Abstract
This study evaluated a multidisciplinary care center, the Pike Market Clinic (PMC), whose physicians provide and coordinate inpatient and outpatient care for downtown low-income elderly in Seattle. We interviewed users of PMC and their near-neighbors with a 206 item questionnaire to compare their medical and social service use, quality of care, and satisfaction. We then estimated mean annual charges/person for inpatient, outpatient and emergency room services in the two groups. Demographic and health status characteristics were similar in the two groups. PMC patients made significantly more annual visits than neighbors to their primary physicians. Visits to non-primary physicians occurred at the same rate in both groups, but PMC patients were referred more often by their primary physicians. Both emergency room and inpatient use were higher in the neighbor group. Social services were used at the same rate by PMC patients and neighbors. Various indices suggested that quality of care and satisfaction were comparable or superior among PMC patients. Using utilization data, we estimated that neighbors generated charges over $1000/person/year greater than PMC patients. Coordination by PMC providers rather than the availability of multidisciplinary services may be largely responsible for utilization differences between PMC patients and their neighbors.
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Laura-Mae Baldwin is Assistant Professor of Family Medicine at the University of Washington, Seattle, Washington. Thomas S. Inui is Professor and Chair of Ambulatory Care and Prevention at Harvard Medical School, Boston, Massachusetts. Sally Stenkamp is in practice at Kaiser Permanente in Riverside, California.
This research was conducted while the first author was a Robert Wood Johnson Clinical Scholar at the University of Washington. The opinions and conclusions in the text are those of the author and do not necessarily represent the views of The Robert Wood Johnson Foundation. The authors would like to thank Marilyn Bergner, PhD for her review of this work, Betsy Lieberman for her administrative support at the Pike Market Clinic, Beth Lindeman, MD for her assistance in interviewing and the many elderly who opened their homes to the interviewers.
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Baldwin, LM., Inui, T.S. & Stenkamp, S. The effect of coordinated, multidisciplinary ambulatory care on service use, charges, quality of care and patient satisfaction in the elderly. J Community Health 18, 95–108 (1993). https://doi.org/10.1007/BF01324418
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DOI: https://doi.org/10.1007/BF01324418