A general method for identifying excess revisit rates: the case of hypertension

To provide a description and application of a novel methodology for comparing actual to expected visit rates at the physician level (controlling for patient characteristics) that could be employed in healthcare monitoring and management.

Two fiscal years (1997/1998 and 1998/1999) of health utilization data extracted from linked administrative data sets on a population-based cohort of 13,688 patients (aged 25+ with hypertension) involving 157 physicians.

We re-analyzed data from a previously published retrospective cohort study to develop and apply a new methodology for identifying higher or lower than expected physician visit rates for hypertension.

We matched each study physician's hypertensive patients on the basis of age, sex, income and co-morbidity to an equal number of control patients drawn from the cohort. We then compared visit rates between the actual practice and the matched control practice.

Although the correlation between the visit rates of the two groups of practices was high (r=.87), there were notable differences in rates, suggesting substantial discretionary practice among physicians.

The methodology outlined in this paper provides a basis for identifying variations in visit levels related to discretionary practice patterns and patient preferences. Deviation from expected visit rates provides a potentially useful measure for performance feedback and quality improvement activities.