A general method for identifying excess revisit rates: the case of hypertension.

Objective: To provide a description and application of a novel methodology for comparing actual to expected visit rates at the physician level (controlling for patient characteristics) that could be employed in healthcare monitoring and management.

Data Sources/study Setting: Two fiscal years (1997/1998 and 1998/1999) of health utilization data extracted from linked administrative data sets on a population-based cohort of 13,688 patients (aged 25+ with hypertension) involving 157 physicians.

Study Design: We re-analyzed data from a previously published retrospective cohort study to develop and apply a new methodology for identifying higher or lower than expected physician visit rates for hypertension.

Data Collection/extraction Methods: We matched each study physician's hypertensive patients on the basis of age, sex, income and co-morbidity to an equal number of control patients drawn from the cohort. We then compared visit rates between the actual practice and the matched control practice.

Principal Findings: Although the correlation between the visit rates of the two groups of practices was high (r=.87), there were notable differences in rates, suggesting substantial discretionary practice among physicians.

Conclusions: The methodology outlined in this paper provides a basis for identifying variations in visit levels related to discretionary practice patterns and patient preferences. Deviation from expected visit rates provides a potentially useful measure for performance feedback and quality improvement activities.