The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice.
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.
Szilagyi
P G
PG
Department of Pediatrics, Strong Memorial Hospital, University of Rochester, School of Medicine and Dentistry, NY 14642.
Roghmann
K J
KJ
Foye
H R
HR
Parks
C
C
MacWhinney
J
J
Miller
R
R
Nazarian
L
L
McInerny
T
T
Klein
S
S
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