Practice Variations and Outcome of Care. Executive Summary and Final Reports

摘要

This study determined the degree of variation in resource use for a population ofindividuals enrolled in a state Medicaid program and the relationship between resource use and quality of ambulatory care, as assessed both from claims reviews and from medical records. A wide variety of types of conditions and indicators of quality were used. The findings indicated that there is a large amount of variation in resource use, both for components of ambulatory care as well as for inpatient care. This variation persisted, although it was less in degree, when case-mix was controlled using the Ambulatory Care Group (ACG) method. Hospital outpatient units that were the usual source of care for patients consumed more resources than either community health centers or office-based physicians. Among the latter, family physicians used the least resources, as compared with other types of physicians. There was no evidence of substitution of ambulatory care for hospital care. Hospitals consistently had the poorest quality of access and appropriateness of care, regardless of cost levels. Overall, medium cost community health centers had the best quality scores.