title: The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases.
abstract: BACKGROUND
  The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution) of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments.
  
  
  METHODS
  We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit), dependent variables (mean number of visits, episodes and direct costs), co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System) and effectiveness.The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others), referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization.The model of cost/patient/year will differentiate fixed/semi-fixed (visits) costs of the variables for each patient attended/year (N = 350,000 inhabitants). The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50).The correlation between the efficiency (relative-weights) and synthetic (by centre and physician) indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000) will be measured using a structured questionnaire including various dimensions.
  
  
  METHODS
  multiple regression analysis (procedure: enter), ANCOVA (method: Bonferroni's adjustment) and multilevel analysis will be carried out to correct models. The level of statistical significance will be p < 0.05.
authors: Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain. asicras@bsa.cat
authors: Antoni
authors: A
authors: Sicras-Mainar
authors: Ruth
authors: R
authors: Navarro-Artieda
authors: Milagrosa
authors: M
authors: Blanca-Tamayo
authors: Soledad
authors: S
authors: Velasco-Velasco
authors: Esperanza
authors: E
authors: Escribano-Herranz
authors: Josep Ramon
authors: JR
authors: Llopart-López
authors: Concepción
authors: C
authors: Violan-Fors
authors: Josep Maria
authors: JM
authors: Vilaseca-Llobet
authors: Encarna
authors: E
authors: Sánchez-Fontcuberta
authors: Jaume
authors: J
authors: Benavent-Areu
authors: Ferran
authors: F
authors: Flor-Serra
authors: Alba
authors: A
authors: Aguado-Jodar
authors: Daniel
authors: D
authors: Rodríguez-López
authors: Alejandra
authors: A
authors: Prados-Torres
authors: Jose
authors: J
authors: Estelrich-Bennasar
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000704:Analysis of Variance; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D011320:Primary Health Care / Q000191:economics*; D012044:Regression Analysis; D012189:Retrospective Studies; D020379:Risk Adjustment; D013030:Spain; D011795:Surveys and Questionnaires