title: Does affiliation of physician groups with one another produce higher quality primary care?
abstract: OBJECTIVE
  Recent reports have emphasized the importance of delivery systems in improving health care quality. However, few prior studies have assessed differences in primary care quality between physician groups that differ in size and organizational configuration. We examined whether larger physician group size and affiliation with networks of multiple groups are associated with higher quality of care.
  
  
  METHODS
  We conducted a cross-sectional observational analysis of 132 physician groups (including 4,358 physicians) who delivered primary care services in Massachusetts in 2002. We compared physician groups on performance scores for 12 Health Plan Employer Data and Information Set (HEDIS) measures reflecting processes of adult primary care.
  
  
  RESULTS
  Network-affiliated physician groups had higher performance scores than non-affiliated groups for 10 of the 12 HEDIS measures (p < 0.05). There was no consistent relationship between group size and performance scores. Multivariable models including group size, network affiliation, and health plan showed that network-affiliated groups had higher performance scores than non-affiliated groups on 8 of the 12 HEDIS measures (p < 0.05), and larger group size was not associated with higher performance scores. Adjusted differences in the performance scores of network-affiliated and non-affiliated groups ranged from 2% to 15%. For 4 HEDIS measures related to diabetes care, performance score differences between network-affiliated and non-affiliated groups were most apparent among the smallest groups.
  
  
  CONCLUSIONS
  Physician group affiliation with networks of multiple groups was associated with higher quality, and for measures of diabetes care the quality advantage of network-affiliation was most evident among smaller physician groups.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Coltin
authors.forename: Steven D
authors.initials: SD
authors.lastname: Pearson
authors.forename: Ken P
authors.initials: KP
authors.lastname: Kleinman
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
authors.forename: Janice A
authors.initials: JA
authors.lastname: Singer
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006123:Group Practice / Q000458:organization & administration*; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006285:Health Planning / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008404:Massachusetts; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care