HOW RURAL PHYSICIANS COMPARE ON COST AND QUALITY MEASURES FOR MEDICAID AMBULATORY CARE EPISODES

This study compares the costs and quality of episodes of care for two common childhood illnesses, urinary tract infections (UTI) and otitis media (OM), across providers practicing in rural, small town, and urba n counties in Alabama in 1992. The data source is Medicaid claims data for children under age 8 who were treated for these conditions. The s tudy found that episodes cared for by rural providers were less expens ive than episodes cared for in other locations, both because fewer rur al episodes included outpatient facility charges and because fewer anc illary services were provided in rural settings. Researchers also foun d that, even controlling for physician characteristics and patient dem ographic and utilization factors, rural episodes were significantly le ss likely to include two process measures of quality of care: fewer ru ral UTI episodes included urine cultures, and fewer rural OM episodes included follow-up visits. This study suggests that, as a group, rural physicians may have a favorable cost profile but a potentially unfavo rable care content profile, compared with other physicians. Both pract ice profile data and explicit care recommendations need to be availabl e to physicians so they can monitor, defend, or alter their clinical p ractices.