Primary care productivity and the health care safety net in New York City.
Urban safety net providers are under pressure to improve primary care productivity. In a survey of ambulatory care facilities in New York City, productivity (measured as the number of primary care visits per provider hour) increases with exam rooms per physician but has no association with computerized information systems or tightly controlled reimbursement. Also, sample facilities rely heavily on residents, which makes these facilities sensitive to medical education policies and raises questions about quality of care for the poor. We conclude that urban safety net providers will have difficulty making the productivity improvements demanded by a more competitive health system.
Duck
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Beth Israel Medical Center, Department of Medicine, Division of Outcomes Measurement and Research, New York, New York, USA.
DeLia
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Cantor
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D000555:Ambulatory Care Information Systems; D003151:Community Health Centers / Q000191:economics / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007349:Insurance, Health, Reimbursement; D017057:Medically Uninsured; D009519:New York City; D009819:Office Visits / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011203:Poverty; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014600:Utilization Review / Q000706:statistics & numerical data; D000078329:Workforce