Physician practice patterns and variation in the delivery of preventive services.
BACKGROUND
Strategies to improve preventive services delivery (PSD) have yielded modest effects. A multidimensional approach that examines distinctive configurations of physician attributes, practice processes, and contextual factors may be informative in understanding delivery of this important form of care.


OBJECTIVE
We identified naturally occurring configurations of physician practice characteristics (PPCs) and assessed their association with PSD, including variation within configurations.


METHODS
Cross-sectional study.


METHODS
One hundred thirty-eight family physicians in 84 community practices and 4,046 outpatient visits.


METHODS
Physician knowledge, attitudes, use of tools and staff, and practice patterns were assessed by ethnographic and survey methods. PSD was assessed using direct observation of the visit and medical record review. Cluster analysis identified unique configurations of PPCs. A priori hypotheses of the configurations likely to perform the best on PSD were tested using a multilevel random effects model.


RESULTS
Six distinct PPC configurations were identified. Although PSD significantly differed across configurations, mean differences between configurations with the lowest and highest PSD were small (i.e., 3.4, 7.7, and 10.8 points for health behavior counseling, screening, and immunizations, respectively, on a 100-point scale). Hypotheses were not confirmed. Considerable variation of PSD rates within configurations was observed.


CONCLUSIONS
Similar rates of PSD can be attained through diverse physician practice configurations. Significant within-configuration variation may reflect dynamic interactions between PPCs as well as between these characteristics and the contexts in which physicians function. Striving for a single ideal configuration may be less valuable for improving PSD than understanding and leveraging existing characteristics within primary care practices.
Flocke
Susan A
SA
Department of Family Medicine, Case Western Reserve University, Cleveland, OH, USA. susan.flocke@case.edu
Litaker
David
D
D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods; D005194:Family Practice / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009819:Office Visits; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000379:methods; D011364:Professional Practice