Does Ownership Make a Difference in Primary Care Practice?

Lindner, Stephan; Solberg, Leif I.; Miller, William L.; Balasubramanian, Bijal A.; Marino, Miguel; McConnell, K. John; Edwards, Samuel T.; Stange, Kurt C.; Springer, Rachel; Cohen, Deborah J.

doi:10.3122/jabfm.2019.03.180271

Cited by 11 publications

(11 citation statements)

References 39 publications

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“…22 In fact, a prior study examining a national program to improve cardiovascular preventative care found that CHCs had considerably higher rates of participation in quality improvement initiatives compared with physicianowned practices. 23 Similarly, some evidence suggests that CHCs may be more likely to escalate care for chronic conditions, like uncontrolled hypertension, compared with private practices. 24 During the same time period as our study, there was a concerted national effort to reform healthcare delivery and certify FQHCs as patient-centered medical homes (PCMH).…”

Section: Discussionmentioning

confidence: 99%

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

Oronce

Fortuna

2019

J GEN INTERN MED

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BACKGROUND: Community health centers (CHCs) are an integral part of the health care safety net. As health systems seek to improve value, it is important to understand the quality of care provided by CHCs. OBJECTIVE: To evaluate the performance of CHCs compared with private practices on a comprehensive set of high-value and low-value care measures. DESIGN: This cross-sectional study used data from the National Ambulatory Medical Care Survey from 2010 through 2012. We compared CHCs with private practices using logistic regression models that adjusted for age, sex, race/ethnicity, insurance, number of chronic illnesses, rural versus urban location, region of country, and survey year. SETTING/PARTICIPANTS: We included outpatient visits to generalist physicians at either CHCs or private practices by patients 18 years and older. MAIN MEASURES: We examined 12 measures of highvalue care and 7 measures of low-value care. RESULTS: A total of 29,155 physician visits, representing 584,208,173 weighted visits, from 2010 through 2012 were included. CHCs were more likely to provide highvalue care by ordering beta-blockers in CHF (46.9% vs. 36.5%; aOR 2.56; 95%CI 1.18-5.56), statins in diabetes (37.0% vs 35.5%; aOR 1.35; 95%CI 1.02-1.79), and providing treatment for osteoporosis (35.7% vs 23.2%; aOR 1.77; 95%CI 1.05-3.00) compared with private practices. CHCs were more likely to avoid low-value screening EKGs (98.7% vs. 88.0%; aOR 11.03; 95%CI 2.67-45.52), CBCs (75.9% vs. 65.7%; aOR 1.72; 95%CI 1.18-2.53), or urinalyses (86.0% vs. 80.5%; aOR 1.87; 95%CI 1.11-3.14) during a general medical exam. CHCs were also less likely to prescribe antibiotics for a URI (48.3% vs. 63.1%; aOR 0.59; 95%CI 0.40-0.88). CONCLUSIONS: On a number of high-value and lowvalue measures of care, CHCs performed similar to or better than private practices. As healthcare delivery reforms continue to progress, CHCs are well positioned to provide high-value healthcare.

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Section: Discussionmentioning

confidence: 99%

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

Oronce

Fortuna

2019

J GEN INTERN MED

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“…The funding agency specified the four targeted CQMs for all practices participating in the national EvidenceNOW initiative. 16 The CQMs for aspirin use, blood pressure control, cholesterol management, and smoking cessation aligned with the National Quality Forum We used all available data reported by practices by June 1, 2018, the end of the final quarter for required CQMs for the analysis reported here. Not all practices were able to report CQMs by this date.…”

Section: Data Sourcesmentioning

confidence: 99%

“…The surveys were designed in collaboration with the national EvidenceNOW evaluation team. 15,16 One 48-item practice survey per practice was completed by a lead administrator and lead clinician to gather descriptive information at the practice and organizational level. The practice survey included the Change Process Capability Questionnaire, an assessment of quality improvement strategies.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Practices began this initiative with varied levels of experience with quality improvement processes. 15,16 Some practices were novices in improving cardiovascular disease care; others had previously completed quality improvement initiatives, entering this study having already achieved high performance on one or more measures. Because practices began at different levels of CQMs, change over time on CQMs was not a good indicator of success that could be applied to all practices.…”

Section: Introductionmentioning

confidence: 99%

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Exemplary Practices in Cardiovascular Care: Results on Clinical Quality Measures from the EvidenceNOW Southwest Cooperative

et al. 2020

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BACKGROUND: Identifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies. OBJECTIVE: To identify practice characteristics associated with high performance on four cardiovascular disease CQMs. DESIGN: Longitudinal cohort study among 211 primary care practices in Colorado and New Mexico. Quarterly CQM reports were obtained from 178 (84.4%) practices. There was 100% response rate for baseline practice characteristics and implementation tracking surveys. Followup implementation tracking surveys were completed for 80.6% of practices. PARTICIPANTS: Adult patients, staff, and clinicians in family medicine, general internal medicine, and mixedspecialty practices. INTERVENTION: Practices received 9 months of practice facilitation and health information technology support, plus biannual collaborative learning sessions. MAIN MEASURES: This study identified practice characteristics associated with overall highest performance using area under the curve (AUC) analysis on aspirin therapy, blood pressure management, and smoking cessation CQMs. RESULTS: Among 178 practices, 39 were exemplars. Exemplars were more likely to be a Federally Qualified Health Center (69.2% vs 35.3%, p = 0.0006), have an underserved designation (69.2% vs 45.3%, p = 0.0083), and have higher percentage of patients with Medicaid (p < 0.0001). Exemplars reported greater use of cardiovascular disease registries (61.5% vs 29.5%,), standing orders (38.5 vs 22.3%) or electronic health record prompts (84.6% vs 49.6%) (all p < 0.05), were more likely to have medical home recognition (74.4% vs 43.2%, p = 0.0006), and reported greater implementation of building blocks of high-performing primary care: regular quality improvement team meetings (3.0 vs 2.2), patient experience survey (3.1 vs 2.2), and resources for patients to manage their health (3.0 vs 2.3). High improvers (n = 45) showed greater improvement implementing team-based care (32.8 vs 11.7, p = 0.0004) and population management (37.4 vs 20.5, p = 0.0057). CONCLUSIONS: Multiple strategies-registries, prompts and protocols, patient self-management support, and patient-team partnership activities-were associated with delivering high-quality cardiovascular care over time, measured by CQMs.

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“…[3][4][5][6][7][8] There is a growing literature that compares cost and quality of care between care provided by integrated providers and those provided by independent providers. Previous studies on this topic have used hospital-based quality data, 9 survey data, [10][11][12] data from selected organizations, 13 or claims data from the Medicare population 14 to investigate the impact of integration on quality of care. This study is one of the first to study the relationship between health system integration and primary care quality and cost of care using commercial claims data.…”

Section: Introductionmentioning

confidence: 99%

Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states

Zhou

Beaulieu

Cutler

2020

Health Services Research

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Objective: To characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between insystem providers and non-system providers for the commercially insured population. Data Sources: Physician membership in health systems was obtained from a unique longitudinal database on health systems and matched at the provider level to 2014 all-payer claims data from Colorado, Massachusetts, Oregon, and Utah. Study Design: Using an observational study design, we compared physicians in health systems to non-system physicians located in the same state and geography on average cost of care (risk-adjusted using the Johns Hopkins' Adjusted Clinical Grouper), five HEDIS quality measures, one measure of developmental screening, and two Prevention Quality Indicator Measures. Data Collection/Extraction Methods: Patients in commercial health plans were attributed to a primary care physician accounting for the plurality of office visits. A cohort for each quality measure was constructed based on appropriate measure specifications.

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Does Ownership Make a Difference in Primary Care Practice?

Cited by 11 publications

References 39 publications

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

Exemplary Practices in Cardiovascular Care: Results on Clinical Quality Measures from the EvidenceNOW Southwest Cooperative

Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states

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