title: Prevalence, predictors, and patient outcomes associated with physician co-management: findings from the Los Angeles Women's Health Study.
abstract: BACKGROUND
  Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes.
  
  
  OBJECTIVE
  To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care.
  
  
  METHODS
  We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n=111; patient n=411).
  
  
  RESULTS
  After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care.
  
  
  CONCLUSIONS
  Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care).
authors.affiliation: VA HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA 91343-2036, USA. droseash@gmail.com
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Rose
authors.forename: Diana M
authors.initials: DM
authors.lastname: Tisnado
authors.forename: May L
authors.initials: ML
authors.lastname: Tao
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010346:Patient Care Management / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011243:Preferred Provider Organizations; D011787:Quality of Health Care