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PubMed2005

The influence of the structure and culture of medical group practices on prescription drug errors.

BACKGROUND: This project was designed to identify the magnitude of prescription drug errors in medical group practices and to explore the influence of the practice structure and culture on those error rates. Seventy-eight practices serving an upper Midwest managed care (Care Plus) plan during 2001 were included in the study. METHODS: Using Care Plus claims data, prescription drug error rates were calculated at the enrollee level and then were aggregated to the group practice that each enrollee selected to provide and manage their care. Practice structure and culture data were obtained from surveys of the practices. Data were analyzed using multivariate regression. RESULTS: Both the culture and the structure of these group practices appear to influence prescription drug error rates. Seeing more patients per clinic hour, more prescriptions per patient, and being cared for in a rural clinic were all strongly associated with more errors. Conversely, having a case manager program is strongly related to fewer errors in all of our analyses. The culture of the practices clearly influences error rates, but the findings are mixed. Practices with cohesive cultures have lower error rates but, contrary to our hypothesis, cultures that value physician autonomy and individuality also have lower error rates than those with a more organizational orientation. Our study supports the contention that there are a substantial number of prescription drug errors in the ambulatory care sector. Even by the strictest definition, there were about 13 errors per 100 prescriptions for Care Plus patients in these group practices during 2001. CONCLUSIONS: Our study demonstrates that the structure of medical group practices influences prescription drug error rates. In some cases, this appears to be a direct relationship, such as the effects of having a case manager program on fewer drug errors, but in other cases the effect appears to be indirect through the improvement of drug prescribing practices. An important aspect of this study is that it provides insights into the relationships of the structure and culture of medical group practices and prescription drug errors and provides direction for future research. Research focused on the factors influencing the high error rates in rural areas and how the interaction of practice structural and cultural attributes influence error rates would add important insights into our findings. For medical practice directors, our data show that they should focus on patient care coordination to reduce errors.

Culture↗
PubMed1998

Group practices need to ensure year 2000 compliance of their electronic systems.

In a group practice, the year 2000 date problem can affect accounting, payment, and billing systems, as well as medical equipment. With the turn of the century drawing closer, group practices should ensure that all the electronic systems that affect their businesses will be year 2000 compliant. Group practices should develop a plan to address all of the possible year 2000 issues that can affect their electronic systems. A three-step procedure that will help group practices implement such a plan comprises creating an inventory of all systems that could be affected, investigating each system's compliance, and getting written assurance of year 2000 compliance from all relevant third parties.

Ambulatory Care Information Systems↗
PubMed1997

Group practice vs. solo practice--a dentist's view.

The percentage of dentists joining group practices has increased sharply in the past fifteen years. Many advantages to practicing in a group setting including social, clinical, and financial aspects have contributed to this change. Solo practice has become increasingly difficult for new dentists. Market forces as well as insurance changes have accelerated the transition to group practice. Multispecialty groups have particular features that have allowed them to become much more popular. The advent of dental practice management companies has fueled the growth of multispecialty groups and has created new business opportunities for dental practice owners.

Dentists↗
PubMed1987

A randomized controlled trial of academic group practice. Improving the operation of the medicine clinic.

We conducted a controlled trial of the adoption of a group-practice model within an academic department of medicine. Ongoing randomization yielded similar groups of patients and residents. To determine the effect of the intervention on medicine-clinic operation, we monitored the hospital outpatient activity of 28 residents and 2299 patients during an 11-month study period. The group-practice clinics generated 20% more patient encounters per month than did the traditional, control clinics (328 vs 273 encounters), primarily because twice as many voluntary, overflow clinic sessions were scheduled (20.2 vs 9.7 sessions). Yet, because group-practice registration was decentralized, patients spent 15% less time in completing scheduled visits (93.2 vs 109.9 minutes). Regular utilizers of the group practices made 7% more scheduled clinic visits on average (3.27 vs 3.05 visits), but 39% fewer walk-in visits (0.14 vs 0.23 visits). Hospital-wide, continuity of care was not affected. We conclude that adoption of a group-practice model at our institution improved clinic productivity, enhanced patient flow, and decreased unscheduled clinic visits.

Continuity of Patient Care↗
PubMed1999

Writing a group practice business plan.

A business plan offers group practices a blueprint to accomplish a variety of goals, such as securing capital, marketing the practice's services, recruiting new employees, developing a strategic plan or a budget, or planning for growth. A business plan should be informative, specific, and visionary. Elements that every business plan should address are a mission statement, strategy, planning, management information, and action scheme. A business plan should include certain information in a prescribed order. By writing a realistic business plan, group practices can work more efficiently and minimize the risk of not meeting their financial projections.

Fee Schedules↗
PubMed1976

The effect of prepaid group practice on physicians' utilization behavior.

The study is concerned with the practice of physicians in a prepaid group practice setting. Specifically, it is concerned 1) with investigating the extent of variation in physician behavior concerning use of clinical resources, that is, office visits and telephone calls, and technical resources, that is, x-rays and laboratory procedures, and 2) with determining the factors that account for such variation. The universe of this study consists of all internists practicing in 1970 in the prepaid group setting of Kaiser Permanente at Portland, Oregon, a total of 34. The overall framework for the study is based on the belief that medical training and the setting in which physicians work are significant determinants of their use of clinical and technical resources in different disease situations. Specifically, the framework posits that different sets of organizational variables are important in determining use of resources for acute and undiagnosed conditions. The findings reported in the study suggest that while the teaching environment in which a physician is trained is important in shaping his clinical personality, the setting in which he actually works contains its own source of influence over his professional activity. These results also provide supportive evidence for the widely held notion that prepaid group practice, through changing the nature of the incentives to physicians and introducing professional regulation, leads to a more efficient way of providing medical care by reducing the use of costly resources.

Consumer Behavior↗
PubMed1986

Group practice in France.

In France, a number of different forms of group practice co-exist. They differ in the number of members and their contractual relationships. 40 per cent of French dentists practise in groups; however, this figure falls to 26 per cent for the true group practices, in only 12 per cent of which are the fees pooled. In most cases groups are established from a solo practice when the number of patients has become too large for the principal to cope alone. The decision to embark on group practice may also stem from a wish for more leisure, the need for ongoing training, and other psychological or social reasons. The association proper is usually preceded by a less formal type of 'collaboration'. A large number of women engage in group practice, either full-time or, more frequently, part-time, but women-only groups are the exception. Eighty per cent of orthodontists practise in a group of some kind. The facility-sharing partnerships (SCMs) (the most frequent form) provide their members with all or part of the requisites for their practice, which itself remains individual, with each member receiving his fees and contributing to the expenses of the group only in proportion to the services received from it. Full partnerships (SCPs), however, embrace not only all the facilities necessary for the practice but also its patients; fees are received in the name of the partnership. Profits are distributed by criteria associated with the practice (time spent, fees received, reputation, etc.); they may also be distributed in equal shares.

Dentists, Women↗
PubMedDate not supplied

Marketing guidelines for medical group practice.

For some groups, patients are no longer available in an endless supply. Administrators are learning that they must respond to changing market situations in order to maintain their group's fair share of the market.

Group Practice↗
PubMedDate not supplied

Measuring the culture of medical group practices.

OBJECTIVE: To develop an instrument that can be used to assess the organizational culture of medical group practices. DATA SOURCES AND STUDY SETTING: Study participants were primary care physicians in 267 medical group practices. The iterative process began in Minnesota and then expanded to practices in 21 other states. DATA COLLECTION METHODS: Practice culture statements were collected using questionnaires distributed at a national medical group practice meeting and mailed questionnaires sent to a broader set of participants identified by the Medical Group Management Association. STUDY DESIGN: Using a framework developed earlier, physicians in medical groups were asked to react to statements that described the basic assumptions and patterns of behavior characteristic of their practices. An iterative process involving over 500 physicians in 267 practices was used to identify and refine statements. Factor analysis was used to group the statements into cohesive cultural dimensions. PRINCIPAL FINDINGS: Thirty-nine statements correlated with nine cultural dimensions were identified and a test of this instrument found that it successfully identified differences in the cultures of medical groups. CONCLUSIONS: Although there is increasing agreement that the culture of medical group practices is one of the most important factors influencing the cost and quality of care, efforts to understand and manage these cultures have been hampered by the lack of a measurement instrument. This article presents an instrument that has broad face validity in the group practice field and successfully differentiates the cultures of different types of practices.

Attitude of Health Personnel↗
PubMed1978

The acceptability of computer applications to group practices.

Of the 72 identified group practices in a midwest urban environment, 39 were found to use computers. The practices had been influenced strongly by vendors in their selection of an automated system or service, and had usually spent less than a work-month analyzing their needs and reviewing alternate ways in which those needs could be met. Ninety-seven percent of the practices had some financial applications and 64% had administrative applications, but only 2.5% had medical applications. For half the practices at least 2 months elapsed from the time the automated applications were put into operation until they were considered to be integrated into the office routine. Advantages experienced by at least a third of the practices using computers were that the work was done faster, information was more readily available, and costs were reduced. The most common disadvantage was inflexibility. Most (89%) of the practices believed that automation was preferable to their previous manual system.

Computers↗
PubMedDate not supplied

Hospital-based group practice: does it change clinic patterns of care?

Initiation of a hospital-based faculty group practice to replace part of a general medical clinic was evaluated in a quasi-experimental design. Practice setting (where patients received their primary care) was the independent variable. The group practice, unlike the traditional clinic, emphasized primary care by providing 24-hour, seven day/week access by telephone; continuity between inpatient and ambulatory care (all patients admitted as private patients of group practice attending physicians) and coordination of care. Resource use, including visits to the primary care site, the emergency room and specialty clinics, and tests ordered at each site were tracked for one year by chart review. Multivariate analysis showed that, contrary to expectations, group practice patients had no fewer emergency room or specialty clinic visits, although they did make more visits to the practice. With respect to tests, practice patients had almost two more tests ordered in the primary care site than clinic patients, although there was no concomitant reduction in tests ordered at other sites. The authors conclude that ambulatory care resource use is an insufficient measure of the effect of a change in practice setting.

Catchment Area, Health↗
PubMed1996

Economics of multispecialty group practice.

The number of physicians organized in multispecialty group practices is growing. Research does not suggest that such practices will achieve economies of scope. Rather, the primary economic advantage to multispecialty group practice may be its ability to coordinate the process of care in a managed care setting, a process for which relatively large practices may be necessary.

Costs and Cost Analysis↗
PubMedDate not supplied

How does the culture of medical group practices influence the types of programs used to assure quality of care?

OBJECTIVE: It is widely acknowledged that the culture of medical group practices greatly influences the quality of care, but little is known about how cultures are translated into specific types of programs focused on quality. This study explores this issue by assessing the influence of the organizational culture on these types of programs in medical group practices in the upper Midwest. DESIGN AND METHODS: Data were obtained from two surveys of medical group practices. The first survey was designed to assess the culture of the practice using a nine-dimension instrument developed previously. The second survey was designed to obtain organizational structure data including the programs identified by the literature as important to the quality of care in medical practices. Completed surveys were obtained from eighty-eight medical groups. The relationship of the group practice culture to structural programs focused on quality of care was analyzed using logistic regression equations. RESULTS: Several interesting patterns emerged. As expected, practices with a strong information culture favor electronic data systems and formal programs that provide comparative or evidence-based data to enhance their clinical practices. However, those with a quality-centered culture appear to prefer patient satisfaction surveys to assess the quality of their care, while practices that are more business-oriented rely on bureaucratic strategies such as benchmarking and physician profiling. Cultures that emphasize the autonomy of physician practice were negatively (but not at a statistically significant level) associated with all the programs studied. Practices with a highly collegial culture appear to rely on informal peer review mechanisms to assure quality rather than any of the structural programs included in this analysis. CONCLUSION: This study suggests that the types of quality programs that group practices develop differ according to their cultures. Consequently, it is important for practice administrators and medical directors to develop quality assurance programs that fit their cultures if they are to gain buy-in by their clinicians. Future research should assess the effect of culture-structure fit on quality and safety outcomes.

Cross-Sectional Studies↗
PubMed2004

Strength in numbers. Medical group practices fill vital niche in U.S. health care system.

As the Medical Group Management Association initiates and celebrates National Medical Group Practice Week, Jan. 26-30, we look back at the evolution of this care delivery model in the United States. Echoes of the historical forces shaping group practice remain; modern pressures continue to influence it. Medical group practice has proven a necessary, responsive and adaptable segment of the health care delivery system.

Anniversaries and Special Events↗
PubMed1991

[A study of referral pattern of group practice centers in Taiwan].

To investigate the referral patterns of group practice centers in Taiwan, 18 group practice centers were studied. These study sites were sampled in a stratified random method over four districts (eastern, northern, central, and southern) in Taiwan. The study period took place between July 1989 and June 1990. Prospective referral forms were applied in every study site during the 12-month period. A computer-assisted data base for referral contents was established to follow up referral cases. During the study period, 1,647 referrals were generated from 735,534 patient visits, for an overall referral rate of 0.22 percent of all office visits. According to the International Classification of Health Problems in Primary Care, 2nd edition, most of the problems that needed referral were signs, symptoms, ill-defined conditions, digestive system diseases, genitourinary system diseases, circulatory system diseases, neoplasms and musculoskeletal, connective tissue diseases. The top 6 consulting specialties were internal medicine, surgery, obstetrics & gynecology, orthopedics, urology and pediatrics. Periodic evaluation of the dynamic referral contents is a useful method to improve the quality of primary medical care.

Adolescent↗