Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries.

Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE

Original Publication: Chicago : American Medical Association, 1960-

Diagnosis*; Chronic Disease/*mortality ; Medicare/*statistics & numerical data ; Mortality/*trends; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Fee-for-Service Plans/statistics & numerical data ; Female ; Geography ; Humans ; Male ; Outcome Assessment, Health Care ; Quality of Health Care ; Risk ; United States/epidemiology

Context: Because diagnosis is typically thought of as purely a patient attribute, it is considered a critical factor in risk-adjustment policies designed to reward efficient and high-quality care.
Objective: To determine the association between frequency of diagnoses for chronic conditions in geographic areas and case-fatality rate among Medicare beneficiaries.
Design, Setting, and Participants: Cross-sectional analysis of the mean number of 9 serious chronic conditions (cancer, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, peripheral artery disease, severe liver disease, diabetes with end-organ disease, chronic renal failure, and dementia) diagnosed in 306 hospital referral regions (HRRs) in the United States; HRRs were divided into quintiles of diagnosis frequency. Participants were 5,153,877 fee-for-service Medicare beneficiaries in 2007.
Main Outcome Measures: Age/sex/race-adjusted case-fatality rates.
Results: Diagnosis frequency ranged across HRRs from 0.58 chronic conditions in Grand Junction, Colorado, to 1.23 in Miami, Florida (mean, 0.90 [95% confidence interval {CI}, 0.89-0.91]; median, 0.87 [interquartile range, 0.80-0.96]). The number of conditions diagnosed was related to risk of death: among patients diagnosed with 0, 1, 2, and 3 conditions the case-fatality rate was 16, 45, 93, and 154 per 1000, respectively. As regional diagnosis frequency increased, however, the case fatality associated with a chronic condition became progressively less. Among patients diagnosed with 1 condition, the case-fatality rate decreased in a stepwise fashion across quintiles of diagnosis frequency, from 51 per 1000 in the lowest quintile to 38 per 1000 in the highest quintile (relative rate, 0.74 [95% CI, 0.72-0.76]). For patients diagnosed with 3 conditions, the corresponding case-fatality rates were 168 and 137 per 1000 (relative rate, 0.81 [95% CI, 0.79-0.84]).
Conclusion: Among fee-for-service Medicare beneficiaries, there is an inverse relationship between the regional frequency of diagnoses and the case-fatality rate for chronic conditions.

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P01 AG019783 United States AG NIA NIH HHS; P01 AG019783-10 United States AG NIA NIH HHS; P01-AG19783 United States AG NIA NIH HHS

Date Created: 20110317 Date Completed: 20110317 Latest Revision: 20220418

20221213

PMC3071496

10.1001/jama.2011.307

21406648