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Health Aff (Millwood). 2014 Sep;33(9):1680-8. doi: 10.1377/hlthaff.2014.0434. Epub 2014 Aug 13.

Small primary care physician practices have low rates of preventable hospital admissions.

Author information

1
Lawrence P. Casalino (lac2021@med.cornell.edu) is the Livingston Farrand Professor in the Department of Healthcare Policy and Research at Weill Cornell Medical College, in New York, New York.
2
Michael F. Pesko is an assistant professor in the Department of Healthcare Policy and Research, Weill Cornell Medical College.
3
Andrew M. Ryan is an associate professor in the Department of Healthcare Policy and Research, Weill Cornell Medical College.
4
Jayme L. Mendelsohn worked on this project as a research coordinator in the Department of Healthcare Policy and Research, Weill Cornell Medical College. She is currently a postbaccalaureate premedical student at Bryn Mawr.
5
Kennon R. Copeland is senior vice president and director in the Department of Statistics and Methodology, NORC at the University of Chicago, in Illinois.
6
Patricia Pamela Ramsay is a research specialist at the School of Public Health, University of California, Berkeley.
7
Xuming Sun worked on this project as a research biostatistician in the Department of Healthcare Policy and Research, Weill Cornell Medical College. She is currently working as a statistician in the New York City Department of Health and Mental Hygiene.
8
Diane R. Rittenhouse is an associate professor in the Department of Family and Community Medicine and Center for Excellence in Primary Care, University of California, San Francisco.
9
Stephen M. Shortell is the Blue Cross of California Distinguished Professor of Health Policy and Management at the School of Public Health, University of California, Berkeley.

Abstract

Nearly two-thirds of US office-based physicians work in practices of fewer than seven physicians. It is often assumed that larger practices provide better care, although there is little evidence for or against this assumption. What is the relationship between practice size--and other practice characteristics, such as ownership or use of medical home processes--and the quality of care? We conducted a national survey of 1,045 primary care-based practices with nineteen or fewer physicians to determine practice characteristics. We used Medicare data to calculate practices' rate of potentially preventable hospital admissions (ambulatory care-sensitive admissions). Compared to practices with 10-19 physicians, practices with 1-2 physicians had 33 percent fewer preventable admissions, and practices with 3-9 physicians had 27 percent fewer. Physician-owned practices had fewer preventable admissions than hospital-owned practices. In an era when health care reform appears to be driving physicians into larger organizations, it is important to measure the comparative performance of practices of all sizes, to learn more about how small practices provide patient care, and to learn more about the types of organizational structures--such as independent practice associations--that may make it possible for small practices to share resources that are useful for improving the quality of care.

KEYWORDS:

Cost of Health Care; Organization and Delivery of Care; Primary Care; Quality Of Care

PMID:
25122562
DOI:
10.1377/hlthaff.2014.0434
[Indexed for MEDLINE]

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