Background Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the impact of these clinics on costs, quality, and delivery of preventive care. Objective To address these concerns, we compared the care for three acute conditions at retail clinics and other care settings. Setting Enrollees of a large Minnesota health plan Patients Enrollees who received care for otitis media, pharyngitis, or urinary tract infection (UTI) Design We aggregated 2005–2006 claims data from a large health plan into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After identifying 2100 episodes (700 each) in which otitis media, pharyngitis, and UTI were treated first in retail clinics, we matched them with episodes in which these illnesses were treated first in physician offices, urgent care clinics and emergency departments. Measurements Costs per episode, performance on 14 quality indicators, receipt of 7 preventive care services at the initial appointment or subsequent 3 months. Results Overall costs of care for episodes initiated at retail clinics were substantially lower than matched episodes initiated at physician offices, urgent care clinics, and emergency departments ($110 vs. $166, $156, $570 respectively, p<0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care clinics ($21, $21, $22), as were aggregate quality scores (63.6%, 61.0%, 62.6%), and patient’s receipt of preventive care (14.5%, 14.2%, 13.7%) (p>0.05 for comparisons with retail clinics). At emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower. Limitations Analyzing claims data limits the number of quality measures and preventive care services studied. Despite matching, patients at different care sites might differ in their severity of illness. Conclusions Compared to physician offices and urgent care clinics, retail clinics provide less costly treatment for three common illnesses, with no apparent adverse impact on quality of care or delivery of preventive care. Funding California HealthCare Foundation

We propose the Adaptive Leadership Framework for Chronic Illness as a novel framework for conceptualizing, studying, and providing care. This framework is an application of the Adaptive Leadership Framework developed by Heifetz and colleagues for business. Our framework views health care as a complex adaptive system and addresses the intersection at which people with chronic illness interface with the care system. We shift focus from symptoms to symptoms and the challenges they pose for patients/families. We describe how providers and patients/families might collaborate to create shared meaning of symptoms and challenges to coproduce appropriate approaches to care.