The dynamics of community health care consolidation: acquisition of physician practices.

Context: Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems.

Effectiveness of decision aids: a review of the evidence.

Increased interest in health care consumerism has created an environment conducive to growth in the use of decision aids (DAs) to support patient decision making. The authors review the research literature published within the past 5 years that assesses the effects of DAs in the areas of screening and treatment. Multiple measures are used to evaluate the effectiveness of DAs, with mixed evidence of impacts.

Linking quality assurance to performance improvement to produce a high reliability organization.

Three basic change management models are currently used in healthcare to produce and sustain quality improvement. We have presented the context to determine where any particular organization stands within these paradigms. We also have introduced a change-management tool used to assess, plan, and monitor leadership effort and commitment to quality improvement and culture change activities, tracked as "momentum for change.

Deploying Six Sigma in a health care system as a work in progress.

Background: An integrated health care system deployed Six Sigma in four clinical projects. The selected projects targeted Medicare profitability, emergency department cycle time reduction, clinic patient preparation, and medication safety. CROSS-PROJECT ANALYSIS: The six-month start-up period yielded several lessons.

Physicians' perceptions of managed care: a review of the literature.

In this article, the authors review the health services research literature regarding physician attitudes and opinions relating to managed care and how managed care has affected their clinical practice. This literature suggests that physician perceptions of managed care are largely related to the nature of their ties to managed care plans and to their selection of practice setting. There are substantial limitations in study designs and execution, suggesting that many of the published findings should be viewed with caution; the research basis regarding physicians' perceptions of managed care is not as strong as the number of articles published on this subject would suggest.

Evaluating health plan quality 3: survey measurement properties.

Objective: To assess the measurement and scaling properties of survey items designed to measure health plan quality from a physician's perspective.

Study Design: Prospective survey design with multivariate regression analysis.

Methods: Data were from 3798 physicians representing 23 health plans in 5 regions: Florida, New York, Colorado, Pennsylvania, and Washington.

Evaluating health plan quality 2: survey design principles for measuring health plan quality.

Objective: To develop principles for measuring the quality of specific health plans from a physician's perspective.

Study Design: Literature review, expert review, cognitive interviews.

Methods: We did a literature review on the use of physician surveys about managed care to determine the contributions and weaknesses of those surveys.

Evaluating health plan quality 1: a conceptual model.

Objective: To develop a theoretical foundation for measuring health plan quality from a physician's perspective.

Study Design: Literature review and theory development.

Methods: We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures.

How are health plans supporting physician practice? The physician perspective.

IPA-model HMOs are now the dominant organizational structures for delivering "managed care" in the United States. Are they taking advantage of opportunities to support physician practices in ways that arguably could improve care? In this paper we report the findings from a survey of generalist and specialist physicians in nineteen health plans. Not surprisingly, we found that generalists are much more likely than specialists are to be the target of health plans' efforts to support care delivery.