What Makes for Primary Care Success? A Team of Researchers Has an Intriguing Answer
I was fascinated to go back and read a little-noticed article that appeared back at the beginning of this year, because of its very strong implications for the healthcare leaders who are innovating to establish patient-centered medical homes and other structures to improve patient care outcomes and patient satisfaction. In the January/February issue of the Annals of Family Medicine, Anthony Jerant, M.D., Joshua Fenton, M.D., M.P.H., and Peter Franks, M.D., all affiliated with the Department of Family and Community Medicine’s Center for Healthcare Policy and Research at the University of California-Davis School of Medicine, examined the question of whether certain characteristics of primary care delivery might be associated with levels of mortality among patients.
These three medical researchers analyzed data regarding over 52,000 patients, drawn from the 2000-2005 Medical Expenditure Panel Survey, a survey of perceptions on the part of healthcare consumers, providers, and employers, published by the Agency for Healthcare Research and Quality (AHRQ).
Adjusting the data for the characteristics of the patient population, including “health status, self-rated health, chronic conditions, and healthcare use and expenditures,” Dr. Jerant and his colleagues wrote in their article that “Our findings complement and expand on those of prior ecologic studies that demonstrated lower mortality rates within geographic areas with relatively higher concentrations of primary care clinicians, defined based on specialty. By comparison, our findings suggest an individual patient-level mortality benefit resulting from greater access to particular primary care attributes.”
Just what were those attributes? The three that came to the fore were:
> comprehensiveness, including care for new health problems, preventive care, and referrals to other providers
> the availability of evening and weekend office hours
> patient-centered care, which the researchers noted related to “asking whether the usual source of care [the physician practice] generally listened to and sought the respondent’s advice when choosing between treatments"
Not surprisingly, the researchers found that racial and ethnic minorities, poorer and less-educated patients and those lacking health insurance reported significantly lower access to such characteristics than other patients, most particularly affluent white women. What’s more, to put into context the types of care delivery-based variables studied by this researchers, the “adjusted hazard ratio” associated with the primary care attributes score was relatively small.
But the fact that a statistically significant set of dimensions was uncovered here is noteworthy. And, importantly, when one looks at the attributes/variables involved all have to do with some combination of optimization of primary care delivery, whether strong clinical care management, good basic services (patient hours), or good physician-patient communications. And these variables, the authors note, are also significant with regard to the development of patient-centered medical homes.
I would also argue that performance along these various dimensions can strongly be improved through the intelligent implementation of electronic health records, clinical documentation systems, and health information exchange initiatives. Indeed, the future of healthcare will be one in which everyone involved—patients, clinicians, payers and purchasers—are all better connected, in appropriate ways, and in which information flows appropriately far more easily between and among points in the care delivery galaxy than it does now.
It will be fascinating to see what researchers find as they study the patient-centered medical homes, accountable care organizations, and other emergent forms of healthcare organization and care delivery, as those forms grow and blossom. My prediction? The creation of the “new healthcare”—one that is data-driven, continuously focused on improvement of care quality, patient safety, efficiency, and cost-effectiveness—will benefit greatly from studies like this one going forward, as the leaders of innovative patient care organizations figure out what really works best—and then continually adjust their care delivery and care management models to keep improving their performance, on behalf of their patients and communities.
