Quality of care in the New Mexico Medicaid program (1971-1975) : the effect of the New Mexico Experimental Medical Care Review Organization on the use of antibiotics for common infectious diseases
One of a series of publications on the New Mexico Experimental Medical Care Review Organization (EMCRO), this study describes patterns of ambulatory care for common infectious diseases (chiefly respiratory) among participants in the New Mexico Medicaid program. The study investigates (1) the effect of physician characteristics on outpatient care and (2) how physician peer review organization (EMCRO) affects that care, especially the use of injectable drugs. The first part of the study focuses on ambulatory visits and all types of injectable drugs. The second part develops a methodology for defining entire episodes of care for six common respiratory infections; with episodes as the analytic unit, use of both intramuscular and oral antibiotics, laboratory tests, and followup visits was explored. Documented findings include improvements in the use of injectable drugs, especially antibiotics, and differences in quality of care delivered by various physicians. Implications for (1) refining and using episode methodology for insurance claims data and (2) national policies on quality of care assessment and assurance are discussed.