Evaluating the relative clinical efficiency of family medicine satellite clinics

A study was conducted to evaluate the impact of decentralization in family medicine clinic services by comparing utilization of services in 3 satellite clinics to utilization patterns of patients served at the hub clinic. It was expected that a hub clinic would be more efficient than satellite clinics because of tighter administrative control and economies of scale. Stable chronically ill patients were used as a homogeneous tracer condition in a secondary analysis of 12 months of archival data. Three types of service use were analyzed: laboratory visits, x-ray visits, and visits to specialists. Among 1,410 stable chronically ill family medicine patients, 303 (21.5%) had 10 more laboratory visits, 222 (15.7%) had 2 or more x-ray visits, and 617 (43.8 %) had 2 or more visits to a specialist. Patients at one of the satellite clinics had greater odds of receiving 2 or more x-rays but lower odds of receiving 10 or more laboratory visits, in comparison with the hub clinic. Patients at the other 2 satellite clinics did not differ from hub patients for any type of service use. Overall, stable chronically ill patients were treated with approximately equal clinical efficiency in our satellite clinics. Some differences in efficiency may occur in some clinics, but these appear to be idiosyncratic rather than due to clinic size or distance from central control.