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At least 163 records · Page 9Linked to original sources
PubMed2006

Do group practices have lower caesarean rates than solo practice obstetric clinics? Evidence from Taiwan.

OBJECTIVE: This study examined physicians' propensity for caesarean deliveries at solo versus group practice obstetrics/gynaecology (ob/gyn) clinics in Taiwan. METHOD: We used population-based (National Health Insurance) claims data covering all 253 618 singleton deliveries conducted at ob/gyn clinics, during 2000-02. The dependent variable, delivery mode, was treated as dichotomous [caesarean section (CS) = 1, vaginal delivery (VD) = 0]. The independent variable of interest was practice size, classified into four categories: 1, 2, 3 and 4+ physicians. Multilevel logistic regression modelling, accounting for clinic-level variation in CS rates, was used to examine CS likelihood by practice size, among the total delivery sample and among the sub-samples disaggregated by obstetric complication status. RESULTS: Solo practices have 7% excess caesarean cases relative to large group practices. After controlling for patient's age, physician demographics, the clinic's geographic location and size of delivery service, and clinic-level random effect, solo practice physicians were 5.38 times as likely as 4+ physician practices to provide caesarean delivery (CI = 4.18 approximately 6.93), 2-physician practices were 3.87 times (CI = 2.99 approximately 5.01) and 3-physician practices 2.72 times (CI = 2.06 approximately 3.59) as likely as 4+ physician practices to provide caesarean delivery. This effect is driven by higher CS propensity among solo and small groups among cases with obstetrically less salient complications and the 'no complications' subset of patients. Wide confidence intervals for odds ratios in these sub-samples also attest to wide variations in clinic-level CS rates among these patient groups. CONCLUSIONS: Solo physicians are the most likely to provide caesarean delivery, and CS likelihood decreases with increasing number of physicians in the practice. Group practice support may reduce the CS likelihood, when it is not clinically indicated. Policy makers should consider initiatives to limit full service delivery privileges to group practice obstetric clinics, in order to reduce unnecessary CS. Solo practice clinics should, at best, be licensed as birthing centres, required to transfer patients needing CS to a larger facility.

Adolescent↗
PubMed2000

Legal considerations in group practices and physician management.

Physicians are restructuring their practices in response to competition, managed care, and federal and state laws and regulations restricting their practice of medicine. Many physicians have formed group practices with the hope of selling this practice in the future. For physicians to profit from ancillary services, the group practice must meet federal and state requirements. If physicians choose to sell the group practice to a physician practice management company, careful review and negotiation of the purchase agreements are necessary to prevent complications if the arrangement is unsuccessful.

Group Practice↗
PubMed1978

A faculty and house-staff group practice: report of an operational model.

The internal medicine group practice at Colorado General Hospital was formed in 1974 to improve patient care and educational experience for residents. Six residents, two faculty members, a nurse practitioner, a dietitian, and a group practice coordinator provide 24 hour-a-day, seven day-a-week care for 666 patients. The program features: a balanced degree of faculty and house staff involvement in direct patient care, a high level of accountability provided by the coordinator, and small group size. The first 19 months of operation are reviewed, and the program is contrasted with other group practices reported in the literature.

Adolescent↗
PubMed1999

Comparison of patient satisfaction results during a period of rapid growth for a specialty group practice.

Orthopaedics Indianapolis is a private specialty group practice that experienced a phase of rapid growth between 1993 and 1996. During this period, the group doubled in size from 18 to 36 physicians without a corresponding increase in support personnel. To maintain the quality of clinical services during and after this rapid expansion, a number of quality improvement efforts were initiated. The 9-item Visit Rating Questionnaire (VRQ) was used four times over this 3-year period to evaluate patients' satisfaction with their visit to our clinic. We found that there was significant improvement during this time in several patient satisfaction constructs, including overall satisfaction, in spite of considerable increase in clinic volume. This paper presents the results of our VRQ surveys and outlines the various methods used to make clinical services more efficient. Having quality improvement efforts lead changes in group practice operations can make a significant impact on satisfaction, even during a period of rapid growth and change.

Group Practice↗
PubMedDate not supplied

The effects of medical group practice organizational factors on physicians' use of resources.

Few studies have systematically examined the influence of physician, patient, and practice characteristics on physician-directed use of resources within the overall environment of medical group practices and none have included the practice culture in the analysis. This study analyzes the effects of the structure and culture of medical group practices on the amount of resources used to manage uncomplicated hypertension episodes of care for enrollees in a Minneapolis/St. Paul HMO during 1990. Three findings emerged from this study: (1) resource use for a well-defined episode of care varies much more than one would expect in this highly competitive managed care environment; (2) the culture of the group practice appears to be more important than organizational structure in determining resource use for the treatment of hypertension; and (3) together the culture and structural variables only explain 8 percent of the variance in resource use. The study indicated that medical group practice organizations have less influence on physicians' practice styles than expected. The group practices studied are all located in a highly competitive managed care environment and these conditions should be causing them to create more standardized practice styles among their physicians. However, wide variations in individual physician practice styles account for most of the differences observed. Either much of the unexplained variance in resource use for this episode of care results from unobserved patient and illness characteristics, or managed healthcare is not yet causing medical group practices in Minnesota to challenge physicians' individualistic practice styles.

Cost-Benefit Analysis↗
PubMed1976

Continuing education activities of physicians in solo and group practice: report on a pilot study.

Group practice has often been suggested as a form of medical care organization that facilitates professional pursuits, including continuing medical education. A survey was conducted among Iowa physicians in fee-for service multispecialty group practice and in other forms of fee-for-service medical practice, including solo practice and small partnerships to determine their levels of engagement in a number of different types of continuing medical education activities. While several differences between the two groups were found, the survey indicated that overall the levels of engagement for the two groups were similar.

Attitude of Health Personnel↗
PubMed1980

The use of prenatal cytogenetic diagnosis: a comparison of rates in prepaid group practices and the general population.

To determine whether the reduction in services associated with prepaid group practice is indiscriminate or limited to medically "discretionary" services, the author compared the utilization rates for prenatal cytogenetic diagnosis (a medically indicated service for women aged 35 and older) in prepaid group practices and the geographically corresponding populations-at-large in four settings. The utilization rates by members of the prepaid group practices were equal to rate calculated for the geographically correspondings populations-at-large in two settings, and 2.3 times greater in the other settings. Whatever factors which may be responsible for the reduction of discretionary services delivered to members of prepaid group practices do not appear to interfere with the delivery of a strongly indicated service, prenatal cytogenetic diagnosis, in the population at risk.

California↗
PubMed1982

[Thyroid other endocrine and disorders in a general internal medicine group practice].

Retrospective analysis of 3397 patients of a general group practice revealed thyroid disease in 5.8% and other endocrine disease (including diabetes) in 2%. Of the total of 6629 diagnoses, one out of 25 was an endocrinopathy. Every 35th practice patient had an endocrine disease which required treatment. Endocrine laboratory tests were ordered in every 7th patient. Diabetes mellitus (1.7%), hyperthyroidism (0.38%), hypothyroidism (0.53%) and euthyroidism after goiter operation (1.4%) were the most frequent endocrine problems recorded. Euthyroid goiter was relatively rare (4%), probably because it was often considered an irrelevant finding and not coded for. The thyroid gland was therefore the most frequently affected endocrine organ and diabetes mellitus the most prevalent endocrine dysfunction. Compared with other diseases, endocrine problems were of intermediate prevalence. The analyzed group practice had relatively young patient population, which may account for the surprisingly low prevalence of diabetes mellitus. On the whole, however, the prevalence of various diseases in this group practice compared well with statistics in representative samples of Swiss medical practices.

Adolescent↗