Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses
Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses
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DOI：
10.7326/0003-4819-151-5-200909010-00006
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发表时间：
2009-09-01
影响因子：
39.2
通讯作者：
McGlynn, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Mehrotra, Ateev;Liu, Hangsheng;McGlynn, Elizabeth A.
背景：零售诊所是越来越受欢迎的医疗保健来源。人们对这些诊所对预防性护理的成本、质量和提供的影响表示担忧。目的：比较零售诊所接受的3种急性疾病的护理与其他护理机构接受的护理。设计：将2005年和2006年医疗计划中的索赔数据汇总为护理事件(包括首次和后续访问、药物和辅助测试)。在确定了2100例(每例700例)在零售诊所首先治疗中耳炎、咽炎和尿路感染(UTI)的病例后，这些病例与在医生办公室、紧急护理中心或急诊科首先治疗这些疾病的其他病例相匹配。地点：明尼苏达州一项大型医疗计划的参与者。患者：接受中耳炎、咽炎和尿路感染(UTI)治疗的参与者。测量：每一病例的成本，14项质量指标的表现，在首次预约或随后的3个月接受7项预防护理服务。结果：零售诊所开始的发作的总体护理成本显著低于在医生办公室、紧急护理中心和急诊科开始的匹配发作的护理费用(分别为110美元vs.166美元、156美元和570美元；每次比较，P<；0.001)。零售诊所、医生办公室和紧急护理中心的处方费用相似(21美元、21美元和22美元)，总体质量评分(63.6%、61.0%和62.6%)和患者接受预防性护理的情况(14.5%、14.2%和13.7%)相似(P&gT；0.05与零售诊所相比)。在急诊科，平均处方费用高于其他设置，综合质量得分显著低于其他设置。限制：对有限数量的质量措施和预防性护理服务进行了研究。结论：零售诊所为3种常见疾病提供的治疗费用低于医生办公室或急救中心，且不会对护理质量或预防性护理的提供产生明显的不良影响。
Background: Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care.Objective: To compare the care received at retail clinics for 3 acute conditions with that received at other care settings.Design: Claims data from 2005 and 2006 from the health plan were aggregated into care episodes ( units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After 2100 episodes ( 700 each) were identified in which otitis media, pharyngitis, and urinary tract infection ( UTI) were treated first in retail clinics, these episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments.Setting: Enrollees of a large Minnesota health plan.Patients: Enrollees who received care for otitis media, pharyngitis, or UTI.Measurements: Costs per episode, performance on 14 quality indicators, and receipt of 7 preventive care services at the initial appointment or subsequent 3 months.Results: Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments ($110 vs. $166, $156, and $570, respectively; P < 0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care centers ($21, $21, and $22), as were aggregate quality scores (63.6%, 61.0%, and 62.6%) and patient's receipt of preventive care (14.5%, 14.2%, and 13.7%) ( P > 0.05 vs. retail clinics). In emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower than in other settings.Limitations: A limited number of quality measures and preventive care services were studied. Despite matching, patients at different care sites might differ in their severity of illness.Conclusion: Retail clinics provide less costly treatment than physician offices or urgent care centers for 3 common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care.