Primary Care Research

Quality of care for patients with coronary heart disease is not strongly influenced by medical practice characteristics

Quality of care for patients with common conditions such as coronary heart disease (CHD) is not strongly influenced by financial characteristics of medical practices, although there does seem to be some relationship between practice structure and quality, according to a new study. Researchers found that primary care patients in multi-site practices were 31 percent more likely to receive high quality of care for CHD than those in single-site practices. Also, patients treated in midsize practices with between 4 and 9 doctors were 23 percent more likely than those in the largest practices to receive high quality care for CHD.

The use of electronic medical records and other approaches to care management were not associated with CHD care quality. Care quality was also not associated with capitation at the practice level (payment cap for each patient the practice serves, regardless of diagnosis), or the use of productivity-based compensation at the physician level, which have become a concern in the past few years.

Bruce E. Landon, M.D., M.B.A., M.Sc., of Harvard Medical School, and colleagues examined the link between the characteristics of 25 medical practices (such as size, financial arrangements, and management processes for cardiovascular disease) and quality of care for CHD based on quality measures documented in the medical records of 1,600 patients with CHD. The researchers focused on a limited set of quality indictors for patients with CHD ranging from aspirin, beta-blocker, or other antiplatelet use after hospital discharge to cholesterol assessment and management to and control of cholesterol and hypertension among those with CHD and hypertension and/or diabetes. The study was supported by the Agency for Healthcare Research and Quality (HS11651).

More details are in "The relationship between medical practice characteristics and quality of care for cardiovascular disease," by Dr. Landon, Sharon Lise T. Normand, Ph.D., Ellen Meara, Ph.D., and others in the April 2008 Medical Care Research and Review 65(2), pp. 167-186.

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