title: Higher practice intensity is associated with higher quality of care but more avoidable admissions for medicare beneficiaries.
abstract: BACKGROUND
  The relationship between practice intensity and the quality and outcomes of care has not been studied.
  
  
  OBJECTIVE
  To examine the relationship between primary care physicians' costliness both for defined episodes of care and for defined patients and the quality and outcomes of care delivered to Medicare beneficiaries.
  
  
  METHODS
  Cross sectional analysis of physician survey data linked to Medicare claims. Physician costliness measures were calculated by comparing the episode specific and overall costs of care for their patients with the care delivered by other physicians.
  
  
  METHODS
  We studied physicians participating in the 2004-2005 Community Tracking Study Physician Survey linked with administrative claims from the Medicare program for the years 2004-2006.
  
  
  METHODS
  Proportion of eligible beneficiaries receiving each of seven preventive services and rates of preventable admissions for acute and chronic conditions.
  
  
  RESULTS
  The 2,211 primary care physician respondents included 937 internists and 1,274 family or general physicians who were linked to more than 250,000 Medicare enrollees. Patients treated by more costly physicians (whether measured by the overall costliness index or the episode-level index) were more likely to receive recommended preventive services, but were also more likely to experience preventable admissions. For instance, physicians in the lowest quartile of costliness performed appropriate monitoring for hemoglobin A1C for diabetics 72.8% of the time, as compared with 81.9% for physicians in the highest quartile of costliness (p < 0.01). In contrast, patients treated by the physicians in the lowest quartile of episode costliness were admitted at a rate of 1.8/100 for both acute and chronic Prevention Quality Indicators (PQIs), as compared with 2.9/100 for both acute and chronic PQIs for those treated by physicians in the highest quartile of costliness (p < 0.001).
  
  
  CONCLUSIONS
  Physician practice patterns are associated with the quality of preventive services delivered to Medicare patients. Ongoing efforts to influence physician practice patterns may have differential effects on different aspects of quality.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, USA, landon@hcp.med.harvard.edu.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: A James
authors.initials: AJ
authors.lastname: O'Malley
authors.forename: M Richard
authors.initials: MR
authors.lastname: McKellar
authors.forename: Jack
authors.initials: J
authors.lastname: Hadley
authors.forename: James D
authors.initials: JD
authors.lastname: Reschovsky
mesh_terms: D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods; D006801:Humans; D006278:Medicare / Q000191:economics / Q000592:standards* / Q000639:trends; D010343:Patient Admission / Q000191:economics / Q000592:standards* / Q000639:trends; D058007:Physicians, Primary Care / Q000191:economics / Q000592:standards* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care / Q000191:economics / Q000592:standards* / Q000639:trends; D014481:United States
references.citation: Med Care. 2007 Jun;45(6):480-8
references.pmid: 17515774
references.citation: Milbank Q. 2010 Dec;88(4):560-94
references.pmid: 21166869
references.citation: Ann Intern Med. 2006 Jul 18;145(2):107-16
references.pmid: 16847293
references.citation: Ann Intern Med. 2003 Feb 18;138(4):288-98
references.pmid: 12585826
references.citation: N Engl J Med. 2010 Jan 7;362(1):1-3
references.pmid: 20007553
references.citation: JAMA. 2005 Jul 27;294(4):473-81
references.pmid: 16046654
references.citation: Ann Intern Med. 2003 Feb 18;138(4):273-87
references.pmid: 12585825
references.citation: Health Serv Res. 2011 Dec;46(6pt1):1863-82
references.pmid: 21790586
references.citation: Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-184-97
references.pmid: 15451981
references.citation: Health Aff (Millwood). 2012 Sep;31(9):2084-93
references.pmid: 22949459
references.citation: J Gen Intern Med. 2007 Aug;22(8):1206-11
references.pmid: 17516106
references.citation: Health Aff (Millwood). 2009 Jul-Aug;28(4):w566-72
references.pmid: 19460774
references.citation: Med Care. 2011 Aug;49(8):679-85
references.pmid: 21478780
references.citation: JAMA. 2012 Mar 14;307(10):1037-45
references.pmid: 22416099
references.citation: J Am Geriatr Soc. 2005 Oct;53(10):1705-11
references.pmid: 16181169
references.citation: Health Aff (Millwood). 2009 May-Jun;28(3):897-906
references.pmid: 19414903
references.citation: JAMA. 2013 Sep 25;310(12):1227-8
references.pmid: 24008265
references.citation: Int J Health Care Finance Econ. 2012 Mar;12(1):87-105
references.pmid: 22399369