title: Organizational and market influences on physician performance on patient experience measures.
abstract: OBJECTIVE
  To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures.
  
  
  METHODS
  This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices.
  
  
  METHODS
  We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects.
  
  
  RESULTS
  Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( p<.001) measures.
  
  
  CONCLUSIONS
  Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable.
authors.affiliation: Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA. hrodriguez@post.harvard.edu
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: Ted
authors.initials: T
authors.lastname: von Glahn
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002140:California; D003142:Communication; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006123:Group Practice / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007193:Independent Practice Associations / Q000458:organization & administration; D008297:Male; D008389:Marketing of Health Services / Q000458:organization & administration*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D008486:Physician Executives / Q000523:psychology; D010816:Physician Incentive Plans / Q000458:organization & administration*; D011361:Professional Competence / Q000592:standards*; D011369:Professional-Patient Relations; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D011795:Surveys and Questionnaires
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