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Objectives: The objective of this study was to explore the use of the Clinical Classification for Health Policy Research (CCHPR) as a casemix adjustment method for examining physician practice patterns., Methods: The data source was 2 years of administrative claims from an 86,000 member health maintenance organization in southeastern Michigan. The CCHPR version 2 algorithm, which is in the public domain, was used to assign each claim to one of 260 clinical categories. CCHPR and age-sex categories were used as explanatory variables in multiple linear regression models with approved claims payments in dollars as the outcome variable. Regressions were performed retrospectively for 1994 and 1995, and with 1994 claims' history to predict 1995 utilization. Similar regressions were performed with age-sex categories alone, and also with the ambulatory diagnostic groups., Results: The adjusted R2 value of the retrospective regression models for total approved dollars was 0.42 for both study years when CCHPR categories were used. In contrast, age-sex explanatory variables alone achieved an R2 of 0.02., Conclusions: The CCHPR method appears to be a promising tool to understand variability in physician resource utilization in managed care.

Objective: To develop a sound method to identify patient and physician characteristics that influence specialty referrals.Design: A retrospective cohort analysis of medical claims data from 1996 supplemented with surveys of primary care physicians.Setting: A 600-member independent practice association in southeastern Michigan that provided care for 90,000 members of an HMO.Patients: Five cohorts, each of 2,000 to 6,000 patients with diagnoses that could be referred to cardiologists, ophthalmologists, pulmonologists, orthopedists, or general surgeons.Main Results: The referral rates for the different cohorts ranged from 1% to 7%. The discriminatory ability of the multivariate logistic models (c-statistic) ranged from 0.66 to 0.79. The likelihood of referral was associated with the patient's diagnoses and medications and with the referring physician's age, years out of medical school, satisfaction with the specialty being referred to, and the importance of making or confirming a diagnosis.Conclusions: Because these methods were not difficult to implement and the results were credible, we believe that other organizations should be able to use them. [ABSTRACT FROM AUTHOR]