Recorded presentation

David Goodman, MD, MS¹, David Bott, PhD¹, Stephen S. Mick, PhD², and H.J. Carretta, ABD MPH³. (1) Center for Evaluative Clinical Sciences, Dartmouth Medical School, 7251 Strasenburgh Hall, Hanover, NH 03755, 603-650-1958, david.m.bott@dartmouth.edu, (2) Department of Health Administration, Virginia Commonwealth University, 1008 E Clay Street, Grant House, Richmond, VA 23298, (3) Health Administration Department, Virginia Commonwealth University/Medical College of Virginia Campus, 1008 E Clay Street, Grant House, Richmond, VA 23219

Research Objective: The availability of primary care clinicians is an important measure of health care resource capacity. The Primary Care Service Area (PCSA) project developed a high-quality measure of primary care within geographic boundaries reflecting local primary care delivery for the entire US that overcomes limitations of current methods. We present an updated definitional method and summary geographic and utilization characteristics for PCSAs nationwide.

Study Design: Small area analysis was employed to associate zipcodes of Medicare beneficiary residence to zipcodes with primary care providers using claims from 1999 Medicare files. Office-based primary care claims were identified by provider specialty, place of service, and CPT codes. Residence zipcode assignments were based upon the plurality of claims adjusted for high utilizers.

Population Studied: Entire US population (Census 2000).

Principal Findings: 6,542 PCSAs were defined with a median of 3 ZCTAs per PCSA. Median total population was 14,922 (inter-quintile range:5,735 - 42,085). The extent residents’ utilization remained within their PCSAs measured by median localization of primary care utilization was 61% (47%-75%).

Conclusions: Our method of defining PCSAs through Medicare physician and outpatient claims produces desirable regions that exhibit high localization of primary care utilization and are reasonably small.

Implications for Policy:  PCSAs linked to information about primary care resources, populations, and utilization have value for three primary activities: 1) evaluation of programs intended to improve availability of primary care in under-served areas, 2) understanding resources and utilization in order to improve the effectiveness and efficiency of medical service delivery, and 3) research seeking to understand the relationship between health care resources and population health outcomes.

Learning Objectives:

• • Define Primary Care Service Areas as used in this project.
  • Access PCSA website.
  • Apply to become a PCSA registered user.
  • Identify potential uses of PCSAs and PCSA data.
  • Understand advantages of ZIP Code Tabulation Areas to other representations of ZIP Code areas.
  • Describe how to analyze measures of primary care resources or utilization using PCSAs as the unit of analysis.

Keywords: Primary Care, Access and Services

Related Web page: pcsa.hrsa.gov/

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation