Quality of Care in Physician Groups
Do Larger Integrated Systems Deliver Higher Quality Care?
Ateev Mehrotra MD MPH RAND Pittsburgh & University of Pittsburgh
AcademyHealth Annual Research Meeting June 5th 2007
Background
Organization of Physician Groups
Integrated Medical Groups Individual Physician Associations (IPAs)
Many believe that integrated medical groups provide higher quality care
Centralized decision making Closer affiliations with physicians Pooled resources
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Previous Evidence
• Large medical groups generally more
likely to implement QI – Provide health promotion – Smoking cessation – Patient reminders for preventive care
McMenamin, Medical Care, 2003
Schmittdiel, Prev Med, 2004 Rittenhouse, Medical Care, 2006
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Two Studies
• Does P4P impact relationship between
organizational structure and use of QI initiatives • Relationship between organizational structure, QI initiatives, and performance on quality measures
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Will Increasing Use of P4P Impact the Relationship between Organization and QI Strategies
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Study Sample
• 100 groups on Massachusetts 2005 publicly
released physician group report card • Interviewed leaders of 79 groups between May and September 2005 • Semi-structured phone interviews lasting 30-60 min
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Prevalence and Magnitude of P4P in Massachusetts
Groups with P4P incentives in health plan contracts
89%
Overall revenue tied to P4P
2.2%
(0.3 – 8.0)
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Use of QI Initiatives
HbA1c Measurement Mammogram Screening Asthma Controller Medication Use Adequacy of Well Child Visits Chlamydia Screening Hyperlipidemia Screening LDL control Hypertension Control 0 20 40 60 80 100
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Variables Associated with Increased Use of QI Initiatives
Odds Ratio (95% CI) Pay-for-performance incentive Physician Group employs majority of physicians (vs. employs minority) Larger group (>median of 39 physicians vs.