Part -time practice and physician performance: Continuity in primary care.

This study assesses the relationship between part-time clinical practice and four measures of primary-care physician performance. Administrative and survey data were gathered on 194 primary care physicians practicing in 25 medical centers of a group-model health maintenance organization. Eighteen physician-level measures were used to form four aggregate performance measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Ordinary least squares regression was employed to examine the associations between physician availability and continuity, practice structure, and performance. Physician clinical hours (79.5% part time with less than five full days) and appointment accessibility measured availability. Ongoing physician continuity---usual provider continuity over one year (UPC), and longitudinality (practice team tenure) measured continuity. Practice structure variables, which might reflect service integration, included clinical-team size, midlevel-practitioner ratio per physician, shared practice, and medical center size. Analysis controlled for confounding physician characteristics of gender, medical seniority, and administrative role as well as for patient-panel composition, measured by full-time-equivalency (FTE) adjusted panel size and chronic disease score (CDS). Reduced clinical hours (.30--.95 FTE) did not reduce cancer screening, diabetic management, or patient satisfaction; however, ambulatory costs were higher. Ongoing continuity was lower and longitudinality higher as physicians' hours decreased. Higher ongoing continuity was not associated with any of the four performance measures. Longitudinality of 4--11 years with clinical team was associated with higher rates of cancer screening, 4--15 years with better diabetic management, and 4--11 years with higher patient satisfaction. Physician continuity over the single year was less strongly associated with performance than was sustained practice availability over many years. Because individual physician performance varied widely across the four measures, care should be taken in assessing physicians with single-focused quality measures.Ph.D.Health and Environmental SciencesHealth care managementManagementMedicineSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132654/2/9977233.pd