Does the culture of a medical practice affect the clinical management of diabetes by primary care providers?

Abstract

Objectives: The financing and organization of primary care in the United States has changed dramatically in recent decades. Primary care physicians have shifted from solo practice to larger group practices. The culture of a medical practice is thought to have an important influence on physician behavior. This study examines the effects of practice culture and organizational structure (while controlling for patient and physician characteristics) on the quality of physician decision-making.

Methods: Data were obtained from a balanced factorial experiment which employed a clinically authentic video-taped scenario of diabetes with emerging peripheral neuropathy.

Results: Our findings show that several key practice culture variables significantly influence clinical decision-making with respect to diabetes. Practice culture may contribute more to whether essential examinations are performed than patient or physician variables or the structural characteristics of clinical organizations.

Conclusions: Attention is beginning to focus on physician behavior in the context of different organizational environments. This study provides additional support for the suggestion that organization-level interventions (especially focused on practice culture) may offer an opportunity to reduce health care disparities and improve the quality of care.

Figure 1

Percent of Variance in Vibration/Monofilament Exam Explained by Practice Culture, Organizational Resources, Patient and Physician Characteristics

Figure 2

Percent of Variance in Examination for Ulcers Explained by Practice Culture, Organizational Resources, Patient and Physician Characteristics