Adjusting for case mix and social class in examining variation in home visits between practices

Published: August 1, 2004
Category: Bibliography > Papers
Authors: Forrest CB, Majeed A, Omar RZ, Sullivan CO
Countries: United Kingdom
Language: null
Types: Care Management
Settings: Academic

Fam Pract 21:355-363.

Public Health Policy Unit, School of Public Policy, University College London, London, UK

OBJECTIVES: The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone.

METHODS: The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year’s diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC).

RESULTS: The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%).

CONCLUSIONS: Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.

PMID: 15249522

Morbidity Patterns,Population Markers,Practice Patterns Comparison,United Kingdom,Adolescent,Adult,Aged Distribution,Age Factors,Aged 80 and over,Child Preschool,Gender,Health Surveys,Infant,Newborn,Logistic Models,Primary Health Care,Prospective studies,Sex Factors,United Kingdom/epidemiology

Please log in/register to access.

Log in/Register

LinkedIn Facebook Twitter

© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System.
All rights reserved. Terms of Use Privacy Statement

Back to top