• Medical care · Sep 2004

    The influence of physicians' practice management strategies and financial arrangements on quality of care among patients with diabetes.

    • Nancy L Keating, Mary Beth Landrum, Bruce E Landon, John Z Ayanian, Catherine Borbas, Robert Wolf, and Edward Guadagnoli.
    • Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA. keating@hcp.med.harvard.edu
    • Med Care. 2004 Sep 1;42(9):829-39.

    ContextHealth care organizations use many strategies to influence physician behavior and the care delivered, but the effect of such strategies on quality is not known.ObjectiveWe sought to assess the influence of practice management strategies and financial arrangements on the quality of diabetes care.DesignThis was a retrospective cohort study including medical record reviews and a physician survey.ParticipantsPatients with diabetes mellitus (n=652) enrolled in 3 health plans located in Minnesota and 399 physicians in 135 practices who cared for them participated in this study.Main Outcome MeasureOur main outcome measures was a quality score indicating receipt of care in accordance with 6 accepted quality indicators.ResultsThe mean quality score was 2.4 (SD 1.2) on a 6-point scale. Only a small proportion of the variation in quality was attributed to characteristics of physicians' practices (5%). Quality scores tended to be higher for patients whose physicians received quality performance reports or utilization profiles from more than 1 source (P=0.08), routinely enrolled diabetic patients in disease-management programs (P=0.06), or received diabetes-specific reports (P=0.06). Quality scores were lower for patients whose physicians were paid according to fee-for-service compared with salary (P=0.04) and served as gatekeepers for >50% of their patients (P=0.06). However, these findings were all of borderline statistical significance, and the absolute differences in quality were small.ConclusionsCurrent practice management strategies and financial arrangements have a limited impact on the quality of care for patients with diabetes. These findings suggest that other strategies may be necessary for health care organizations to improve care for patients with diabetes.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…