The influence of care management tools on physician practice change across organizational settings.
BACKGROUND
A study was conducted to assess whether physician reports of practice change were associated with the type of health care organization delivering the tools and the type or number of tools received.


METHODS
A mail survey was sent in 2001 to primary care physicians practicing in the 13 largest urban counties in California.


RESULTS
Physicians were more likely to report a practice change if they received care management tools from a medical group (28%) or a group/staff model health maintenance organization (HMO; 24%) than if they received tools from a health plan (9%; p = .01 and p =.005, respectively). HMO physicians were significantly more likely to receive each type of tool than other physicians. After adjusting for the type or number of tools, the receipt of care management tools from medical groups, but not HMOs, remained a significant predictor of practice change. Physicians reported practice change in association with the number of tools received from a medical group (adjusted odds ratio [AOR] 1.49; 95% confidence interval [CI] 1.08-2.06) and the tools received from an independent practice association, health plan, or hospital outside a medical group (AOR 1.21; 95% CI 1.03-1.42).


CONCLUSIONS
Medical groups have the strongest influence on practice change, whereas group/staff model HMOs have the highest level of implementation.
Haggstrom
David A
DA
VA HSR&D Center for the Implementation of Evidence-Based Practice, Indianapolis, USA. dahaggst@iupui.edu
Bindman
Andrew B
AB
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing / Q000458:organization & administration; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006279:Health Maintenance Organizations; D006801:Humans; D007193:Independent Practice Associations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration*; D010821:Physicians, Family / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011216:Practice Management, Medical; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration; D017010:Reminder Systems