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The Effect of Physician Group Culture and Structure on Quality of Care Outcomes

The Effect of Physician Group Culture and Structure on Quality of Care Outcomes. Amy Smalarz, MHA, PhD Candidate Academy Health Research Meeting June 26, 2005. Overview. Background/Theory/Model Methods Results Conclusions Policy Implications. Study Focus and Goals.

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The Effect of Physician Group Culture and Structure on Quality of Care Outcomes

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  1. The Effect of Physician Group Culture and Structure on Quality of Care Outcomes Amy Smalarz, MHA, PhD Candidate Academy Health Research Meeting June 26, 2005

  2. Overview • Background/Theory/Model • Methods • Results • Conclusions • Policy Implications

  3. Study Focus and Goals • Focus shifting from individual to group • Factors of potential influence: • Culture • Structure • Incentives are temporary; we need sustained change and improvement (Kralewski et al., 2003; Hammons et al., 2001; Miller and Bougberg, 2002; Wakefield et al., 2001)

  4. Theoretical View of Culture

  5. Model Culture Outputs Unit (Group) Individual (Physician) Inputs Environment Work Structure Physicians Adaptation of Nadler et al.’s Congruence Model

  6. Methods • Culture Survey • Surveyed 1,206 physicians from 57 groups; received 734 from 45 groups (61% response rate) • Structure Survey • Surveyed office administrators/managers from 57 groups; received 45 completed surveys • Quality Data from local Insurer • Regression Analysis • DEA (aka Frontier) Analysis

  7. Structure Variables

  8. Quality of Care Outcome Variables • Diabetic Care • Eye Exams • HbA1C control • LDL control • Cholesterol Management • High Blood Pressure Management • Adult Well Visits

  9. Results

  10. Results* Culture Structure Structure Culture * Only significant variables presented

  11. Conclusions • Variance of culture and structure exists among physician groups in MA • Aspects of culture explain some of the quality of care variations among physician groups in MA • Aspects of structure explain some of the quality of care variations among physician groups in MA • A nationwide study should be conducted to strengthen these findings and apply them nationally

  12. Potential Policy Implications • Physician profiling tools need to include culture and structure to support… • Sustained change and improvement • Meaningful incentives • Quality-oriented group processes

  13. Acknowledgements • My Committee Members • Stanley Wallack, PhD – Chair • John Kralewski, PhD • Christopher Tompkins, PhD • Jody Hoffer Gittell, PhD • Jon Chilingerian, PhD • AHRQ Fellowship/Training Grant

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