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Forget the ‘Personal Touch:’ Larger Physician Practices May Provide Higher-Quality Care, Study Finds

PITTSBURGH, December 5, 2006 — Many health care consumers might prefer the perceived “personal touch” of the small neighborhood doctor’s office. But in the first study comparing quality measures to the size and structure of physician groups, researchers found that larger, integrated medical groups generally provide higher-quality care, according to an article in the current issue of the Annals of Internal Medicine.

The study, led by Ateev Mehrotra, M.D., of the University of Pittsburgh School of Medicine and RAND Health, analyzed data from 119 California physician groups that contracted with PacifiCare, a large health maintenance organization, between July 1999 and June 2000. The researchers examined three preventive-care measures, such as percentage of eligible patients who received mammograms, and three chronic disease-management measures, including percentage of patients with asthma who received a controller medication. The integrated medical groups—with employed physicians practicing together in facilities owned and managed by the group—had higher scores than the independent practices on four of the six quality measures, according to the study.

“Most physicians in this country work in independent, one-, two-, or three-person practices,” said Dr. Mehrotra. “But the larger systems with employed physicians actually had higher-quality care, and sometimes that difference was substantial. This goes against the perception by some patients that the best care is provided at your small doctor’s office around the corner.”

While the larger groups were far more likely to use electronic medical records and to adopt quality-improvement strategies, such as contacting patients to remind them of missed appointments, these strategies explained little of the quality differences, the study found. The results do not suggest that such strategies are wrong, but “underscore the importance of understanding how organizational setting influences the quality of care provided,” the article noted. While other studies have suggested that the organizational structure of physician groups can affect quality, this is the first to demonstrate this empirically, according to the authors.

The researchers speculated that the centralized decision-making and closer affiliations of the integrated groups might enable them to provide higher-quality care, at least for the types of medical services measured by PacifiCare’s performance reports. And these groups may have more resources to invest in improving care. Younger doctors with the latest training might also be more likely to join these larger, employed-physician groups, Dr. Mehrotra noted.

Co-authors are Arnold M. Epstein, M.D., and Meredith B. Rosenthal, Ph.D., both of the Harvard School of Public Health. The study was supported by grants from the California HealthCare Foundation and the Commonwealth Fund. The funders had no role in the design of the study or the analyses. Dr. Mehrotra was supported by an institutional National Research Service Award.

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