title: Methodological challenges of measuring primary care delivery to pediatric medicaid beneficiaries who use community health centers.
abstract: Efforts to measure quality of care have focused on ambulatory care providers. We examined the performance of community health centers serving children on Medicaid in 3 states. Descriptive analysis showed considerable patient population heterogeneity, and regression analysis demonstrated that variation explained by the assigned provider was small (mean R(2) = 4.3%) compared with the variation explained by patient demographic variables (mean R(2) = 29.9%). The results reinforce the need for caution when one is attributing quality differences to provider performance.
authors.affiliation: Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110, USA.
authors.forename: Karen R
authors.initials: KR
authors.lastname: Tyo
authors.forename: Deborah
authors.initials: D
authors.lastname: Gurewich
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008484:Medicaid / Q000706:statistics & numerical data*; D010372:Pediatrics; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D014481:United States