Physician Profiling -- An Analysis of Inpatient Practice Patterns in Florida and Oregon

Hg, Welch; Me, Miller; Wp, Welch

doi:10.1056/nejm199403033300906

Cited by 83 publications

(41 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Abundant information shows large variation, not explained by characteristics of patients or illnesses, in virtually every component of health care, including resource utilization. [1][2][3][4][5][6] Much of this variation reflects inefficiency, waste, and suboptimal care. 2,4,7 Thus, improving cost-effectiveness is advanced by understanding the genesis of health care costs and in particular the sources of cost variation.…”

Section: Methodsmentioning

confidence: 99%

Effect of Collaborative Care on Cost Variation in an Intensive Care Unit

Garland

2013

American Journal of Critical Care

View full text Add to dashboard Cite

Background Improving the cost-effectiveness of health care requires an understanding of the genesis of health care costs and in particular the sources of cost variation. Little is known about how multiple physicians, caring collaboratively for patients, contribute to costs. Objective To explore the effect of collaborative care by physicians on variation in discretionary costs in an intensive care unit (ICU) by determining the contributions of the attending intensivists and ICU fellows. Methods Prospective, observational study using a multivariable model of median discretionary costs for the first day in the ICU, adjusting for confounding variables. Analysis included 3514 patients who spent more than 2 hours in the ICU on the initial day. Impact of the physicians was assessed via variables representing the specific intensivist and ICU fellow responsible on the first ICU day and allowing for interaction terms. Results On the initial day, patients spent a median of 10.6 hours (interquartile range, 6.3-16.5) in the ICU, with median discretionary costs of $1343 (interquartile range, $788-2208). There was large variation in adjusted costs attributable to both the intensivists ($359; 95% CI, $244-$474) and the fellows ($756; 95% CI, $550-$965). The interaction terms were not significant (P = .12-.79). ConclusionsIn an ICU care model with intensivists and subspecialty fellows, both types of physicians contributed significantly to the observed variation in discretionary costs. However, even in the presence of a hierarchical arrangement of clinical responsibilities, the influences on costs of the 2 types of physicians were independent.

show abstract

Section: Methodsmentioning

confidence: 99%

Effect of Collaborative Care on Cost Variation in an Intensive Care Unit

Garland

2013

American Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…There was no substitution between inpatient and outpatient care. In another study on larger regions, physicians in Florida turned out to use one and a half times more resources per admission for inpatient treatment than their colleagues in Oregon, when adjusted for the physicians' case-mix [3]. In a third study by the Wennberg group, patients in Boston who were initially hospitalized with acute myocardial infarction, a stroke, gastrointestinal bleeding, hip fracture or cancer surgery had a 1.64 higher chance of readmission in the next 3 years than comparable patients in New Haven [4].…”

Section: Intmductionmentioning

confidence: 99%

The ambiguous relationship between practice variation and appropriateness of care: an agenda for further research

Casparie

1996

Health Policy

View full text Add to dashboard Cite

The analysis of variation in the use of health care services, and particularly of practice variation, has been the subject of renewed interest because of the view that the inappropriate use of procedures could be a major cause of these differences. In this article, recent literature is reviewed and the results of personal research are described on both the variation in care provision and on appropriateness assessment. In the few studies which have focussed on both subjects no evidence has yet been found to suggest that practice variation is to be explained by differences in appropriateness rates. However, there are still many methodological pitfalls in both variation analyses (statistical problems) and appropriateness assessment (reliability of the judgement), implying that this conclusion is far from definitive. More research should therefore be conducted on methodological questions of variation analysis and appropriateness assessment. Furthermore in variation analysis the relative contribution of all potential determinants has to be studied on the various levels of care provision. Finally, to study the relationship between practice variation and appropriateness of care, the clinical problem and not the procedure should be the starting point.

show abstract

“…20 Claims data can be used to improve appropriate utilization, target continuing medical education, help manage complex patients, identify underserved patients, and detect misprescribing as well as fraud and abuse. [32][33][34][35][36][37][38][39] This study examined the pharmacy claims of a population with a condition that is highly prevalent yet difficult to control in many cases. The results suggest a lack of compliance with recommended therapies and missed opportunities of education and intervention during an acute event.…”

Section: Number Of Patients On Inhaled Anti-inflammatoriesmentioning

confidence: 99%