This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Peter G. Szilagyi, MD, MPH; Klaus J. Roghmann, PhD; Howard R. Foye, MD; Caroline Parks, RN; James MacWhinney, MD; Robert Miller, MD; Lawrence Nazarian, MD; Thomas Mclnerny, MD; Suzanne Klein, MD

JAMA. 1990;263(16):2198-2203.

Abstract
We compared the use of pediatric ambulatory medical care of 640 children who switched from a traditional Blue Cross plan to more comprehensive independent practice association plans with that of matched patients who remained with Blue Cross in one large, suburban pediatric practice in Rochester, NY. A quasiexperimental, retrospective cohort design was used. Use of pediatric ambulatory medical care by patients in the independent practice association plan and control patients was determined by medical chart review for 1 year before and 1 year after each patient's switch. During the baseline year, patients who would join the independent practice association plan already had 19% more acute-illness visits than control patients. During the second year, patients in the independent practice association plan averaged 42% more acute-illness visits, 22% more well child—care visits, 93% more chronic-illness visits, 27% more after-hours visits, 53% more weekend visits, 185% more laboratory studies, and 70% more referrals. The shift toward independent practice association plans in this open-market setting increased use of ambulatory medical care for pediatric patients.

(JAMA. 1990;263:2198-2203)

Author Affiliations
From the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Strong Memorial Hospital, The University of Rochester (NY) School of Medicine and Dentistry.

Footnotes
Reprint requests to Department of Pediatrics, Strong Memorial Hospital, 601 Elmwood Ave, Box 777, Rochester, NY 14642 (Dr Szilagyi).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Managed Care Organization Characteristics and Outpatient Specialty Care Use Among Children With Chronic Illness
Shenkman et al.
Pediatrics 2005;115:1547-1554.
ABSTRACT | FULL TEXT  

The Rate and Cost of Hospital Readmissions for Preventable Conditions
Friedman and Basu
Med Care Res Rev 2004;61:225-240.
ABSTRACT  

The Evolution of the State Children's Health Insurance Program (SCHIP) in New York: Changing Program Features and Enrollee Characteristics
Dick et al.
Pediatrics 2003;112:e542-550.
ABSTRACT | FULL TEXT  

Gatekeeping and Referral of Children and Adolescents to Specialty Care
Forrest et al.
Pediatrics 1999;104:28-34.
ABSTRACT | FULL TEXT  

Managed Care Plan Performance Since 1980: A Literature Analysis
Miller and Luft
JAMA 1994;271:1512-1519.
ABSTRACT