的医生健康系统成员的特征，并比较医疗系统内和非系统内医疗服务提供者对商业保险人群的初级保健质量和费用。数据来源卫生系统中的医生成员来自唯一的卫生系统纵向数据库，并在提供者级别与来自科罗拉多州、马萨诸塞州、俄勒冈州和犹他州的2014年全额付款人索赔数据进行匹配。研究设计采用观察性研究设计，我们比较了医疗系统中的医生和位于相同州和地理位置的非系统医生在平均医疗费用(使用约翰霍普金斯调整的临床分组进行风险调整)、五项HEDIS质量指标、HEDIS质量指标、一项发育筛查措施和两项预防质量指标措施。数据收集/提取方法商业健康计划中的患者归因于初级保健医生，占就诊次数的多数。每个质量指标的队列都是基于适当的指标规格构建的。主要发现从2012年到2016年，卫生系统中医生的比例稳步上升，从科罗拉多州的48%到2016年犹他州的63%不等。与不在系统中的医生相比，系统医生在大多数HEDIS质量指标上的表现与非系统医生相似。被归因于系统内医生的患者的动态护理敏感入院率(以每10万人的入院率衡量)高约40%(P<；0.05)：急性复合体的921.33个系统内与674.61个非系统内；慢性综合系统内提供者的2540.91个系统内与1972.17个系统内与每个成员每月平均29美元(P<；0.05)的平均费用(453.37比432.93)相关。总体而言，与各州和地理位置的差异相比，系统成员在绩效方面的差异相对较小。结论从2012年到2016年，医生在医疗系统中的比例越来越大。卫生系统中的提供者并没有比非系统提供者更有效地为商业参保者提供初级保健。
Objective To characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population.Data Sources Physician membership in health systems was obtained from a unique longitudinal database on health systems and matched at the provider level to 2014 all-payer claims data from Colorado, Massachusetts, Oregon, and Utah.Study Design Using an observational study design, we compared physicians in health systems to non-system physicians located in the same state and geography on average cost of care (risk-adjusted using the Johns Hopkins' Adjusted Clinical Grouper), five HEDIS quality measures, one measure of developmental screening, and two Prevention Quality Indicator Measures.Data Collection/Extraction Methods Patients in commercial health plans were attributed to a primary care physician accounting for the plurality of office visits. A cohort for each quality measure was constructed based on appropriate measure specifications.Principal Findings The share of physicians in health systems increased steadily from 2012 to 2016 and ranged from 48% in Colorado to 63% in Utah in 2016. Compared to physicians not in a system, system physicians performed similarly on most HEDIS quality metrics compared to non-system physicians. Patients attributed to in-system physicians had about 40% higher rates (P < .05) of Ambulatory Care Sensitive Admissions (measured in admissions per 100 000:921.33 in-system vs 674.61 not-in-system for acute composite; 2540.91 in-system vs 1972.17 for chronic composite In-system providers were associated with $29 (P < .05) higher average per member per month costs (453.37 vs 432.93). Overall, differences in performance by system membership were relatively small compared to differences across states and geography.Conclusion A growing share of physicians is part of a health system from 2012 to 2016. Providers in health systems are not delivering primary care more efficiently than non-system providers for the commercially insured.