摘要：Efforts to measure quality of care have focused on ambulatory care providers. We examined the performance of community health centers serving children on Medicaid in 3 states. Descriptive analysis showed considerable patient population heterogeneity, and regression analysis demonstrated that variation explained by the assigned provider was small (mean R2 = 4.3%) compared with the variation explained by patient demographic variables (mean R2 = 29.9%). The results reinforce the need for caution when one is attributing quality differences to provider performance. Efforts to measure the performance of ambulatory care providers have encountered methodological challenges. 1–4 Patient characteristics have been shown to be an important determinant of outcomes, making risk adjustment difficult. 5–8 The relative contribution of provider-level factors in explaining performance variability has appeared low. 9,10 We used administrative data to explore patient- and provider-level determinants of performance variability within the community health center (CHC) delivery system.
