Primary care practice coordination versus physician continuity

Abstract

Background and objectives: This study assesses the influence of primary care continuity--both clinician and system--on patient outcomes. We consider the presumed benefits of physician continuity and practice coordination within a multi-specialty group.

Methods: The practices of 194 family physicians and general internists caring for 320000 adult members of a health maintenance organization were evaluated using four aggregate measures of outcomes--cancer screening in women, diabetic management examinations, patient satisfaction ratings, and ambulatory costs. Physician continuity and practice coordination were assessed using sequential sets of multiple regression models while controlling for patient panel and physician characteristics.

Results: Physician continuity, defined as seeing the same designated physician during 1 year, was not associated with any patient outcome. Practice coordination, measured by shared practice, team tenure, and medical clinic size, was significantly associated with three of the outcomes. Both medical clinic size and shared practice were associated with higher rates of cancer screening and diabetic management examinations. Team tenure exhibited a significant positive association with cancer screening, diabetic management, and patient satisfaction.

Conclusions: While physician continuity was not associated with patient outcomes, primary care practice structure was. Practice coordination should be assessed to identify mechanisms to support improved care.