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Quality of Care

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Practice sites and medical groups may be more meaningful sources for measuring health care quality than health plans

Many national efforts to assess health care quality have focused on health plans as the chief measure. The Consumer Assessment of Health Plans Study (CAHPS®) survey, which was developed by the Agency for Healthcare Research and Quality, is the most widely used health care survey in the United States. However, medical groups and doctors' offices hire and fire physicians, shape and reinforce practice culture, and determine the pace and flow of patient visits. In fact, a new study using the recently developed "group CAHPS®" (G-CAHPS®) survey found that practice sites and medical groups explained substantial amounts of the variation in patient assessments of care within health plans.

Practice sites and medical groups may explain more of the variation in certain measures of health care quality than health plans, according to Paul D. Cleary, Ph.D., of Harvard Medical School. Dr. Cleary and his colleagues evaluated variations in G-CAHPS® scores among a sample of adult patients who received care in 1999 through three managed care contracts of Partners Community Healthcare, Inc., which included 28 medical groups that provided care at 49 practice sites (doctor's office or clinic). Their study was supported in part by AHRQ (HS09205). The G-CAHPS® contains 100 questions, 50 of which pertain to patient experiences with their medical group, 5 pertain to global evaluation of care, and others relate to patient demographics, health status, and use of services.

Practice sites accounted for at least 60 percent of the explainable variation for eight out of the nine measures of care for which there were significant between-site differences and the largest share of explainable variation for three of the four global rating items. Groups accounted for the second largest share of variability for most measures (accounting for 30 percent of the variance for access to and timeliness of care), but these effects were modest relative to site-level effects. Regional service organizations (RSOs), which included one or more medical groups such as physician/hospital organizations, did not explain a significant amount of variability in responses, and health plans accounted for even less variation.

More details are in "Variation in patient-reported quality among health care organizations," by Loel S. Solomon, Ph.D., Alan M. Zaslavsky, Ph.D., Bruce R. Landon, M.D., M.B.A., and Dr. Cleary, in the Summer 2002 Health Care Financing Review 23(4), pp. 85-98.

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