Regional variations in health status

CONTEXT. Knowledge about variations in the health status of patients seekin g primary care in different parts of the United States is limited. OBJECTIVE. To examine regional variations in the physical and mental health of patients receiving primary care in the largest integrated health care s ystem in the United States which is operated by the Department of Veteran A ffairs (VA). STUDY DESIGN AND SETTING. We performed a mailed, cross sectional survey of 54,844 patients who were enrolled in seven VA General Internal Medicine cli nics. RESULTS. Among the 30,690 patients who returned an initial set of screening questionnaires, the prevalence of common chronic conditions varied by as m uch as 60% among the seven clinics. Moreover, patients' general health (mea sured by the SF-36) also varied significantly in a pattern that mirrored th e observed differences in the prevalence of chronic conditions. After adjus tment for important comorbid illnesses and sociodemographic factors, geogra phic site accounted for a small percentage of the explained variance in pat ient assessed health status. CONCLUSIONS. The substantial differences in the health of patients enrolled in different VA primary clinics have important implications for the evalua tion of clinical performance and health outcomes. Most of these differences can be attributed to sociodemographic and comorbid factors.