Geographic variation in diagnosis frequency and risk of XXXX among Medicare beneficiaries.

@entity1 @entity712 @entity3657 @entity6 @entity5 @entity303 @entity409 @entity177 @entity1030 @entity453 @entity204 @entity454
CONTEXT: Because diagnosis is typically thought of as purely a @entity1 attribute, it is considered a critical factor in risk-adjustment policies designed to reward efficient and high-quality care. OBJECTIVE: To determine the association between frequency of diagnoses for chronic conditions in geographic areas and case-fatality rate among Medicare beneficiaries. DESIGN, SETTING, AND @entity1 : Cross-sectional analysis of the mean number of 9 serious chronic conditions ( @entity5 , @entity1030 , @entity453 , @entity712 , @entity3657 , severe @entity409 , @entity6 with @entity454 , @entity177 , and @entity303 ) diagnosed in 306 hospital referral regions (HRRs) in the United States; HRRs were divided into quintiles of diagnosis frequency. @entity1 were 5,153,877 fee-for-service Medicare beneficiaries in 2007. MAIN OUTCOME MEASURES: Age/sex/race-adjusted case-fatality rates. RESULTS: Diagnosis frequency ranged across HRRs from 0.58 chronic conditions in Grand Junction, Colorado, to 1.23 in Miami, Florida (mean, 0.90 [95% confidence interval {CI}, 0.89-0.91]; median, 0.87 [interquartile range, 0.80-0.96]). The number of conditions diagnosed was related to risk of @entity204 : among @entity1 diagnosed with 0, 1, 2, and 3 conditions the case-fatality rate was 16, 45, 93, and 154 per 1000, respectively. As regional diagnosis frequency increased, however, the case fatality associated with a chronic condition became progressively less. Among @entity1 diagnosed with 1 condition, the case-fatality rate decreased in a stepwise fashion across quintiles of diagnosis frequency, from 51 per 1000 in the lowest quintile to 38 per 1000 in the highest quintile (relative rate, 0.74 [95% CI, 0.72-0.76]). For @entity1 diagnosed with 3 conditions, the corresponding case-fatality rates were 168 and 137 per 1000 (relative rate, 0.81 [95% CI, 0.79-0.84]). CONCLUSION: Among fee-for-service Medicare beneficiaries, there is an inverse relationship between the regional frequency of diagnoses and the case-fatality rate for chronic conditions.
