The effect of multiple-facility visiting by patients on quality of care assessment

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Although process of care quality assessment often take place on a facility basis, in a management chronic illness such as cancer, patients often receive treatment in multiple facilities. Such patient visit patterns can affect observed performance score if the treatment provided in other facilities are missing. This study used insurance claims data obtained from insurance companies, in which patients can be traced for visits to multiple facilities, and analyzed the influence of patients' visiting multiple facilities on the quality scores. We found, for example, a 14 percentage-point difference on a performance of radiation therapy after breast conserving surgery for breast cancer, a typical quality criteria in the area of care. When we measure quality of care, enough attention should be paid to patients receiving care in multiple facilities.