Skip to main content

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

Journal of General Internal Medicine volume 22, pages 1385–1392 (2007)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

    Google Scholar 

  2. Chassin MR, Galvin RW. The urgent need to improve health care quality: Institute of Medicine national roundtable on health care quality. JAMA 1998;280:1000–5.

    PubMed  Article  CAS  Google Scholar 

  3. Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States? Milbank Q 1998;76:517–63.

    PubMed  Article  CAS  Google Scholar 

  4. Robinson JC. Consolidation of medical groups into physician practice management organizations. JAMA 1998;279:144–49.

    PubMed  Article  CAS  Google Scholar 

  5. Casalino LP, Devers KJ, Lake TK, et al. Benefits of and barriers to large medical group practice in the United States. Arch Intern Med 2003;163:1958–64.

    PubMed  Article  Google Scholar 

  6. Shortell SM, Schmittdiel J. Prepaid groups and organized delivery systems: promise, performance, and potential. In: Enthoven AC, Tollen LA, eds. Toward a 21st Century Health System: the Contributions and Promise of Prepaid Group Practice. San Francisco, CA: Jossey-Bass; 2004:1–21.

    Google Scholar 

  7. Berwick DM, Jain SH. The basis for quality care in prepaid group practice. In: Enthoven AC, Tollen LA, eds. Toward a 21st Century Health System: the Contributions and Promise of Prepaid Group Practice. San Francisco, CA: Jossey-Bass; 2004:22–44.

    Google Scholar 

  8. Chuang KH, Luft HS, Dudley RA. The clinical and economic performance of prepaid group practice. In: Enthoven AC, Tollen LA, eds. Toward a 21st Century Health System: the Contributions and Promise of Prepaid Group Practice. San Francisco, CA: Jossey-Bass; 2004:45–60.

    Google Scholar 

  9. Lawrence D. From chaos to care: the promise of team-based medicine. United States of America: Perseus Publishing; 2002.

    Google Scholar 

  10. Casalino LP. Disease management and the organization of physician practice. JAMA 2005;293:485–8.

    PubMed  Article  CAS  Google Scholar 

  11. Miller RH, Bovbjerg RR. Efforts to improve patient safety in large, capitated medical groups: description and conceptual model. J Health Polit Policy Law 2002;27:401–40.

    PubMed  Article  Google Scholar 

  12. Burns LR. Medical organization structures that promote quality and efficiency: past research and future considerations. Qual Manag Health Care 1995;3:10–18.

    PubMed  CAS  Google Scholar 

  13. Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA 2003;289:434–41.

    PubMed  Article  Google Scholar 

  14. Barr DA. The effects of organizational structure on primary care outcomes under managed care. Ann Intern Med 1995;122:353–9.

    PubMed  CAS  Google Scholar 

  15. Shortell SM. Increasing value: a research agenda for addressing the managerial and organizational challenges facing health care in the United States. Med Care Res Rev 2004;61:12S–30S.

    PubMed  Article  Google Scholar 

  16. Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study. J Gen Intern Med 2000;15:441–50.

    PubMed  Article  CAS  Google Scholar 

  17. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medical errors. JAMA 2005;293:1197–203.

    PubMed  Article  CAS  Google Scholar 

  18. Robinson JC. The end of managed care. JAMA 2001;285:2622–8.

    PubMed  Article  CAS  Google Scholar 

  19. Audet A, Doty MM, Shamasdin J, et al. Measure, learn, and improve: physicians’ involvement in quality improvement. Health Aff 2005;24:843–53.

    Article  Google Scholar 

  20. Rittenhouse DR, Grumbach K, O’Neill EH, et al. Physician organization and care management in California: from cottage to Kaiser. Health Aff 2004;23:51–62.

    Article  Google Scholar 

  21. Chehab EL, Panicker N, Alper PR, et al. The impact of practice setting on physician perceptions of the quality of practice and patient care in the managed care era. Arch Intern Med 2001;161:202–11.

    PubMed  Article  CAS  Google Scholar 

  22. Pham HH, Schrag D, Hargraves JL, et al. Delivery of preventive services to older adults by primary care physicians. JAMA 2005;294:473–81.

    PubMed  Article  CAS  Google Scholar 

  23. Spoeri RK, Ullman R. Measuring and reporting managed care performance: lessons learned and new initiatives. Ann Intern Med 1997;127(8, pt 2):726–32.

    PubMed  CAS  Google Scholar 

  24. Zeger S, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121–30.

    PubMed  Article  CAS  Google Scholar 

  25. Liang KY, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22.

    Article  Google Scholar 

  26. Zaslavsky AM, Hochheimer JN, Schneider EC, et al. Impact of sociodemographic case mix on the HEDIS measures of health plan quality. Med Care 2000;38:981–92.

    PubMed  Article  CAS  Google Scholar 

  27. Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA 2002;287:1288–94.

    PubMed  Article  Google Scholar 

  28. Institute of Medicine. Performance Measurement: Accelerating Improvement. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  29. Schneider EC, Zaslavsky AM, Landon BE, et al. National quality monitoring of medicare health plans: the relationship between enrollees’ reports and the quality of care. Med Care 2001;39:1313–25.

    PubMed  Article  CAS  Google Scholar 

  30. Werner RM, Bradlow ET. Relationship between Medicare’s hospital compare performance measures and mortality rates. JAMA 2006;296:2694–702.

    PubMed  Article  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Mark W. Friedberg MD, MPP & Eric C. Schneider MD, MSc

  2. Massachusetts Health Quality Partners, Watertown, Massachusetts, USA

    Kathryn L. Coltin MPH & Janice A. Singer MPH, MA

  3. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts, USA

    Steven D. Pearson MD, MSc & Ken P. Kleinman ScD

  4. Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA

    Jie Zheng PhD

  5. Harvard School of Public Health, 667 Huntington Avenue, Boston, Massachusetts, 02115, USA

    Eric C. Schneider MD, MSc

Authors
  1. Mark W. Friedberg MD, MPP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathryn L. Coltin MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven D. Pearson MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ken P. Kleinman ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jie Zheng PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Janice A. Singer MPH, MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eric C. Schneider MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric C. Schneider MD, MSc.

Appendix

Appendix

Table 5 Appendix: HEDIS Service Definitions
Full size table

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

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

KEY WORDS

  • quality of care
  • primary care
  • HEDIS measures
  • health care organization