Characteristics of Hospital Referral Regions by Quartile of Mean Ratio of Primary Care to Specialist Visits in the Last 6 Months of Life
| Quartile of PCP Involvement | |||||
|---|---|---|---|---|---|
| Measure | First (Lowest) (n = 76) | Second (n = 77) | Third (n = 77) | Fourth (Highest) (n = 76) | P Value |
| Outcomes | |||||
| Deaths of chronically ill beneficiaries, No.a | 376,118 | 303,772 | 242,084 | 185,728 | – |
| Ratio of PCP:specialist visits in the last 6 mo of life (range) | 0.66 (0.38–0.77) | 0.88 (0.78–0.98) | 1.08 (0.98–1.21) | 1.42 (1.21–2.55) | – |
| Patient characteristics | |||||
| Mean age, y | 72.11 | 71.31 | 70.97 | 71.08 | <.001 |
| Female, % | 56.0 | 55.5 | 55.2 | 54.3 | <.001 |
| African American, % | 11.4 | 10.2 | 7.9 | 3.6 | <.001 |
| HCC score, mean | 1.04 | 0.99 | 0.97 | 0.92 | <.001 |
| Population characteristics | |||||
| Below FPL, % | 13.9 | 16.1 | 15.9 | 15.5 | .005 |
| Urban, % | 92.8 | 79.1 | 68.3 | 55.1 | <.001 |
| Obese, % | 25.2 | 27.5 | 27.3 | 27.4 | <.001 |
| History of stroke, % | 4.5 | 3.9 | 3.8 | 3.3 | <.001 |
| Health care supply characteristics | |||||
| Medical doctors per 100,000, No. | 203.23 | 187.50 | 188.70 | 192.90 | .10 |
| PCPs per 100,000, No. | 51.10 | 49.57 | 56.42 | 63.18 | <.001 |
| Specialists per 100,000, No. | 130.23 | 118.59 | 116.60 | 114.96 | <.001 |
| Hospital beds per 1,000, No. | 50.74 | 43.23 | 41.05 | 37.67 | <.001 |
| ICU beds per 1,000, No. | 21.49 | 15.95 | 12.24 | 10.24 | <.001 |
FPL = federal poverty limit; HCC = hierarchical condition category; HRR = hospital referral region; ICU = intensive care unit; PCP = primary care physician.
Note: There were 306 HRRs, capturing 1,107,702 total decedents in 2010.
↵a Chronically ill Medicare beneficiaries, deceased in 2010.