Primary care practice organization influences colorectal cancer screening performance.

Objective: To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors.

Data Sources/study Setting: Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001).

Study Design: Practices were characterized by degrees of centralization (e.

Measuring the quality of colorectal cancer screening: the importance of follow-up.

Purpose: As evidence mounts for effectiveness, an increasing proportion of the United States population undergoes colorectal cancer screening. However, relatively little is known about rates of follow-up after abnormal results from initial screening tests. This study examines patterns of colorectal cancer screening and follow-up within the nation's largest integrated health care system: the Veterans Health Administration.

Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

Background: Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates.

Objectives: To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates.

Systems Learning from Physician Performance Data.

Context: Data collected in 1998 on primary physician performance, including Health Plan Employer Data and Information Set (HEDIS) measures, were the basis of reports distributed quarterly to 194 primary care physicians at 25 medical centers in Group Health Cooperative. Here, we summarize results of research designed to assess reliability of measures of physician performance and to identify practice components which influence patient outcome. Various aspects of these results are published in Medical Care, The Journal of General Internal Medicine, and Family Medicine.

Primary care practice coordination versus physician continuity.

Background And Objectives: This study assesses the influence of primary care continuity--both clinician and system--on patient outcomes. We consider the presumed benefits of physician continuity and practice coordination within a multi-specialty group.

Methods: The practices of 194 family physicians and general internists caring for 320000 adult members of a health maintenance organization were evaluated using four aggregate measures of outcomes--cancer screening in women, diabetic management examinations, patient satisfaction ratings, and ambulatory costs.

Physician performance assessment: nonequivalence of primary care measures.

Background: Assessment of the performance of primary care physicians requires multiple, reliable measures. This article explores the appropriateness of selected Health Plan Employer Data and Information Set (HEDIS) measures, developed to assess health plans, to assess individual physician performance.

Objectives: To determine the consistency and reliability of 4 measures of primary care physician performance measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs.

Effect of part-time practice on patient outcomes.

Background: Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes.

Objective: To determine whether patient outcomes vary with physicians' clinic hours.

Design: Cross-sectional retrospective design assessing primary care practices in 1998.