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Physician Organization Impacts Primary Care Quality

Integrated medical groups provide better quality than individual practice associations

TUESDAY, Dec. 5 (HealthDay News) -- Integrated medical groups provide higher-quality primary care than individual practice associations, according to the results of a study published in the Dec. 5 issue of the Annals of Internal Medicine.

Ateev Mehrotra, M.D., M.P.H., from RAND Health and the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues compared the quality of primary care provided by integrated medical groups, or IMGs, with that provided by individual practice associations, IPAs, within 119 physician groups in a large health maintenance organization. The care of the 1.7 million enrollees was examined based on six quality measures.

IMGs performed significantly better in terms of the percentage receiving mammography (relative risk, 1.15), Pap smear screening (RR, 2.29), chlamydia screening (RR, 2.17) and diabetic eye screening (RR, 1.55). There were no significant differences in the percentage receiving an asthma controller medication or a beta-blocker after acute myocardial infarction. The differences could not be explained by IMGs' more frequent use of electronic medical records or quality-improvement strategies, the authors note.

"This study should not be considered evidence that, in general, medical groups provide higher-quality care than do IPAs," states Lawrence Casalino, M.D., of the University of Chicago, in an accompanying editorial, noting there were only 19 IMGs that were quite large, averaging 242 physicians each. However, the editorialist notes that the study "highlights critical, but largely unexplored, questions about the organization of physician practice."

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