Geographic Variation in Quality of Care for Commercially Insured Patients

Abstract BACKGROUND: Extensive evidence documents geographic variation in spending, but limited research assesses geographic variation in quality, particularly among commercially insured enrollees. OBJECTIVE: To measure geographic variation in quality measures, correlation among measures, and correlation between measures and spending for commercially insured enrollees. DATA SOURCE: Administrative claims from the 2007-2009 Truven MarketScan database. METHODS: We calculated variation in, and correlations among, 10 quality measures across 306 Hospital Referral Regions (HRRs), adjusting for beneficiary traits and sample size differences. Further, we created a quality index and correlated it with spending. RESULTS: The coefficient of variation of HRR-level performance ranged from 0.04 to 0.38. Correlations among quality measures generally ranged from 0.2 to 0.5. Quality was modestly positively related to spending. CONCLUSION: Quality varied across HRRs and there was only a modest geographic "quality footprint." © Health Research and Educational Trust. KEYWORDS: Geographic variation; markets; quality; spending