VARIATION AMONG RHEUMATOLOGISTS IN CLINICAL OUTCOMES AND FREQUENCY OFOFFICE VISITS FOR RHEUMATOID-ARTHRITIS

Objective. To estimate the variation among rheumatologists in clinical outcomes and frequency of office visits for patients with rheumatoid arthritis (RA), after accounting for patient demographic and clinical characteristics and treatments prescribed. Methods. Multiple regressio n analysis using random effects for rheumatologists and adjustments fo r patient characteristics and treatments received, based on data deriv ed from a panel study of persons with RA. Results. During the years 19 84-1993, rheumatologists accounted for a moderate amount of the total variation in clinical outcomes and nearly one-third of the total varia tion in frequency of office visits. For example, in 1993 rheumatologis t associated variation in 4 clinical outcomes ranged from 16 to 25%, w hile the variation in office visit frequency attributable to rheumatol ogists stood at 46% of the total variation. However, rheumatologist as sociated variation in clinical outcomes was not statistically signific ant in any year, while variation in office visits was highly significa nt in all years (p less than or equal to 0.0001). Although there was a n increase in the percentage of variation attributable to rheumatologi sts for all outcomes examined across the years of this study, the time trend reached statistical significance only for frequency of office v isits (2.4% per year; p = 0.0135) and functional status (1.6% per year ; p = 0.0034). Conclusion. The magnitude and strength of rheumatologis t associated variation in frequency of office visits, without comparab le strength in the variation in clinical outcomes, may suggest ineffic iencies in the use of resources for the care of persons with RA. Furth er work is needed to directly examine the relationship between health outcomes and resource utilization.