Physician Networks and Children with Chronic Conditions

描述：目标。研究目的：1）描述健康生态学 在管理式保健计划的医生网络中为受保儿童提供的保健 哮喘或糖尿病; 2）确定 保健计划和儿童保健计划的网外福利和费用分摊 看网络外医生的可能性;以及3）确定是否 儿童的护理质量和支出有很大差异 看网络内和网络外的医生。设计回顾性 队列研究人口所有哮喘儿童（n= 12，204）或糖尿病儿童 （n= 1，468）由Premera Blue Cross、Regence Blue Shield、Medicaid 1998年7月至6月，华盛顿州实施了一项基本健康计划， 1999.数据源健康计划信息、医疗索赔、医生 参与计划网络，美国医学会医师硕士 文件，医生办公室调查，医生焦点小组。措施健康计划 指数，医生参与保健计划网络; 医生，按专业划分，孩子们在网络内外看到; 年度总支出;哮喘和糖尿病的质量指标; 医生办公室的特点。数据分析对于目标1，描述性， 将进行双变量、聚类和网络分析，以了解 医生网络中的护理生态学。对于目标2和3，回归模型 将被估计为：a）确定网络外 利益和成本分担，以及儿童是否看到网络内与网络外 医生;和B）确定护理质量和支出是否 类似或不同的儿童看网络内与网络外的医生。

DESCRIPTION: Aims. Study aims are: 1) to describe the ecology of health care in physician networks of managed care plans for insured children with asthma or diabetes; and 2) to determine the associations between the out-of-network benefits and cost-sharing of health plans and children's likelihood of seeing an out-of-network physician; and 3) to determine whether quality of care and expenditures are significantly different among children seeing in-network vs. out-of-network physicians. Design. Retrospective cohort study. Population. All children with asthma (n=12,204) or diabetes (n=1,468) covered by Premera Blue Cross, Regence Blue Shield, the Medicaid program, or the Basic Health Plan in Washington state in July 1998 - June 1999. Data Sources. Health plan information, medical claims, physician participation in plan networks, American Medical Association Physician Master File, physician office survey, physician focus groups. Measures. Health plan indexes, physician participation in health plan networks; number of physicians, by specialty, that children see inside vs. outside the network; total annual expenditures; quality indicators for asthma and diabetes; characteristics of physician offices. Data Analysis. For Aim 1, descriptive, bivariate, cluster, and network analyses will be conducted to understand the ecology of care in physician networks. For Aims 2 and 3, regression models will be estimated to: a) determine the association between out-of-network benefits and cost sharing and whether children see in- vs. out-of-network physicians; and b) determine whether quality of care and expenditures are similar or different for children seeing in- vs. out-of-network physicians.