reports

Hold it – my patients are sicker! The importance of case mix adjustment to practitioner profiles in British Columbia

British Columbia Med J 43:328-333.

Ministry of Health and Ministry Responsible for Seniors, Province of British Columbia; UBC Centre for Health Services & Policy Research, and Department of Health Care and Epidemiology; Departments of Health Policy and Management and Pediatrics at Johns Hopkins University in Baltimore

Practitioner profiles are used to influence practitioner practice patterns, to provide physicians an opportunity to compare their practice patterns with their peers, and to focus audit resources. To measure the efficiency of practice, an estimate of the level of expected cost is needed. Traditional measures of expected cost based on age and gender of patients have been demonstrated to be a relatively poor predictor of individual need for health care services. A case mix adjustment method known as adjusted clinical groups has been evaluated extensively in the United States and has been the subject of recent evaluations in British Columbia and Manitoba. The adjusted clinical groups system places each patient into a mutually exclusive morbidity category, based on the combinations and types of ICD-9 codes that pertain to the individual over an extended period of time. Adjusted clinical groups are far more predictive of resource use than are age/gender categories. Measures of practitioner efficiency are more meaningful using adjusted clinical groups expected costs rather than age/gender expected costs.