Association between physician supply, local practice norms, and outpatient visit rates.
نویسندگان
چکیده
BACKGROUND There is considerable regional variation in Medicare outpatient visit rates; such variations may be the consequence of patient health, race/ethnicity differences, patient preferences, or physician supply and beliefs about the efficacy of frequently scheduled visits. OBJECTIVE The objective of the study was to test associations between varying regional Medicare outpatient visit rates and beneficiaries' health, race/ethnicity, preferences, and physician practice norms and supply. METHODS We used Medicare claims from 2006 and 2007 and data from national surveys of 3 different groups in 2005-Medicare beneficiaries, cardiologists, and primary care physicians. Regression analysis tested explanations for outpatient visit rates: patient health (self-reported and hierarchical condition category score), self-reported race/ethnicity, preferences for care, and local physician practice norms and supply in beneficiaries' Hospital Referral Regions (HRRs) of residence. RESULTS Beneficiaries in the highest quintile of the hierarchical condition category scores experienced 4.99 more visits than those in the lowest. Beneficiaries who were black experienced 2.14 fewer visits than others with similar health and preferences. Higher care-seeking preferences were marginally significantly associated with more visits, whereas education and poverty were insignificant. HRRs with high physician supply and high-frequency practice norms were associated with 2.04 additional visits per year, whereas HRRs with high supply but low-frequency norms were associated with 1.45 additional visits. Adjusting for all individual beneficiary covariates explained <20% of the original associations between visit rates and physician supply and practice norms. CONCLUSIONS Medicare beneficiaries' health status, race, and preferences help explain individual office visit frequency; in particular, African-American patients appear to experience lower access to care. Yet, these factors explain a small fraction of the observed regional differences associated with physician supply and beliefs about the appropriate frequency of office visits.
منابع مشابه
Universal coverage without universal access: a study of psychiatrist supply and practice patterns in Ontario
BACKGROUND We studied the relationships among psychiatrist supply, practice patterns, and access to psychiatrists in Ontario Local Health Integration Networks (LHINs) with differing levels of psychiatrist supply. METHODS We analyzed practice patterns of full-time psychiatrists (n = 1379) and postdischarge care to patients who had been admitted to hospital for psychiatric care, according to LH...
متن کاملImproving influenza vaccination rates in the elderly.
BACKGROUND Vaccination coverage for influenza in the elderly remains low when the physician is the only person responsible for immunization. Integration of other health care workers may improve the coverage rate of at-risk groups. OBJECTIVES To estimate vaccination coverage rate by using a strategy based on the systematic intervention of a health care professional proposing vaccination before...
متن کاملProvincial Level Survey Provides Evidence for Remarkably Short Outpatient Visit Length in Iran
Background and Objectives: Visit length is a crucial aspect of patient-physician relationship that its inadequacy can negatively influence the treatment efficiency. Studies on visit length and the factors influencing it are limited in developing countries. Thus, the objective of this study was to survey this variable at provincial level, and provide data on factors affecting it. Methods: A ...
متن کاملEvaluating visit quality in plan of health sector evolution in Iran: A local survey from Tabriz
Background and aims: Quality of visit services is a decisive aspect of patient-physician communication that its inadequacy can negatively influence the diagnosis efficiency. The aim of this study was to survey visit quality at provincial level during plan of health sector evolution in Tabriz. Methods: A sample of 540 patients who referred to the outpatien...
متن کاملPhysician-elder interaction in community family practice.
OBJECTIVE To determine whether outpatient visits by elders seeing community family physicians differ in length or content from visits by younger patients; socioemotional preferences predict visit content; and satisfaction correlates with visit content differentially across age. METHODS In a multimethod cross-sectional study of 84 community family practices in northeastern Ohio, 3453 adult pat...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Medical care
دوره 51 6 شماره
صفحات -
تاریخ انتشار 2013