Article Title

Managing Multiple Conditions During an Acute Episode: Impacts on Costs and Clinical Quality

Publication Date



cost, clinical quality


Background/Aims: Managing multiple conditions during an acute visit often requires more comprehensive evaluation of concurrent conditions and is associated with higher per-visit cost. However, little is known about whether managing multiple conditions during a single visit affects overall costs or quality. This study examines this potential impact on the annual cost per patient and clinical quality.

Methods: Data were from electronic health records and claims of a large ambulatory group practice with mixed payment sources. We studied primary care physicians (PCPs) in 2010–2013 (n = 309) who had 1,099 PCP-years, the unit of analysis. Annual costs were expressed as the ratio of the observed costs to the expected costs adjusted for patient age, sex and clinical conditions. Costs included standardized fees for physicians, laboratory/imaging orders, specialist services and medications. For the measure of clinical quality, we combined various indicators pertinent to primary care practice (e.g. management of chronic conditions and preventive service) and created a composite average score (number of patients who met the target/number of eligible patients for that measure). We analyzed the ratio of the observed score to the expected score adjusted for the composition of new (vs. established) patients in the PCP panel. The management of multiple conditions was identified through the diagnosis codes for treating “other” conditions during acute episodes. PCPs were classified into three tertiles based on the average number of other conditions addressed per episode across all acute episodes. We then tested whether costs and quality differed across the tertiles.

Results: The risk-adjusted costs were not significantly different across tertiles of “other conditions” (0.997 [± 0.174], 1.005 [± 0.191] and 1.010 [± 0.269] for the low, middle and high groups, respectively). Managing other conditions during acute episodes was associated with higher quality: PCPs in the top tertile of other conditions addressed had higher quality scores than the middle (1.048 vs. 1.033, P = 0.06) and low groups (1.048 vs. 1.030, P = 0.05).

Conclusion: Our preliminary findings suggest that managing multiple conditions during acute episodes may be associated with better care (higher quality but not higher costs per year). More refined analyses will be conducted to confirm the robustness of findings.




June 30th, 2016


August 12th, 2016