Primary Care Quality in the Medicare Program

Safran, Dana Gelb; Wilson, Ira B.; Rogers, William H.; Montgomery, Jana E.; Chang, Hong

doi:10.1001/archinte.162.7.757

Cited by 43 publications

(10 citation statements)

References 40 publications

(53 reference statements)

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“…Research indicates that while most quality performance measures are superior in the traditional FFS program, enrollees in some private plans may have better financial access to care [115]. Research has also sought to identify the most appropriate site for delivering primary care to low-income populations in the USA; these studies have mixed findings, with vaccination rates higher in hospital outpatient settings but fewer delays in receiving care in physicians' offices [116].…”

Section: Methodsmentioning

confidence: 99%

The Impact of Primary Care: A Focused Review

2012

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Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.

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Section: Methodsmentioning

confidence: 99%

The Impact of Primary Care: A Focused Review

2012

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“…Previous studies indicate that patients of staff/group model health maintenance organizations (HMOs) consistently report worse experiences of care and lower visit continuity compared with patients of network HMOs (Safran, Tarlov, and Rogers 1994; Safran et al 2000; Safran et al 2002). Over the past decade, physicians belonging to staff/group model HMOs diversified their health plan contracts in order to gain access to patients who were opting for health plans that offered broader physician networks (Robinson and Casalino 1996; Robinson 2001).…”

mentioning

confidence: 99%

Organizational and Market Influences on Physician Performance on Patient Experience Measures

Rodríguez

Glahn

Rogers

et al. 2009

Health Services Research

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Objective. To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. Data Sources. This study employs Clinician and Group CAHPS survey data (n 5 105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. Study Design. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Principal Findings. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p 5 .007) and care coordination ( p 5 .03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p 5 .04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p 5 .04) and care coordination ( po.001) measures. Conclusions. Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable.

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“…Compared with patients enrolled in Medicare health maintenance organizations, those who had Medicarefee-for-serviceinsurancereportlongerandhigher-quality relationships with their PCPs. 44 Second, our study was limited to administrative data contained within the SEER-Medicare database, which omits important patient factors (eg, healthy behaviors, severity of comorbid illness, and medication use) that may be associated with CRC stage at diagnosis or mortality. Third, we did not differentiate CRC tests according to indication (screening vs diagnostic); thus, the rate of previous CRC screening may be lower than the 45.7% found.…”

Section: Commentmentioning

confidence: 99%

Primary Care Utilization and Colorectal Cancer Outcomes Among Medicare Beneficiaries

Ferrante¹

2011

Arch Intern Med

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Background Primary medical care may improve colorectal cancer (CRC) outcomes through increased use of CRC screening tests and earlier diagnosis. We examined the association between primary care utilization and CRC screening, stage at diagnosis, CRC mortality, and all-cause mortality. Methods We conducted a retrospective cohort study of patients, aged 67 to 85 years, diagnosed as having CRC between 1994 and 2005 in the Surveillance, Epidemiology, and End Results–Medicare–linked database. Association of the number of visits to primary care physicians (PCPs) in the 3- to 27-month period before the CRC diagnosis and CRC screening, early-stage diagnosis, CRC mortality, and all-cause mortality were examined using multivariable logistic regression and Cox proportional hazards models. Results The odds of CRC screening and early-stage diagnosis increased with increasing number of PCP visits (P<.001 for trend). Compared with persons having 0 or 1 PCP visit, patients with 5 to 10 visits had increased odds of ever receiving CRC screening at least 3 months before diagnosis (adjusted odds ratio, 2.60; 95% CI, 2.48-2.72) and early-stage diagnosis (1.35; 1.29-1.42). Persons with 5 to 10 visits had 16% lower CRC mortality (adjusted hazard ratio [AHR], 0.84; 95% CI, 0.80-0.88) and 6% lower all-cause mortality (0.94; 0.91-0.97) compared with persons with 0 or 1 visit. Conclusions Medicare beneficiaries with CRC have better outcomes if they have greater utilization of primary care before diagnosis. Revitalization of primary care in the United States may help strengthen the national efforts to reduce the burden of CRC.

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Primary Care Quality in the Medicare Program

Cited by 43 publications

References 40 publications

The Impact of Primary Care: A Focused Review

The Impact of Primary Care: A Focused Review

Organizational and Market Influences on Physician Performance on Patient Experience Measures

Primary Care Utilization and Colorectal Cancer Outcomes Among Medicare Beneficiaries

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