Qualidade na Atenção Primária Acesso livre

Abstrato

Cost and Quality in Hypertension Care:Observations from a Primary Care Quality Improvement Initiative

Valerie A. Carey, Michelle R. Casey, Gregory H. Partridge, Thomas Mahoney, Howard B. Beckman

Background: Cost-savings programs should not be undertaken at the expense of patient health. Therefore, the relationships between medical care utilization and health outcomes must be studied to determine where savings might be achieved without compromising appropriate treatments. Previous studies have found that cost variations have little impact on health outcomes, although these results have been challenged. Few published studies have examined costoutcome associations for specific conditions treated in a primary care setting.

Aims: We investigate the relationship between blood pressure control rates and hypertension care costs for adult hypertensive patients served by primary care practices participating in a regional quality improvement program in western New York State.

Methods: This project used an observational design at the practice level. Counts of hypertensive patients with controlled and uncontrolled blood pressure were provided by 32 primary care practices participating in a quality improvement program involving ~50,000 hypertensive patients over a 12-month period. Cost data was derived from a separate de-identified, multi-payer medical claims database. Hypertensive patients visiting physicians at the participating practices were identified, and hypertensionspecific service costs for these patients were aggregated at the practice level. A generalized linear model was used to model the effects of care costs on blood pressure control rates. The analysis was performed while controlling for practice location, a likely proxy for patient socioeconomic status and other environmental and demographic factors.

Results: We find that the annual cost of hypertension care does not have a statistically significant association with blood pressure control for this population.

Conclusion: Factors other than cost of care must explain differences in blood pressure control rates among these primary care practices. Identifying low-cost, highquality practices may provide lessons to improve the cost and quality of care. However, examination of disaggregated data and larger sample sizes are desirable to form firmer conclusions at the practice level.