Hospital-Based Primary Care Clinics More Likely to Deliver Low-Value Care

The site of a medical office building impacts more than just its price and desirability.

In fact, the location of a medical practice may play a significant role in the delivery of low-value care, according to a study recently published in JAMA Internal Medicine.

For the study, John N. Mafi of the University of California at Los Angeles (UCLA) and colleagues analyzed data from the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey. In total, the researchers looked at 31,162 visits for upper respiratory tract infection, headaches and back pain, representing about 739 million primary care visits between 1997 and 2013.

Patients visiting hospital-based primary care clinics and seeing a doctor who’s not their usual doctor were the most likely to receive services and tests that aren’t necessary, the researchers found, according to FierceHealthcare.

Specifically, visits to hospital-based clinics involved more imaging than visits to community-based clinics, the study found. Visits to hospital-based clinics also involved over twice the rate of referrals to specialists as visits to community-based clinics.

Therefore, it’s more likely for patients to be over-treated or over-tested when they switch from doctor to doctor, the study authors determined.

Patients who went to hospital-based primary care clinics, on average, were also younger than those who went to community-based primary care clinics.

Overall, hospital-based primary care clinics include more specialty referrals and low-value care than community-based, physician-owned practices, the researchers concluded.

“These findings suggest that practice location has a larger role than ownership or incentive factors in low-value care delivery and that the association of these structural attributes also appears to be related to visits to physicians who are not the patient’s [primary care provider],” the  study authors wrote, according to Medscape.

Read the study abstract here.

Written by Mary Kate Nelson