Volume 54 | Number 2 | April 2019

Abstract List

Ann S. O'Malley MD, MPH, Eugene C. Rich MD, Lisa Shang MS, Tyler Rose BS, Arkadipta Ghosh, Dmitriy Poznyak Ph.D., Deborah Peikes PhD


To develop claims‐based measures of comprehensiveness of primary care physicians (s) and summarize their associations with health care utilization and cost.

Data Sources and Study Setting

A total of 5359 s caring for over 1 million Medicare fee‐for‐service beneficiaries from 1404 practices.

Study Design

We developed Medicare claims‐based measures of physician comprehensiveness ( and ) and used a previously developed measure. We analyzed the association of s’ comprehensiveness in 2013 with their beneficiaries’ emergency department, hospitalizations rates, and ambulatory care‐sensitive condition () admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering.

Principal Findings

Each measure varied across s and had low correlation with the other measures—as intended, they capture different aspects of comprehensiveness. For patients whose s’ comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use ( < 0.05) in one or more measures: : total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department () visits, −16.3 (−2.4 percent); : total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); visits, −19.7 (−2.9 percent); : visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and admission rates.


These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of s providing more comprehensive care had lower hospitalization rates, visits, and total Medicare expenditures.