Do integrated medical groups provide higher-quality medical care than individual practice associations?
BACKGROUND
The association between the organizational structure of physician groups and health care quality has never been evaluated empirically.


OBJECTIVE
To examine whether integrated medical groups (IMGs) provide higher-quality primary care than individual practice associations (IPAs).


METHODS
Cross-sectional study.


METHODS
PacifiCare, a large health maintenance organization.


METHODS
Approximately 1.7 million enrollees of PacifiCare cared for by 119 California physician groups between July 1999 and June 2000.


METHODS
The percentage of eligible PacifiCare enrollees who received mammography, Papanicolaou smear screening, chlamydia screening, diabetic eye examination, an asthma controller medication, or a beta-blocker after acute myocardial infarction.


RESULTS
Physician groups identified as IMGs, compared with those identified as IPAs, had higher rates of mammography (relative risk, 1.15 [95% CI, 1.01 to 1.33]), Papanicolaou smear screening (relative risk, 2.29 [CI, 1.53 to 3.42]), chlamydia screening (relative risk, 2.17 [CI, 1.04 to 4.55]), and diabetic eye screening (relative risk, 1.55 [CI, 1.28 to 1.88]). Leaders of IMGs were more likely to report using EMRs (37% vs. 2%; P < 0.001) and quality improvement strategies, but these characteristics explained little of the quality differences between IMGs and IPAs.


CONCLUSIONS
Organizational characteristics, including group type, were reported by physician group leaders and not directly assessed. Patient characteristics that could have accounted for some of the observed differences also were not assessed.


CONCLUSIONS
Patients cared for in IMGs generally received higher-quality primary care than those cared for in IPAs. Having an EMR and implementation of quality improvement strategies did not explain the differences in quality. These findings suggest that physician group type influences health care quality.
Mehrotra
Ateev
A
University of Pittsburgh and RAND Health, Pittsburgh, Pennsylvania 15213-2665, USA. mehrotra@rand.org
Epstein
Arnold M
AM
Rosenthal
Meredith B
MB
D002140:California; D003430:Cross-Sectional Studies; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007193:Independent Practice Associations / Q000458:organization & administration / Q000592:standards*; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D011787:Quality of Health Care