Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

O’Malley, Ann S.; Rich, Eugene C.

doi:10.1007/s11606-015-3300-z

Cited by 46 publications

(74 citation statements)

References 55 publications

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“…We do not know whether this indicates that GPs’ definition of comprehensive services is narrowing, patients increasingly prefer specialist care or simply if GPs restrict their portfolio of services for convenience or economic reasons. While a recent study from O’Malley described a declining comprehensiveness in the U.S. and Canada, there are also studies that suggest otherwise in the Netherlands [17, 34, 35]. Our findings could be interpreted as a sign of increasing fragmentation or declining comprehensiveness of PHC.…”

Section: Discussionmentioning

confidence: 41%

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

et al. 2017

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BackgroundStudies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. In Norway, general practitioners (GPs) are traditionally expected to perform IUD-insertions and several surgical procedures as a part of comprehensive PHC. We aimed to investigate variation in the provision of surgical procedures and IUD-insertions across GPs and over time and explore determinants of such variation.MethodsRetrospective registry study of Norwegian GPs. From a comprehensive database of GPs’ reimbursement claims, we obtained procedure codes and GP characteristics such as age, gender, list size and municipality characteristics from 2006 through 2013. Multivariable logistic regression models were fitted to explore determinants of practice variation.ResultsWe extracted data from 4,828 GPs. In 2013, 91.0, 76.1 and 74.8% were reimbursed at least once for minor and major surgical procedures and IUD-insertion, respectively. Female GPs had lower odds for performing major surgical procedures (OR 0.38, 95% CI 0.32–0.45) and higher odds for performing IUD-insertions (OR 6.28, 95% CI 4.47–8.82) than male GPs. Older GPs and GPs with shorter patient lists were less likely to perform surgical procedures. GPs with longer patient lists had higher odds for performing IUD-insertions. The proportion of GPs performing surgical procedures increased over time, while the proportion decreased for IUD-insertions. The number of IUD-insertions in specialist care increased from 12,575 in 2011 to 15 216 (+21.0%) in 2014.ConclusionWe observed a large variation in the provision of surgical procedures and IUD-insertions amongst GPs in Norway. The GPs’ age, gender, list size and size of municipality were associated with performing the procedures. Our findings suggest a shift of IUD-insertions from primary to specialist care.

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Section: Discussionmentioning

confidence: 41%

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

et al. 2017

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“…I do think that the investigators demonstrate the ability to answer this within a 34‐country study context, and they should be commended for that. The multilevel modeling approach appears to be statistically valid, and the results are in line with the fairly scant literature that exists in this area (Starfield, Shi, and Macinko ; O'Malley and Rich ). In particular, the wide range of countries studied along with the focus on actual patient experience measured right after interactions with the primary care system are notable strengths of the paper.…”

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confidence: 77%

The Necessary Return of Comprehensive Primary Health Care

Bitton

2017

Health Services Research

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“…While comprehensiveness is a key element of primary care, due to the complexity of measuring its multiple dimensions, there are few ways to measure and track it . Comprehensiveness is the extent to which the patient's primary care provider (clinician, practice, or team) recognizes and meets the large majority of the patient's physical and common mental health care needs, including prevention and wellness, and acute, chronic, and comorbid condition management .…”

Section: Introductionmentioning

confidence: 99%

New approaches to measuring the comprehensiveness of primary care physicians

O’Malley

Rich

Shang

et al. 2019

Health Services Research

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Objective To develop claims‐based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting A total of 5359 PCPs caring for over 1 million Medicare fee‐for‐service beneficiaries from 1404 practices. Study Design We developed Medicare claims‐based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs’ comprehensiveness in 2013 with their beneficiaries’ emergency department, hospitalizations rates, and ambulatory care‐sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings Each measure varied across PCPs and had low correlation with the other measures—as intended, they capture different aspects of comprehensiveness. For patients whose PCPs’ comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.

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Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

Cited by 46 publications

References 55 publications

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

The Necessary Return of Comprehensive Primary Health Care

New approaches to measuring the comprehensiveness of primary care physicians

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