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Whether Chronic Diseases Are Diagnosed May Depend on Where You Live
Date:3/15/2011

By Jenifer Goodwin
HealthDay Reporter

TUESDAY, March 15 (HealthDay News) -- The likelihood of Medicare patients being diagnosed with a chronic disease may depend on where they live, a disparity that makes it more difficult to assess the quality of care patients receive, a new study finds.

Certain groups of Medicare patients in regions with the most diagnoses also had a lower case-fatality rate for chronic conditions such as coronary artery disease and kidney failure, but the reasons for that are unclear, the researchers reported.

It would stand to reason that whether a person is diagnosed with a chronic disease has to do with how ill they are, the researchers said.

But instead, the findings suggest that chronic disease diagnosis is influenced by the "intensity of health care" in a particular region, which includes how many doctors and specialists are operating in a particular region, access to those doctors and the likelihood of doctors to send you to a specialist or to order lab and imaging tests.

"The study suggests disease diagnosis is not only a property of the patient, but associated with the intensity with which health care is delivered in a region," said senior study author Dr. John Wennberg, a professor emeritus and founder of the Dartmouth Institute. "For example, if in certain regions people see lots of doctors, have lots of visits to doctors and lots of lab tests, that could be because there is a perfect relationship between illness and the amount of care that's delivered. But it could be that the more doctors you see, the more diagnoses you get."

The study, conducted by Dr. H. Gilbert Welch of the Department of Veterans Affairs Medical Center, White River Junction, Vt., and colleagues, appears in the March 16 issue of the Journal of the American Medical Association. It was funded in part by the National Institute on Aging.

Researchers analyzed records on nearly 5.2 mill
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