Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?

5 December 2006 | Volume 145 Issue 11 | Pages 826-833

Background: The association between the organizational structure of physician groups and health care quality has never been evaluated empirically.

Objective: To examine whether integrated medical groups (IMGs) provide higher-quality primary care than individual practice associations (IPAs).

Design: Cross-sectional study.

Setting: PacifiCare, a large health maintenance organization.

Participants: Approximately 1.7 million enrollees of PacifiCare cared for by 119 California physician groups between July 1999 and June 2000.

Measurements: The percentage of eligible PacifiCare enrollees who received mammography, Papanicolaou smear screening, chlamydia screening, diabetic eye examination, an asthma controller medication, or a ß-blocker after acute myocardial infarction.

Results: Physician groups identified as IMGs, compared with those identified as IPAs, had higher rates of mammography (relative risk, 1.15 [95% CI, 1.01 to 1.33]), Papanicolaou smear screening (relative risk, 2.29 [CI, 1.53 to 3.42]), chlamydia screening (relative risk, 2.17 [CI, 1.04 to 4.55]), and diabetic eye screening (relative risk, 1.55 [CI, 1.28 to 1.88]). Leaders of IMGs were more likely to report using EMRs (37% vs. 2%; P < 0.001) and quality improvement strategies, but these characteristics explained little of the quality differences between IMGs and IPAs.

Limitations: Organizational characteristics, including group type, were reported by physician group leaders and not directly assessed. Patient characteristics that could have accounted for some of the observed differences also were not assessed.

Conclusions: Patients cared for in IMGs generally received higher-quality primary care than those cared for in IPAs. Having an EMR and implementation of quality improvement strategies did not explain the differences in quality. These findings suggest that physician group type influences health care quality.

Editors' Notes Context The quality of health care may differ by the way physician practice groups are organized. Physician practices that are members of integrated medical groups (IMGs) may have resources to improve quality that independent physician practices do not. Contribution The authors used data from a quality report card of a California health maintenance organization to compare the quality of care delivered by IMGs or individual practice associations. They found that IMGs tended to do better on standard measures of quality, such as Papanicolaou smears and diabetic eye screening. Cautions Group type and other organizational characteristics important in the analysis were reported by physician group leaders and were not directly assessed. Differences in patients also were not assessed. Implications Integrated medical groups seemed to do better on some measures of quality, suggesting that it is important to account for organizational setting in measures of and discussions about health care quality. —The Editors

 

Author and Article Information

From University of Pittsburgh and RAND Health, Pittsburgh, Pennsylvania; and Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts.

Acknowledgments: The authors thank Sam Ho and colleagues at PacifiCare and the leaders of the physician organizations in their network for their cooperation and assistance. They also thank Alan Zaslavsky for statistical advice.

Grant Support: Data collection for this study was supported by the California HealthCare Foundation and the Commonwealth Fund. Dr. Mehrotra was supported by an institutional National Research Service Award (5 T32 HP11001-15).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Ateev Mehrotra, MD, MPH, RAND Health and University of Pittsburgh School of Medicine, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665; e-mail, mehrotra{at}rand.org.

Current Author Addresses: Dr. Mehrotra: RAND Health and University of Pittsburgh School of Medicine, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665.

Dr. Epstein: Harvard School of Public Health, Kresge Building, Room 403, 677 Huntington Avenue, Boston, MA 02115.

Dr. Rosenthal: Harvard School of Public Health, Kresge Building, Room 405, 677 Huntington Avenue, Boston, MA 02115.

Read all Rapid Responses

Integrated medical groups may not be better than individual practice associations

P Dileep Kumar

Annals Online, 22 Dec 2006 [Full text]

Authors' Response

Ateev Mehrotra, et al.

Annals Online, 29 Jan 2007 [Full text]