title: The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice.
abstract: We compared the use of pediatric ambulatory medical care of 640 children who switched from a traditional Blue Cross plan to more comprehensive independent practice association plans with that of matched patients who remained with Blue Cross in one large, suburban pediatric practice in Rochester, NY. A quasi-experimental, retrospective cohort design was used. Use of pediatric ambulatory medical care by patients in the independent practice association plan and control patients was determined by medical chart review for 1 year before and 1 year after each patient's switch. During the baseline year, patients who would join the independent practice association plan already had 19% more acute-illness visits than control patients. During the second year, patients in the independent practice association plan averaged 42% more acute-illness visits, 22% more well child-care visits, 93% more chronic-illness visits, 27% more after-hours visits, 53% more weekend visits, 185% more laboratory studies, and 70% more referrals. The shift toward independent practice association plans in this open-market setting increased use of ambulatory medical care for pediatric patients.
authors.affiliation: Department of Pediatrics, Strong Memorial Hospital, University of Rochester, School of Medicine and Dentistry, NY 14642.
authors.forename: P G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: K J
authors.initials: KJ
authors.lastname: Roghmann
authors.forename: H R
authors.initials: HR
authors.lastname: Foye
authors.forename: C
authors.initials: C
authors.lastname: Parks
authors.forename: J
authors.initials: J
authors.lastname: MacWhinney
authors.forename: R
authors.initials: R
authors.lastname: Miller
authors.forename: L
authors.initials: L
authors.lastname: Nazarian
authors.forename: T
authors.initials: T
authors.lastname: McInerny
authors.forename: S
authors.initials: S
authors.lastname: Klein
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D000704:Analysis of Variance; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D002648:Child; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007193:Independent Practice Associations / Q000706:statistics & numerical data*; D008297:Male; D009518:New York; D010372:Pediatrics / Q000191:economics / Q000458:organization & administration*; D011331:Private Practice / Q000706:statistics & numerical data*; D012189:Retrospective Studies