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Does Ownership Make a Difference in Primary Care Practice?

Stephan Lindner1, Leif I Solberg2, William L Miller2

  • 1From Center for Health Systems Effectiveness & Department of Emergency Medicine, Oregon Health & Science University, Portland, (SL, KJM); School of Public Health, Oregon Health & Science University, Portland State University, Portland (SL, MM, KJM); Department of Emergency Medicine, Oregon Health & Science University, Portland (SL, KJM); HealthPartners Institute, Minneapolis, Minnesota (LIS); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (BAB); Department of Family Medicine, Oregon Health & Science University, Portland, (MM STE, RJS, DJC); Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, OR (STE); Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, and Sociology, Case Western Reserve University, Cleveland, OH (KCS). lindners@ohsu.edu.

Journal of the American Board of Family Medicine : JABFM
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PubMed
Summary
This summary is machine-generated.

Primary care practice ownership impacts quality improvement processes, with Federally Qualified Health Centers (FQHCs) leading. Cardiovascular preventive care (ABCS) was largely similar across ownership types, indicating a complex relationship between quality improvement strategies and patient outcomes.

Keywords:
Cardiovascular DiseasesCross Sectional AnalysisDelivery of Health CareGroup PracticeOwnershipPrimary Health CareProcess MeasuresQuality Improvement

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Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Quality Improvement Science

Background:

  • Primary care practices vary significantly in structural characteristics and operational processes.
  • Understanding differences in quality improvement (QI) and cardiovascular preventive care delivery based on practice ownership is crucial for optimizing patient outcomes.
  • The EvidenceNOW initiative highlighted the need to assess practice-level variations in care delivery.

Purpose of the Study:

  • To compare structural characteristics, quality improvement processes, and cardiovascular preventive care (aspirin prescription, blood pressure control, cholesterol management, smoking cessation support - ABCS) across different primary care practice ownership types.
  • To identify potential disparities in care delivery and QI implementation based on whether a practice is physician-owned, health system-affiliated, or a Federally Qualified Health Center (FQHC).

Main Methods:

  • Cross-sectional analysis of 989 small to medium primary care practices.
  • Utilized electronic health record and survey data collected between September 2015 and April 2017.
  • Compared physician-owned, health system/medical group, and FQHC practices using 15 practice characteristic measures, 9 QI process measures, and 4 ABCS quality measures.

Main Results:

  • Physician-owned practices were more likely to be solo and less likely to have undergone major recent changes.
  • Federally Qualified Health Centers (FQHCs) reported the highest utilization of quality improvement processes, followed by health system practices.
  • Cardiovascular preventive care (ABCS) performance was generally similar across ownership types, except for smoking cessation support, which was higher in health system practices and FQHCs compared to physician-owned practices.

Conclusions:

  • Primary care practice ownership is associated with variations in the adoption of quality improvement strategies, with FQHCs demonstrating the highest engagement.
  • The similar performance in most cardiovascular preventive care measures (ABCS) across ownership types suggests that QI strategies do not directly or solely translate to improved clinical outcomes.
  • Further research is needed to elucidate the complex pathways linking quality improvement initiatives, practice characteristics, and measurable cardiovascular health outcomes in diverse primary care settings.