Westerfield W, Naidoo A, Patric K, Slagle J; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1333.
BlueCross BlueShield of Tennessee, Health Services Research, 801 Pine Street, 3E, Chattanooga, TN 37402 Tel. 423.755.6260 Fax
RESEARCH OBJECTIVE: The primary objective of this study was to measure the relative variation in the courses of treatment selected by a provider or specialty to treat asthma without comorbidity. The secondary objective of this study was to determine the most common course of treatment used by a provider or specialty to treat asthma without comorbidity. STUDY DESIGN: Treatment variation was measured using the Index of Qualitative Variation. Called the Index of Treatment Variation (ITV) for the purposes of this study, the ITV is an appropriate measure for determining the relative number of differences in a given set of items. ITV scores range from 0.00 to 1.00. An ITV score of 0.00 indicates no treatment variation, while an ITV score of 1.00 indicates maximum treatment variation. To measure the variation in distinct courses of treatment, data based on an episode of care model and extracted from a commercial Preferred Provider Organization were used. The data covered episodes of care from June 2002 May 2003. Episodes from the Episode Treatment Group 389 Asthma without Comorbidity were chosen to test the variation in asthma treatments. Berenson & Eggers Type of Service Codes were used to identify medical treatments. Therapeutic Class Codes were used to identify drug therapies. POPULATION STUDIED: 2,923 episodes of asthma without comorbidity were studied. The episodes were treated by a variety of specialties including Internal Medicine, Family Practice, Pediatric Medicine, Nurse Practitioner, Pulmonary Disease, Emergency Medicine, and Allergy & Immunology. PRINCIPAL FINDINGS: ITV scores for individual providers ranged from 0.84 to 1.00. The most common ITV score was 1.00. The provider with the lowest treatment variation was an Allergy & Immunologist. This particular provider treated 5 episodes of asthma and used 3 different courses of treatment. The providers most common course of treatment included an office visit, a respiratory flow volume loop, an adrenergic agent, a sympathomimetic agent, and other unclassified drug therapies. The specialty with the lowest treatment variation was also Allergy & Immunology. This specialty treated 144 episodes of asthma and used 106 different courses of treatment. This specialties most common course of treatment included an office visit, a respiratory volume flow loop, an adrenergic agent, and a sympathomimetic agent. CONCLUSIONS: The variation in treatment courses used by the providers and specialists to treat asthma appears clinically significant. The most common approach to the treatment of asthma was a different course of treatment for each episode. The Index of Treatment Variation is a useful measure for comparing the amount of variation in courses of treatment selected by providers and/or specialties to treat a particular illness. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The Index of Treatment Variation is a valuable and flexible measure. Combined with an episode of care model, the Index of Treatment Variation could be used in practice pattern analysis, disease profiling, evidence-based medicine, and quality measures
Publication Types:
Keywords:
- Ambulatory Care
- Asthma
- Child
- Family Practice
- Hospitalization
- Humans
- Hypersensitivity
- Internal Medicine
- Office Visits
- Research Design
- Weights and Measures
- immunology
- methods
- therapy
- hsrmtgs
UI: 103624367
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