Primary care physicians' links to other physicians through Medicare patients: the scope of care coordination.
Primary care physicians' links to other physicians through Medicare patients: the scope of care coordination.
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DOI：
10.7326/0003-4819-150-4-200902170-00004
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发表时间：
2009-02-17
影响因子：
39.2
通讯作者：
Schrag D
中科院分区：
文献类型：
--
作者：
Pham HH;O'Malley AS;Bach PB;Saiontz-Martinez C;Schrag D
初级保健医生应协调对患者的护理。评估为初级保健医生的医疗保险患者提供护理的医生同行人数。2005年，2,284名初级保健医生对2004-2005年社区跟踪S（CTS）医生调查做出了回应。2005年，每位医生的主要患者被确定为受益人，该医生为他们开出的评价和管理就诊费比任何其他医生都多。每名医生的同行医生数量是1）索引医生的主要患者就诊的其他独特医生和2）2005年期间担任索引医生的每个非主要患者的主要医生的其他独特医生的总和。典型的初级保健医生有229（IQR 125 -340）个其他医生在117（IQR 66 -175）个不同的实践中工作，必须与他们协调护理，相当于每100名由初级保健医生管理的医疗保险受益人增加99名医生和53个实践。考虑到只有31%的初级保健医生的初级患者患有4种或更多种慢性疾病，同行的数量仍然很大[36个诊所的86名医生]。同行的数量因地理区域、实践类型和对医疗补助收入的依赖而异。估计数仅基于按服务收费的医疗保险患者和医生同行，因此可能低估了同行的数量。调查的答复率不高，可能使调查结果偏向不可预测的方向。在照顾他或她自己的初级和非初级患者超过一年，每个初级保健医生可能必须与大量的个人医生同事谁也提供照顾这些患者协调。
Primary care physicians are expected to coordinate care for their patients. Assess the number of physician peers providing care to the Medicare patients of a primary care physician Cross-sectional analysis of claims data Fee-for-service Medicare in 2005 2,284 primary care physicians who responded to the 2004-2005 Community Tracking S (CTS) Physician Survey. Primary patients for each physician identified as beneficiaries for whom the physician billed for more evaluation and management visits than any other physician in 2005. The number of physician peers for each physician was the sum of 1) other unique physicians that the index physician's primary patients visited, and 2) other unique physicians who served as the primary physician for each of the index physician's non-primary patients during 2005. The typical primary care physician has 229 (IQR125-340) other physicians working in 117 (IQR66-175) different practices with whom care would have to be coordinated, equivalent to an additional 99 physicians and 53 practices for every 100 Medicare beneficiaries managed by the primary care physician. Considering only the 31% of a primary care physician's primary patients who had 4 or more chronic conditions, the number of peers was still substantial [86 physicians in 36 practices]. The number of peers varied with geographic region, practice type, and reliance on Medicaid revenues. Estimates are based on only fee-for-service Medicare patients and physician peers, and therefore likely undercount the number of peers. The modest response rate of the CTS survey may bias results in unpredictable directions. In caring for his or her own primary and non-primary patients over one year, each primary care physician potentially must coordinate with a large number of individual physician colleagues who also provide care to these patients.
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影响因子：
7.2
作者：
Asch, DA;Jedrziewski, MK;Christakis, NA
通讯作者：
Christakis, NA
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
158.5
作者：
Pham, Hoangmai H.;Schrag, Deborah;Bach, Peter B.
通讯作者：
Bach, Peter B.
影响因子：
3
作者：
Schrag, D;Xu, F;Bach, PB
通讯作者：
Bach, PB
影响因子：
158.5
作者：
Druss, BG;Marcus, SC;Pincus, HA
通讯作者：
Pincus, HA