Physician patient-sharing networks and the cost and intensity of care in US hospitals.

BACKGROUND: There is substantial variation in the cost and intensity of care delivered by US hospitals. We assessed how the structure of patient-sharing networks of physicians affiliated with hospitals might contribute to this variation. METHODS: We constructed hospital-based professional networks based on patient-sharing ties among 61,461 physicians affiliated with 528 hospitals in 51 hospital referral regions in the US using Medicare data on clinical encounters during 2006. We estimated linear regression models to assess the relationship between measures of hospital network structure and hospital measures of spending and care intensity in the last 2 years of life. RESULTS: The typical physician in an average-sized urban hospital was connected to 187 other doctors for every 100 Medicare patients shared with other doctors. For the average-sized urban hospital an increase of 1 standard deviation (SD) in the median number of connections per physician was associated with a 17.8% increase in total spending, in addition to 17.4% more hospital days, and 23.8% more physician visits (all P<0.001). In addition, higher "centrality" of primary care providers within these hospital networks was associated with 14.7% fewer medical specialist visits (P<0.001) and lower spending on imaging and tests (-9.2% and -12.9% for 1 SD increase in centrality, P<0.001). CONCLUSIONS: Hospital-based physician network structure has a significant relationship with an institution's care patterns for their patients. Hospitals with doctors who have higher numbers of connections have higher costs and more intensive care, and hospitals with primary care-centered networks have lower costs and care intensity.

Relationship between quality improvement processes and clinical performance.

OBJECTIVES: To examine the association between performance on clinical process measures and intermediate outcomes and the use of chronic care management processes (CMPs), electronic medical record (EMR) capabilities, and participation in external quality improvement (QI) initiatives. STUDY DESIGN: Cross-sectional analysis of linked 2006 clinical performance scores from the Integrated Healthcare Association's pay-for-performance program and survey data from the 2nd National Study of Physician Organizations among 108 California physician organizations (POs). METHODS: Controlling for differences in PO size, organization type (medical group or independent practice association), and Medicaid revenue, we used ordinary least squares regression analysis to examine the association between the use of CMPs, EMR capabilities, and external QI initiatives and performance on the following 3 clinical composite measures: diabetes management, processes of care, and intermediate outcomes (diabetes and cardiovascular). RESULTS: Greater use of CMPs was significantly associated with clinical performance: among POs using more than 5 CMPs, we observed a 3.2-point higher diabetes management score on a performance scale with scores ranging from 0 to 100 (P <.001), while for each 1.0-point increase on the CMP index, we observed a 1.0-point gain in intermediate outcomes (P <.001). Participation in external QI initiatives was positively associated with improved delivery of clinical processes of care: a 1.0-point increase on the QI index translated into a 1.4-point gain in processes-of-care performance (P = .02). No relationship was observed between EMR capabilities and performance. CONCLUSION: Greater investments in CMPs and QI interventions may help POs raise clinical performance and achieve success under performance-based accountability schemes.

La evaluación del desempeño como alternativa a la baja productividad de los servicios públicos de salud en Venezuela: experiencia en un servicio de gastroenterología / The evaluation of the acting like alternative to the drop productivity by of the public service health in Venezuela: experience in a gastroentherology service

A pesar de que en 1996 se implantó un nuevo programa de Gerencia en el Servicio de Gastroenterología del Hospital Universitario de Maracaibo, se realizó entre los años 1996-1998, la intención de nuestro trabajo es evaluar la Gerencia y el desempeño de nuestro servicio, además evaluar las políticas de estado y su eficiencia en el desempeño de la salud pública

"Virtual" health care organizations and the challenges of improving quality.

This article examines the challenges of improving health care quality continuously within and across "virtual" provider organizations such as independent practice associations and physician-hospital organizations. It draws on recent research and theory about interorganizational networks in other fields to develop recommendations for securing physicians' commitment to quality improvement strategies in today's health care environment.

Sistemas de información en anatomía patológica: análisis de las soluciones existentes / Information System in anatomical pathology: Analysis of the existing solutions

Antecedentes: En los últimos dos años se está procediendo a la renovación de los sistemas informáticos en anatomía patológica de numerosos hospitales. Por ello consideramos interesante revisar los sistemas informáticos más habituales y conocer los principales aspectos que debemos exigir en estos programas. Material y métodos: Cuatro sistemas informáticos (Master-Pat NovoPath, PatWin e InfoPAT) han sido evaluados por los usuarios de siete hospitales distribuyendo entre los usuarios y los fabricantes una encuesta con 105 variables. Resultados: Los sistemas más modernos ofrecen un número muy alto de funcionalidades, destacando los más modernos por su integración en el resto del sistema de información hospitalario, si bien los sistemas de ayuda, la codificación y la gestión de imágenes son algunos aspectos que la mayoría de programas necesitan mejorar. Conclusión: Los nuevos programas informáticos son de gran calidad y las prestaciones muy parecidas, por lo que es aconsejable evaluar las necesidades de cada servicio para poder escogerla solución óptima (AU)

Using compensation to improve primary care.

Progressive primary care networks are now placing significant portions of physician salaries at risk by linking compensation to quantifiable measures such as net medical revenue (collections), reduced practice expenses, cost and utilization, quality of care and patient satisfaction. For most networks, a combination of productivity increases and expense reductions are critical to ensure financial survival. This case study illustrates how one network's unique incentive compensation program targeted higher productivity levels by incentivizing desirable behaviors.

Providers develop health plan to manage Medicaid patients without woes of HMOs.

Managing Medicaid lives without HMOs. Providers in Pitt County, NC, have developed their own kind of managed care plan that brings together traditional Medicaid providers with private physicians seeking to improve care quality and patient access. Providers in the plan hope it can keep commercial HMOs out of the local Medicaid business.

Risk contracting calls for more use of disease management.

This is the second of a series on how PHOs, IPAs, and other provider groups can manage a population of patients. The August issue of PHO Advisor included stories on managing Medicaid populations under risk contracts and establishing wellness programs.