Primary care provider turnover and quality in managed care organizations.
OBJECTIVE
To examine the association between primary care provider turnover in managed care organizations and measures of member satisfaction and preventive care.


METHODS
Retrospective cohort study of a national sample of 615 managed care organizations that reported HEDIS data to the National Committee for Quality Assurance from 1999 through 2001.


METHODS
Multivariable hierarchical regression modeling was used to evaluate the association between health plan primary care provider turnover rate and member satisfaction and preventive care measures, including childhood immunization, well-child visits, cholesterol, diabetes management, and breast and cervical cancer screening, adjusting for patient and organizational characteristics, time, and repeated measures.


RESULTS
The median primary care provider turnover rate was 7.1% (range, 0%-53.3%). After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction, including overall rating of healthcare (P < .01). A 10% higher primary care provider turnover rate was associated with 0.9% fewer members rating high overall satisfaction with healthcare. Health plans with higher provider turnover rates also had lower rates of preventive care, including childhood immunization (P = .045), well-child visits (P = .002), cholesterol screening after cardiac event (P = .042), and cervical cancer screening (P = .024). For example, a 10% higher primary care provider turnover was associated with a 2.7% lower rate of child-members receiving well-child visits in the first 15 months of life.


CONCLUSIONS
Primary care provider turnover is associated with several measures of care quality, including aspects of member satisfaction and preventive care. Future studies should evaluate whether interventions to reduce primary care provider turnover can improve quality of care and patient outcomes.
Plomondon
Mary E
ME
Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, Colo 80220, USA. meg.plomondon@va.gov
Magid
David J
DJ
Steiner
John F
JF
MaWhinney
Samantha
S
Gifford
Blair D
BD
Shih
Sarah C
SC
Grunwald
Gary K
GK
Rumsfeld
John S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010563:Personnel Turnover / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000600:supply & distribution*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D000078329:Workforce