Outcome and cost of family physicians' care--pilot study of three diagnosis-related groups in elderly inpatients.
BACKGROUND
Health care analysts have speculated whether a primary-care-based delivery system would improve outcomes and costs for the currently preponderantly specialist-directed United States system. This pilot study compares outcomes and costs of family physicians' care with those of other physicians' care for three diagnosis-related groups (DRGs) and shows the feasibility of a larger scale research program using the Pennsylvania MedisGroups data base.


METHODS
A cross-sectional comparison of outcomes and costs of hospital care given by either family physicians or other physicians was conducted using patients aged 65 years and older who were hospitalized during 1990. The study population was 2420 inpatients: 847 with DRG 174 (gastrointestinal bleeding), 628 with DRG 243 (medical back pain), and 945 with DRG 296 (metabolic disorders). Patients were stratified into five admission severity groups for each DRG. Comparison variables were MedisGroups major morbidity classification, in-hospital mortality, mean length of stay, and total charges.


RESULTS
The family physician group delivered inpatient care to the elderly with gastrointestinal bleeding at significantly less cost than other physicians without any compromise of effectiveness. There was a similar but less striking trend for medical back pain. Results were variable for metabolic disorders.


CONCLUSIONS
The results of this pilot study apply only to the three DRGs in the region at the time investigated. Generalizations should be avoided before additional DRGs are studied throughout the rest of the state. This pilot study demonstrates the feasibility of such research.
MacLean
D S
DS
Department of Extended Care and Geriatrics, Polyclinic Medical Center, Harrisburg, Pennsylvania 17110-2098.
D000368:Aged; D001416:Back Pain / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D004470:Economics, Medical; D005194:Family Practice / Q000191:economics* / Q000592:standards*; D005240:Feasibility Studies; D005249:Fees and Charges; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000628:therapy; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data; D008511:Medicine / Q000592:standards*; D008659:Metabolic Diseases / Q000191:economics / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics* / Q000592:standards*; D011787:Quality of Health Care; D012720:Severity of Illness Index; D013038:Specialization