Does Ownership Make a Difference in Primary Care Practice?

Autor:	Lindner S; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS). lindners@ohsu.edu., Solberg LI; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Miller WL; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Balasubramanian BA; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Marino M; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., McConnell KJ; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Edwards ST; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Stange KC; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Springer RJ; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS)., Cohen DJ; From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS).
Jazyk:	angličtina
Zdroj:	Journal of the American Board of Family Medicine : JABFM [J Am Board Fam Med] 2019 May-Jun; Vol. 32 (3), pp. 398-407.
DOI:	10.3122/jabfm.2019.03.180271
Abstrakt:	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. Competing Interests: Conflict of interest: none declared. (© Copyright 2019 by the American Board of Family Medicine.)
Databáze:	MEDLINE
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