title: Geographic Variation in Quality of Care for Commercially Insured Patients.
abstract: Extensive evidence documents geographic variation in spending, but limited research assesses geographic variation in quality, particularly among commercially insured enrollees.
  
  
  
  To measure geographic variation in quality measures, correlation among measures, and correlation between measures and spending for commercially insured enrollees.
  
  
  
  Administrative claims from the 2007-2009 Truven MarketScan database.
  
  
  
  We calculated variation in, and correlations among, 10 quality measures across 306 Hospital Referral Regions (HRRs), adjusting for beneficiary traits and sample size differences. Further, we created a quality index and correlated it with spending.
  
  
  
  The coefficient of variation of HRR-level performance ranged from 0.04 to 0.38. Correlations among quality measures generally ranged from 0.2 to 0.5. Quality was modestly positively related to spending.
  
  
  
  Quality varied across HRRs and there was only a modest geographic "quality footprint."
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Redondo Beach, CA.
authors.forename: Michael Richard
authors.initials: MR
authors.lastname: McKellar
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: North Campus Research Complex, Ann Arbor, MI.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D062306:Geography, Medical / Q000706:statistics & numerical data; D006264:Health Benefit Plans, Employee / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: Geographic variation; markets; quality; spending