Physician Networks and Children with Chronic Conditions

描述：AIMS。研究的目的是：1)描述健康的生态 为患有以下疾病的参保儿童提供管理护理计划的医生网络中的护理 哮喘或糖尿病；以及2)确定 保健计划和儿童保健计划的网络外收益和费用分担 去看网络外的医生的可能性；以及3)确定 儿童之间的护理质量和支出有很大差异 网络内医生与网络外医生的对比。设计。回顾 队列研究。人口。所有患有哮喘(n=12,204)或糖尿病的儿童 (n=1,468)由Premera Blue Cross，Regence Blue Shield，Medicaid覆盖 计划，或华盛顿州1998年7月至6月的基本健康计划 1999年。数据源。健康计划信息、医疗索赔、医生 参加PLAN网络，美国医学会内科硕士 档案，医生办公室调查，医生焦点小组。措施。健康计划 索引，医生参与健康计划网络；数目 根据专业，儿童在网络内部与外部看到的医生； 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。对于目标2和目标3，回归模型 将被估计为：a)确定网络外 收益和成本分担，以及孩子是否看到网络内和网络外 医生；以及b)确定护理质量和支出是否 对于儿童看网络内和网络外的医生来说，相似或不同。

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.