Journal of General Internal Medicine

, Volume 22, Issue 10, pp 1385–1392 | Cite as

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

  • Mark W. Friedberg
  • Kathryn L. Coltin
  • Steven D. Pearson
  • Ken P. Kleinman
  • Jie Zheng
  • Janice A. Singer
  • Eric C. Schneider
Original Article



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.


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.


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.


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.


quality of care primary care HEDIS measures health care organization 


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Mark W. Friedberg
    • 1
  • Kathryn L. Coltin
    • 2
  • Steven D. Pearson
    • 3
  • Ken P. Kleinman
    • 3
  • Jie Zheng
    • 4
  • Janice A. Singer
    • 2
  • Eric C. Schneider
    • 1
    • 5
  1. 1.Division of General Internal MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Massachusetts Health Quality PartnersWatertownUSA
  3. 3.Department of Ambulatory Care and PreventionHarvard Medical SchoolBostonUSA
  4. 4.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  5. 5.Harvard School of Public HealthBostonUSA

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