Ambulatory Subspecialty Visits in a Large Pediatric Primary Care Network

Authors

  • Louis Vernacchio,

    Corresponding author
    1. Division of General Pediatrics, Children's Hospital Boston, Boston, MA
    2. Department of Pediatrics, Harvard Medical School, Boston, MA
    • The Pediatric Physicians' Organization at Children's, Brookline, MA
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  • Jennifer M. Muto,

    1. The Pediatric Physicians' Organization at Children's, Brookline, MA
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  • Gregory Young,

    1. The Pediatric Physicians' Organization at Children's, Brookline, MA
    2. Division of General Pediatrics, Children's Hospital Boston, Boston, MA
    3. Department of Pediatrics, Harvard Medical School, Boston, MA
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  • Wanessa Risko

    1. The Pediatric Physicians' Organization at Children's, Brookline, MA
    2. Division of General Pediatrics, Children's Hospital Boston, Boston, MA
    3. Department of Pediatrics, Harvard Medical School, Boston, MA
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Address correspondence to Louis Vernacchio, M.D, M.Sc., The Pediatric Physicians' Organization at Children's, 33 Pond Avenue, Suite 102-B, Brookline, MA 02445; e-mail: louis.vernacchio@childrens.harvard.edu.

Abstract

Objective

To determine patterns of subspecialty utilization within a pediatric primary care network.

Data Sources/Study Setting

Paid claims from a large not-for-profit health plan for patients of The Pediatric Physicians' Organization at Children's, a network of private pediatric practices affiliated with Children's Hospital Boston.

Principal Findings

The subspecialty visit rate was 1.01 visits per subject-year. In 2007, 56.8 percent of subjects had no subspecialty visits, whereas 4.2 percent had ≥5 visits; the corresponding figures in 2008 were 54.1 and 4.5 percent, respectively. The most frequently visited subspecialties were Ophthalmology, Orthopedics, Dermatology, Otorhinolaryngology, and Allergy/Immunology. Visit rates varied sevenfold by practice.

Conclusions

Wide practice variability in pediatric subspecialty utilization suggests an opportunity for reducing unnecessary visits. Better integration between primary care and the most commonly used subspecialties will be needed to meaningfully reduce unnecessary visits and enhance value.

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