title: Why do we observe a limited impact of primary care access measures on clinical quality indicators?
abstract: The study assessed the effects of enhanced primary care access and continuity on clinical quality in a large, multipayer, multispecialty ambulatory care organization with fee-for-service provider incentives. The difference-in-differences estimates indicate that access to own primary care physician is a statistically significant predictor of improved clinical quality, although the effect size is small such that clinical significance may be negligible. Reduced time for own primary care physician appointment and increased enrollment in electronic personal health record are positive predictors of chronic disease management processes and preventive screening but are inconsistently associated with clinical outcomes. Challenges in identifying relationships between access and quality outcomes in a real-world setting are also discussed.
authors.affiliation: Research Institute, Palo Alto Medical Foundation, Palo Alto, California.
authors.forename: Sukyung
authors.initials: S
authors.lastname: Chung
authors.forename: Laura
authors.initials: L
authors.lastname: Panattoni
authors.forename: Dorothy
authors.initials: D
authors.lastname: Hung
authors.forename: Nicole
authors.initials: N
authors.lastname: Johns
authors.forename: Laurel
authors.initials: L
authors.lastname: Trujillo
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards*; D002908:Chronic Disease; D057286:Electronic Health Records; D006297:Health Services Accessibility; D006801:Humans; D017063:Outcome Assessment, Health Care; D058007:Physicians, Primary Care; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D014481:United States