Does Ownership Make a Difference in Primary Care Practice?

Journal of the American Board of Family Medicine: JABFM

Rachel J. Springer^1¹  William L. Miller^1²  K. John McConnell^1³  Miguel Marino^1⁴  Samuel T. Edwards^1⁵  Bijal A. Balasubramanian^1⁶  Leif I. Solberg^1⁷  Kurt C. Stange^1⁸  Stephan Lindner^1⁹ 

[1] Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)^1;Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM);Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB);Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM);Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC);HealthPartners Institute, Minneapolis, Minnesota (LIS);School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM);Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE);From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM)

关键词: Cardiovascular Diseases;    Cross Sectional Analysis;    Delivery of Health Care;    Group Practice;    Ownership;    Primary Health Care;    Process Measures;    Quality Improvement;   

DOI  :  10.3122/jabfm.2019.03.180271

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices. Methods: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based practice characteristic measures, 9 survey-based quality improvement process measures, and 4 electronic health record-based cardiovascular disease prevention quality measures, namely, aspirin prescription, blood pressure control, cholesterol management, and smoking cessation support (ABCS). Results: Physician-owned practices were more likely to be solo (45.0% compared with 8.1%, P < .001 for health system practices and 12.8%, P = .009 for FQHCs) and less likely to have experienced a major change (eg, moved to a new location) in the last year (43.1% vs 65.4%, P = .01 and 72.1%, P = .001, respectively). FQHCs reported the highest use of quality improvement processes, followed by health system practices. ABCS performance was similar across ownership type, with the exception of smoking cessation support (51.0% for physician-owned practices vs 67.3%, P = .004 for health system practices and 69.3%, P = .004 for FQHCs). Conclusions: Primary care practice ownership was associated with differences in quality improvement process measures, with FQHCs reporting the highest use of such quality-improvement strategies. ABCS were mostly unrelated to ownership, suggesting a complex path between quality improvement strategies and outcomes.

【 授权许可】

CC BY