Table 1.
Step number | Step title | Step methods | Result of step |
---|---|---|---|
Step 1 | Visit frequency groups | Categorize Medicare beneficiaries according to their frequency of PC visits | 5 groups of beneficiaries stratified by frequency of PC visits |
Step 2 | Visit regularity subgroups | Sub-divide each of the 5 groups from Step 1 into “regular” and “irregular” subgroups based on regularity of PC visits | 10 subgroups of beneficiaries |
Step 3 | Probability of being in regular subgroup | Use beneficiary demographic and clinical characteristics to predict the probability of a beneficiary having more than the median regularity of PC visits | Estimated probability (range 0–1) for each beneficiary to be assigned to the regular subgroup |
Step 4 | Expected site-level proportion of beneficiaries with regular visits | Categorize sites based on whether they had more or fewer beneficiaries in the regular PC subgroup than would be predicted | Calculated proportion (range 0–100%) of beneficiaries at each site, within each PC frequency group, predicted to be in the regular subgroup |
Step 5 | Site-level comparison of observed and expected | Compare the observed proportion of beneficiaries in the regular subgroup at each site with the expected proportion, to generate an observed minus expected (O-E) score | Each site characterized as having more, fewer, or about the same proportion of beneficiaries in the regular subgroup than predicted |
Step 6 | Beneficiary-level analyses | Test the beneficiary-level hypothesis that beneficiaries with more regular PC visits would have better outcomesa than beneficiaries with less regular PC visits | Beneficiary-level hypothesis is accepted or rejectedb |
Step 7 | Site-level analyses | Test the site-level hypothesis that sites with more regular PC visits than predicted would have better outcomesa than sites with less regular PC visits than predicted based upon beneficiary characteristics | FQHC site-level hypothesis is accepted or rejectedc |
PC primary care
aBetter outcomes are defined as fewer ED visits, fewer hospitalizations, and lower total Medicare expenditures
bIf the hypothesis is accepted, beneficiaries with more regular PC visits had better outcomes than beneficiaries with less regular PC visits
cIf the hypothesis is accepted, beneficiaries at FQHC sites with more regular PC visits than predicted had better outcomes than beneficiaries at FQHC sites with less regular PC visits than predicted