Background: Current publicly reported quality performance measures directly compare primary care to specialty care. Specialists see short-term patients referred due to poor control of their disease who then return to their local provider. Our study looked to determine if outcomes measured in short-term care patients differed from those in long-term care patients and what impact those differences may have on quality performance profiles for specialists.
Methods: Retrospective cohort from a large academic medical Center. Performance was measured as "Optimal Care"--all or none attainment of goals. Patients with short-term care (<90 days contact) versus long-term care (>90 days contact) were evaluated for both specialty and primary care practices during the year 2008.
Results: Patients with short-term care had significantly lower "Optimal Care": 7.2% vs. 19.7% for optimal diabetes care in endocrinology and 41.3% vs. 53.1% for optimal ischemic vascular disease care in cardiology (p < 0.001). Combining short and long term care patients lowered overall perceived performance for the specialty practice.
Conclusions: Factors other than quality affect the perceived performance of the specialty practice. Extending current primary care quality measurement to short-term specialty care patients without adjustment produces misleading results.
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| http://dx.doi.org/10.1186/s12913-015-0757-8 | DOI Listing |
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