[Comparative study at 4 health centres of efficiency, measured on the basis of ambulatory care groups]. / Estudio comparativo de la eficiencia, medida a partir de los Ambulatory Care Groups, entre 4 centros de salud.

OBJECTIVE: To measure efficiency in the use of resources for the care lists of four primary care centres (PCC), by using ambulatory care Groups (ACGs). DESIGN: Retrospective, observational study. SETTING: Four PC teams. PARTICIPANTS: All patients attended during 2003. MEASUREMENTS: Dependent variables (costs per patient, between medical lists [family medicine, paediatrics] and PCCs) and case load variables. The model of costs for each patient was set by differentiating the semi-fixed and variable costs. The efficiency index (EI) was set as the quotient between the observed real cost and the expected cost on the basis of ACG distribution, by indirect standardization. The study population was 62,311 patients seen, with an average of 4.8+/-3.2 episodes/patient/year. MAIN RESULTS: The total health care cost reached 24,135,236.62 euro, of which 65.2% was for prescription, 28.9% for semi-fixed costs, and 2.9% for cost of specialist referrals. The average total cost per patient/year was 387.34 euro+/-145.87 euro (average relative weight). The EI for each centre was: 0.93 (95% CI, 0.85-1.01), 0.97 (95% CI, 0.89-1.05), 1.04 (95% CI, 0.96-1.12), and 1.05 (95% CI, 0.97-1.13), P < .0001. In addition, differences between the medical lists (rank, 0.63-1.56) and between the paediatrics lists (rank, 0.73-1.26) were found (P = .005). CONCLUSIONS: The ACGs enabled us to estimate the efficiency of our PCCs and care lists. Efficiency cannot be isolated from other dimensions of the quality of health care delivery. Study of the EI improved our understanding of the profile of professionals and health centres.

Estudio comparativo de la eficiencia, medida a partir de los Ambulatory Care Groups, entre 4 centros de salud / Comparative study at 4 health centres of efficiency, measured on the basis of ambulatory care groups

Objetivo. Medir la eficiencia en el uso de recursos entre los cupos asistenciales de 4 centros de atención primaria de salud (APS), a partir de la utilización de los Ambulatory Care Groups (ACG). Diseño. Estudio observacional retrospectivo. Emplazamiento. Cuatro equipos de atención primaria. Participantes. Todos los pacientes atendidos durante el año 2003. Mediciones. Variables dependientes (costes por paciente, entre cupos médicos [medicina de familia, pediatría] y centros asistenciales) y de casuística. El modelo de costes para cada paciente se estableció diferenciando los costes semifijos y los variables. El índice de eficiencia (IE) se estableció entre el cociente entre el coste real observado y el coste esperado en función de la distribución ACG, por estandarización indirecta. Resultados principales. La población de estudio fue de 62.311 pacientes atendidos, con una media de 4,8 ± 3,2 episodios/paciente/año. El coste total de la atención sanitaria ascendió a 24.135.236,62 €, de los cuales el 65,2% correspondió a la prescripción de farmacia, el 28,9% a los costes semifijos y el 2,9% al coste de las derivaciones a especialistas. El promedio de coste total por paciente/año fue de 387,34 ± 145,87 € (peso relativo medio). El IE por centro fue de 0,93 (intervalo de confianza [IC] del 95% 0,85-1,01), 0,97 (IC del 95% del 95% 0,89-1,05), 1,04 (IC del 95% 0,96-1,12) y 1,05 (IC del 95%, 0,97-1,13), respectivamente (p < 0,0001). Además, se observan diferencias entre los cupos médicos (rango, 0,63-1,56) y entre los cupos pediátricos (rango, 0,73-1,26) (p = 0,005). Conclusiones. Los ACG permiten realizar una aproximación a la medida de la eficiencia de centros y cupos asistenciales de APS de nuestro entorno. La eficiencia no puede ser considerada de manera aislada de otras dimensiones de la calidad asistencial. El estudio del IE permite profundizar en el conocimiento del perfil de los profesionales y de los centros de salud

Objective. To measure efficiency in the use of resources for the care lists of four primary care centres (PCC), by using ambulatory care Groups (ACGs). Design. Retrospective, observational study. Setting. Four PC teams. Participants. All patients attended during 2003. Measurements. Dependent variables (costs per patient, between medical lists [family medicine, paediatrics] and PCCs) and case load variables. The model of costs for each patient was set by differentiating the semi-fixed and variable costs. The efficiency index (EI) was set as the quotient between the observed real cost and the expected cost on the basis of ACG distribution, by indirect standardization. The study population was 62 311 patients seen, with an average of 4.8±3.2 episodes/patient/year. Main results. The total health care cost reached €24 135 236.62, of which 65.2% was for prescription, 28.9% for semi-fixed costs, and 2.9% for cost of specialist referrals. The average total cost per patient/year was €387.34±€145.87 (average relative weight). The EI for each centre was: 0.93 (95% CI, 0.85-1.01), 0.97 (95% CI, 0.89-1.05), 1.04 (95% CI, 0.96-1.12), and 1.05 (95% CI, 0.97-1.13), P<.0001. In addition, differences between the medical lists (rank, 0.63-1.56) and between the paediatrics lists (rank, 0.73-1.26) were found (P=.005). Conclusions. The ACGs enabled us to estimate the efficiency of our PCCs and care lists. Efficiency cannot be isolated from other dimensions of the quality of health care delivery. Study of the EI improved our understanding of the profile of professionals and health centres