Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions
Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions
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DOI：
10.1377/hlthaff.2014.0434
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发表时间：
2014-09-01
期刊：
影响因子：
9.7
通讯作者：
Shortell, Stephen M.
中科院分区：
文献类型：
--
作者：
Casalino, Lawrence P.;Pesko, Michael F.;Shortell, Stephen M.
近三分之二的美国办公室医生从事的工作不到7名医生。人们通常认为，更大的实践可以提供更好的护理，尽管几乎没有证据支持或反对这一假设。诊所规模和其他诊所特征，如医疗家庭流程的所有权或使用，与护理质量之间的关系是什么？我们对1,045家以初级保健为基础的诊所进行了全国性调查，调查对象为19名或更少的医生，以确定诊所的特点。我们使用联邦医疗保险的数据来计算诊所潜在的可预防住院入院率(门诊护理敏感入院)。与10-19名医生的做法相比，1-2名医生的可预防入院人数减少了33%，3-9名医生的做法减少了27%。医生拥有的诊所比医院拥有的诊所可预防的入院人数更少。在一个医疗改革似乎正在推动医生进入更大组织的时代，重要的是衡量各种规模的做法的相对业绩，更多地了解小型诊所如何提供患者护理，以及更多地了解可能使小型诊所共享有助于提高护理质量的资源的组织结构类型--例如独立的诊所协会。
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.