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Health Serv Res. 1999 June; 34(2): 485–502.
PMCID: PMC1089019

Quality of primary care practice in a large HMO according to physician specialty.

Abstract

OBJECTIVE: To determine whether physician specialty was associated with differences in the quality of primary care practice and patient satisfaction in a large, group model HMO. DATA SOURCES/STUDY SETTING: 10,608 patients ages 35-85 years, selected using stratified probability sampling from the primary care panels of 60 family physicians (FPs), 245 general internists (GIMs), and 55 subspecialty internists (SIMs) at 13 facilities in the Kaiser Permanente Medical Care Program of Northern California. Patients were surveyed in 1995. STUDY DESIGN: A cross-sectional patient survey measured patient reports of physician performance on primary care measures of coordination, comprehensiveness, and accessibility of care, preventive care procedures, and health promotion. Additional items measured patient satisfaction and health values and beliefs. PRINCIPAL FINDINGS: Patients were remarkably similar across physician specialty groups in their health values and beliefs, ratings of the quality of primary care, and satisfaction. Patients rated GIMs higher than FPs on coordination (adjusted mean scores 68.0 and 58.4 respectively, p<.001) and slightly higher on accessibility and prevention; GIMs were rated more highly than SIMs on comprehensiveness (adjusted mean scores 76.4 and 73.8, p<.01). There were no significant differences between specialty groups on a variety of measures of patient satisfaction. CONCLUSIONS: Few differences in the quality of primary care were observed by physician specialty in the setting of a large, well-established group model HMO. These similarities may result from the direct influence of practice setting on physician behavior and organization of care or, indirectly, through the types of physicians attracted to a well-established group model HMO. In some settings, practice organization may have more influence than physician specialty on the delivery of primary care.

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Selected References

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  • Ayanian JZ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL, McNeil BJ. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med. 1994 Oct 27;331(17):1136–1142. [PubMed]
  • Bertakis KD, Robbins JA. Gatekeeping in primary care: a comparison of internal medicine and family practice. J Fam Pract. 1987 Mar;24(3):305–309. [PubMed]
  • Bindman AB, Grumbach K, Osmond D, Vranizan K, Stewart AL. Primary care and receipt of preventive services. J Gen Intern Med. 1996 May;11(5):269–276. [PubMed]
  • Borowsky SJ, Kravitz RL, Laouri M, Leake B, Partridge J, Kaushik V, Haywood LJ, Brook RH. Effect of physician specialty on use of necessary coronary angiography. J Am Coll Cardiol. 1995 Nov 15;26(6):1484–1491. [PubMed]
  • Bowman MA. The quality of care provided by family physicians. J Fam Pract. 1989 Mar;28(3):346–355. [PubMed]
  • Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med. 1995 Oct 5;333(14):913–917. [PubMed]
  • Cherkin DC, Hart LG, Rosenblatt RA. Patient satisfaction with family physicians and general internists: is there a difference? J Fam Pract. 1988 May;26(5):543–551. [PubMed]
  • Cherkin DC, Rosenblatt RA, Hart LG, Schleiter MK. A comparison of the patients and practices of recent graduates of family practice and general internal medicine residency programs. Med Care. 1986 Dec;24(12):1136–1150. [PubMed]
  • Dietrich AJ, Goldberg H. Preventive content of adult primary care: do generalists and subspecialists differ? Am J Public Health. 1984 Mar;74(3):223–227. [PubMed]
  • Franks P, Nutting PA, Clancy CM. Health care reform, primary care, and the need for research. JAMA. 1993 Sep 22;270(12):1449–1453. [PubMed]
  • Garg ML, Mulligan JL, Gliebe WA, Parekh RR. Physician specialty, quality and cost of inpatient care. Soc Sci Med. 1979 Oct;13C(3):187–190. [PubMed]
  • Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, Keller A, Tarlov AR, Ware JE., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed]
  • Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. 1995 Nov 8;274(18):1436–1444. [PubMed]
  • Greenwald HP, Peterson ML, Garrison LP, Hart LG, Moscovice IS, Hall TL, Perrin EB. Interspecialty variation in office-based care. Med Care. 1984 Jan;22(1):14–29. [PubMed]
  • Hiatt RA, Pérez-Stable EJ, Quesenberry C, Jr, Sabogal F, Otero-Sabogal R, McPhee SJ. Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California. Prev Med. 1995 May;24(3):278–285. [PubMed]
  • Hueston WJ, Applegate JA, Mansfield CJ, King DE, McClaflin RR. Practice variations between family physicians and obstetricians in the management of low-risk pregnancies. J Fam Pract. 1995 Apr;40(4):345–351. [PubMed]
  • Jollis JG, DeLong ER, Peterson ED, Muhlbaier LH, Fortin DF, Califf RM, Mark DB. Outcome of acute myocardial infarction according to the specialty of the admitting physician. N Engl J Med. 1996 Dec 19;335(25):1880–1887. [PubMed]
  • Kletke PR, Emmons DW, Gillis KD. Current trends in physicians' practice arrangements. From owners to employees. JAMA. 1996 Aug 21;276(7):555–560. [PubMed]
  • Kravitz RL, Greenfield S, Rogers W, Manning WG, Jr, Zubkoff M, Nelson EC, Tarlov AR, Ware JE., Jr Differences in the mix of patients among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1617–1623. [PubMed]
  • Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992 May;82(5):703–710. [PubMed]
  • McBride CA, Shugars DA, DiMatteo MR, Lepper HS, O'Neil EH, Damush TM. The physician's role. Views of the public and the profession on seven aspects of patient care. Arch Fam Med. 1994 Nov;3(11):948–953. [PubMed]
  • Montaño DE, Phillips WR. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health. 1995 Jun;85(6):795–800. [PubMed]
  • Rivo ML, Saultz JW, Wartman SA, DeWitt TG. Defining the generalist physician's training. JAMA. 1994 May 18;271(19):1499–1504. [PubMed]
  • Rosenblatt RA, Hart LG, Gamliel S, Goldstein B, McClendon BJ. Identifying primary care disciplines by analyzing the diagnostic content of ambulatory care. J Am Board Fam Pract. 1995 Jan-Feb;8(1):34–45. [PubMed]
  • Rosenblatt RA, Hart LG, Baldwin LM, Chan L, Schneeweiss R. The generalist role of specialty physicians: is there a hidden system of primary care? JAMA. 1998 May 6;279(17):1364–1370. [PubMed]
  • Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware JE., Jr Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. JAMA. 1993 Aug 18;270(7):835–840. [PubMed]
  • Safran DG, Tarlov AR, Rogers WH. Primary care performance in fee-for-service and prepaid health care systems. Results from the Medical Outcomes Study. JAMA. 1994 May 25;271(20):1579–1586. [PubMed]
  • Schauffler HH, Rodriguez T, Milstein A. Health education and patient satisfaction. J Fam Pract. 1996 Jan;42(1):62–68. [PubMed]
  • Schreiber TL, Elkhatib A, Grines CL, O'Neill WW. Cardiologist versus internist management of patients with unstable angina: treatment patterns and outcomes. J Am Coll Cardiol. 1995 Sep;26(3):577–582. [PubMed]
  • Selby JV, Grumbach K, Quesenberry CP, Jr, Schmittdiel JA, Truman AF. Differences in resource use and costs of primary care in a large HMO according to physician specialty. Health Serv Res. 1999 Jun;34(2):503–518. [PMC free article] [PubMed]
  • Starfield B, Bice T, Schach E, Rabin D, White KL. How "regular" is the "regular source of medical care"? Pediatrics. 1973 May;51(5):822–832. [PubMed]
  • Stewart AL, Grumbach K, Osmond DH, Vranizan K, Komaromy M, Bindman AB. Primary care and patient perceptions of access to care. J Fam Pract. 1997 Feb;44(2):177–185. [PubMed]
  • Ward MM, Leigh JP, Fries JF. Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care. Arch Intern Med. 1993 Oct 11;153(19):2229–2237. [PubMed]

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