Improving Patient Care
1 September 2009

Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses

Publication: Annals of Internal Medicine
Volume 151, Number 5

Abstract

Background:

Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care.

Objective:

To compare the care received at retail clinics for 3 acute conditions with that received at other care settings.

Design:

Claims data from 2005 and 2006 from the health plan were aggregated into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After 2100 episodes (700 each) were identified in which otitis media, pharyngitis, and urinary tract infection (UTI) were treated first in retail clinics, these episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments.

Setting:

Enrollees of a large Minnesota health plan.

Patients:

Enrollees who received care for otitis media, pharyngitis, or UTI.

Measurements:

Costs per episode, performance on 14 quality indicators, and receipt of 7 preventive care services at the initial appointment or subsequent 3 months.

Results:

Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments ($110 vs. $166, $156, and $570, respectively; P < 0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care centers ($21, $21, and $22), as were aggregate quality scores (63.6%, 61.0%, and 62.6%) and patient's receipt of preventive care (14.5%, 14.2%, and 13.7%) (P > 0.05 vs. retail clinics). In emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower than in other settings.

Limitations:

A limited number of quality measures and preventive care services were studied. Despite matching, patients at different care sites might differ in their severity of illness.

Conclusion:

Retail clinics provide less costly treatment than physician offices or urgent care centers for 3 common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care.

Primary Funding Source:

California HealthCare Foundation.

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Supplemental Material

Supplement. Appendix

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 151Number 51 September 2009
Pages: 321 - 328

History

Published online: 1 September 2009
Published in issue: 1 September 2009

Keywords

Authors

Affiliations

Ateev Mehrotra, MD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
Hangsheng Liu, PhD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
John L. Adams, PhD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
Margaret C. Wang, PhD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
Judith R. Lave, PhD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
N. Marcus Thygeson, MD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
Leif I. Solberg, MD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
Elizabeth A. McGlynn, PhD
From RAND Health, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and HealthPartners Research Foundation, Minneapolis, Minnesota.
Grant Support: By the California Health Care Foundation and a career development award (KL2-RR024154-03) from the National Center for Research Resources, a component of the National Institutes of Health.
Disclosures: None disclosed.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Mehrotra ([email protected]). Data set: Available through written agreements with the authors and HealthPartners.
Corresponding Author: Ateev Mehrotra, MD, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213; e-mail, [email protected].
Current Author Addresses: Dr. Mehrotra: Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213.
Dr. Liu: RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665.
Drs. Adams, Wang, and McGlynn: RAND, 1776 Main Street, Box 2138, Santa Monica, CA 90407.
Dr. Lave: A614 Crabtree Hall, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261.
Dr. Thygeson: HealthPartners, 8170 33rd Avenue South, Bloomington, MN 55425.
Dr. Solberg: HealthPartners Research Foundation, Box 1524, MS 21111R, Minneapolis, MN 55440.
Author Contributions: Conception and design: A. Mehrotra, J.R. Lave, N.M. Thygeson, L.I. Solberg, E.A. McGlynn.
Analysis and interpretation of the data: A. Mehrotra, H. Liu, M.C. Wang, J.R. Lave, N.M. Thygeson, L.I. Solberg, E.A. McGlynn.
Drafting of the article: A. Mehrotra.
Critical revision of the article for important intellectual content: H. Liu, M.C. Wang, J.R. Lave, N.M. Thygeson, L.I. Solberg, E.A. McGlynn.
Final approval of the article: A. Mehrotra, H. Liu, J.R. Lave, L.I. Solberg, E.A. McGlynn.
Provision of study materials or patients: A. Mehrotra.
Statistical expertise: H. Liu, J.L. Adams.
Obtaining of funding: A. Mehrotra.
Administrative, technical, or logistic support: L.I. Solberg.
Collection and assembly of data: A. Mehrotra, L.I. Solberg.

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Ateev Mehrotra, Hangsheng Liu, John L. Adams, et al. Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses. Ann Intern Med.2009;151:321-328. [Epub 1 September 2009]. doi:10.7326/0003-4819-151-5-200909010-00006

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