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Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care?

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Abstract

Purpose

Recent reports have emphasized the importance of delivery systems in improving health care quality. However, few prior studies have assessed differences in primary care quality between physician groups that differ in size and organizational configuration. We examined whether larger physician group size and affiliation with networks of multiple groups are associated with higher quality of care.

Methods

We conducted a cross-sectional observational analysis of 132 physician groups (including 4,358 physicians) who delivered primary care services in Massachusetts in 2002. We compared physician groups on performance scores for 12 Health Plan Employer Data and Information Set (HEDIS) measures reflecting processes of adult primary care.

Results

Network-affiliated physician groups had higher performance scores than non-affiliated groups for 10 of the 12 HEDIS measures (p < 0.05). There was no consistent relationship between group size and performance scores. Multivariable models including group size, network affiliation, and health plan showed that network-affiliated groups had higher performance scores than non-affiliated groups on 8 of the 12 HEDIS measures (p < 0.05), and larger group size was not associated with higher performance scores. Adjusted differences in the performance scores of network-affiliated and non-affiliated groups ranged from 2% to 15%. For 4 HEDIS measures related to diabetes care, performance score differences between network-affiliated and non-affiliated groups were most apparent among the smallest groups.

Conclusions

Physician group affiliation with networks of multiple groups was associated with higher quality, and for measures of diabetes care the quality advantage of network-affiliation was most evident among smaller physician groups.

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Acknowledgments

This study was funded by the Martin Solomon Education Fund at Brigham and Women’s Hospital. The Robert Wood Johnson Foundation supported the development of the MHQP database. The findings of this paper were presented at the 2006 Annual Meeting of the Society of General Internal Medicine on April 28, 2006.

Potential conflicts of interest

Dr. Pearson reports that he is a consultant for America’s Health Insurance Plans (AHIP). No other authors have any potential conflicts of interest to report.

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Correspondence to Eric C. Schneider MD, MSc.

Appendix

Appendix

Table 5 Appendix: HEDIS Service Definitions

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Friedberg, M.W., Coltin, K.L., Pearson, S.D. et al. Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care?. J GEN INTERN MED 22, 1385–1392 (2007). https://doi.org/10.1007/s11606-007-0234-0

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  • DOI: https://doi.org/10.1007/s11606-007-0234-0

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