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Patient-Physician “Connectedness” Affects Quality of Care

This study also is the subject of an American College of Physicians video news story

Philadelphia, March 3, 2009 -- Health care in the United States is often fragmented and uncoordinated. It is common for patients to receive episodic care from different physicians. A new study in Annals of Internal Medicine, however, finds that patients who are connected to a specific primary care physician are more likely to receive guideline-consistent care than those who are connected to a practice but not a physician.

Researchers looked at 155,590 adults in a primary care network to determine which patients received most of their care from a specific physician, practice, or neither. They found that patients who were not connected to a particular physician were less likely to receive recommended care. In addition, these patients were less likely to complete recommended testing for preventive and chronic illness care.

“This study provides strong evidence for the value of having a regular doctor,” said Steven Atlas, M.D., Director of Primary Care Quality Improvement at Massachusetts General Hospital, and lead author of the study.

Researchers used the term “connectedness” to describe the closeness of the relationship between a patient and an individual physician. The researchers found that patients who were connected to a physician were more likely to have health insurance, speak English, and be non-Hispanic white. However, connectedness was associated with larger disparities in screening rates than was race or ethnicity.

“The process of establishing a strong relationship with a specific physician may represent an important key to understanding disparities in care,” said Dr. Atlas. “Greater insight into the role of patient- provider- or practice-level barriers to establishing a closely connected primary care relationship may lead to improved quality of care for vulnerable patients.”

But according to researchers, continuity of care is a shared responsibility between physicians and patients. Even if physicians or practices treated all patients similarly, patients vary in their ability and willingness to adhere to recommendations.

According to Dr. Atlas, this study has health care policy implications as well.

“Pay-for-performance initiatives hinge on the ability to accurately assign performance measures to those practitioners who have some control over the outcome. Our study results suggest that physicians with a relatively low percentage of connected patients are likely to receive lower scores on performance measures when compared to physicians with a higher proportion of connected patients,” said Dr. Atlas.

Annals of Internal Medicine is one of the five most widely cited peer-reviewed medical journals in the world. The journal has been published for 82 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians, the largest medical specialty organization and the second-largest physician group in the United States.

ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

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