Year: 1999
Type: editorial
Abstract: PatrickJ.O'Connor For decades, the identity of the right healthcare provider to deliver primary care in the United States has been a hotly debated policy question (Starfield 1992).However, the most important question is not who should be delivering primary care, but how to improve primary care (Donaldson 1996; Healthy Peopk 2000 1990).Quality ofcare is far from optimal (O'Connor, Solberg, and Baird 1998), and our understanding of reasons for this is far from complete.Why do substantial variations in quality measures exist across medical groups and clinics-even across clinics with a similar mix of patients and provider specialties (Kralewski, Rich, Bernhardt, et al. 1998)?To improve primary care services, it is important to identify factors in the practice environment that influence quality and cost of care.The complex web of interactions among patient characteristics, provider characteristics, and the practice environment is just beginning to be conceptualized and explored in a systematic way (Landon, Wilson, and Cleary 1998; Phillips et al. 1998; Crabtree, Miller, Stange, et al. 1998).The reports in this issue of HSR by Grumbach et al. (1999) and Selby, Grumbach, Quesenberry, et al. (1999), address the relative importance of the physician's specialty and practice environment in primary care.These investigators compared the quality and costs of primary care delivered by primary care physicians and by the subspecialist physicians who were delivering primary care services in the same clinics.Patient satisfaction measures were uniformly high and did not vary across physician specialties.Quality measures showed few differences across specialties.Primary care provided by the subspecialists was more expensive, with the subspecialty physicians having higher hospitalization rates, referral rates, radiology service use, and
Source: PubMed Central
Author: P J O'Connor
Institution: HealthPartners
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W161165394