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Patient–Physician Connectedness and Quality of Primary Care
- Steven J. Atlas, MD, MPH;
- Richard W. Grant, MD, MPH;
- Timothy G. Ferris, MD;
- Yuchiao Chang, PhD; and
- Michael J. Barry, MD
Abstract
Background: Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not known.
Objective: To determine whether patient–physician connectedness affects measures of clinical performance.
Design: Population-based cohort study.
Setting: Academic network of 4 community health centers and 9 hospital-affiliated primary care practices.
Patients: 155 590 adults with 1 or more visits to a study practice from 2003 to 2005.
Measurements: A validated algorithm was used to connect patients to either 1 of 181 physicians or 1 of 13 practices in which they received most of their care. Performance measures included breast, cervical, and colorectal cancer screening in eligible patients; hemoglobin A1c measurement and control in patients with diabetes; and low-density lipoprotein cholesterol measurement and control in patients with diabetes and coronary artery disease.
Results: Overall, 92 315 patients (59.3%) were connected to a specific physician, whereas 53 669 patients (34.5%) were connected only to a specific practice and 9606 patients (6.2%) could not be connected to a physician or practice. The proportion of patients in a practice who could be connected to a physician varied markedly (45.6% to 71.2% of patients per practice; P < 0.001). Physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care (for example, adjusted mammography rates were 78.1% vs. 65.9% [P < 0.001] and adjusted hemoglobin A1c rates were 90.3% vs. 74.9% [P < 0.001]). Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity.
Limitation: Patient–physician connectedness was assessed in 1 primary care network.
Conclusion: Patients seen in primary care practices seem to be variably connected with a specific physician, and less connected patients are less likely to receive guideline-consistent care.
Funding: National Cancer Institute.
Article and Author Information
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Acknowledgment: The authors thank Jeffrey Ashburner, MPH, for manuscript preparation and statistical analyses.
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Grant Support: By the National Cancer Institute (grant NCI 1 R21 CA121908) and institutional funding from the Massachusetts General Hospital Primary Care Operations Improvement Program. Dr. Grant is supported by a National Institute of Diabetes and Digestive and Kidney Diseases Career Development Award (K23 DK067452), and Dr. Ferris was supported in part by the Agency for Healthcare Research and Quality (grant 5R01 HS015002).
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Potential Financial Conflicts of Interest: None disclosed.
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Reproducible Research Statement: Study protocol: Patient–physician connected algorithm and methods available from Dr. Atlas (e-mail, satlas{at}partners.org). Statistical code: Available from Dr. Atlas (e-mail, satlas{at}partners.org). Data set: Not available.
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Requests for Single Reprints: Steven J. Atlas, MD, MPH, General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, satlas{at}partners.org.
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Current Author Addresses: Drs. Atlas, Grant, Chang, and Barry: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
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Dr. Ferris: Massachusetts General Hospital, 55 Fruit Street, Bulfinch 205, Boston, MA 02114.
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Author Contributions: Conception and design: S.J. Atlas, R.W. Grant, T.G. Ferris, M.J. Barry.
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Analysis and interpretation of the data: S.J. Atlas, R.W. Grant, T.G. Ferris, Y. Chang, M.J. Barry.
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Drafting of the article: S.J. Atlas, T.G. Ferris.
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Critical revision of the article for important intellectual content: R.W. Grant, T.G. Ferris, M.J. Barry.
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Final approval of the article: S.J. Atlas, R.W. Grant, T.G. Ferris, Y. Chang, M.J. Barry.
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Provision of study materials or patients: S.J. Atlas.
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Statistical expertise: Y. Chang.
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Obtaining of funding: S.J. Atlas, M.J. Barry.
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Administrative, technical, or logistic support: M.J. Barry.
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