Patient-physician connectedness and quality of primary care

Abstract

Background: Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not known.

Objective: To determine whether patient-physician connectedness affects measures of clinical performance.

Design: Population-based cohort study.

Setting: Academic network of 4 community health centers and 9 hospital-affiliated primary care practices.

Patients: 155 590 adults with 1 or more visits to a study practice from 2003 to 2005.

Measurements: A validated algorithm was used to connect patients to either 1 of 181 physicians or 1 of 13 practices in which they received most of their care. Performance measures included breast, cervical, and colorectal cancer screening in eligible patients; hemoglobin A(1c) measurement and control in patients with diabetes; and low-density lipoprotein cholesterol measurement and control in patients with diabetes and coronary artery disease.

Results: Overall, 92 315 patients (59.3%) were connected to a specific physician, whereas 53 669 patients (34.5%) were connected only to a specific practice and 9606 patients (6.2%) could not be connected to a physician or practice. The proportion of patients in a practice who could be connected to a physician varied markedly (45.6% to 71.2% of patients per practice; P < 0.001). Physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care (for example, adjusted mammography rates were 78.1% vs. 65.9% [P < 0.001] and adjusted hemoglobin A(1c) rates were 90.3% vs. 74.9% [P < 0.001]). Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity.

Limitation: Patient-physician connectedness was assessed in 1 primary care network.

Conclusion: Patients seen in primary care practices seem to be variably connected with a specific physician, and less connected patients are less likely to receive guideline-consistent care.

Funding: National Cancer Institute.

Figure 1

Method of connecting patients with specific primary care physicians or practices MGH = Massachusetts General Hospital; PCP = primary care physician. The square boxes represent the patient population seen in the MGH primary care network and their initial assessment based on listed provider. The hexagonal boxes represent the algorithms that connect patients to a specific physician or practice. The rounded boxes represent the disposition of the primary care population based on patient–physician connectedness. * Patients younger than 18 years and those who were deceased are also included in this category.

Figure 2

Patient connectedness in the 13 practice sites *Community health center.

Figure 3

Patient connectedness, by race or ethnicity.

Figure 4

Breast cancer screening rates, by patient connectedness and by race or ethnicity Adjusted rates of breast cancer screening with mammography in the previous 2 years among eligible women age 42 to 69 years.