Grumbach K, Selby J V, Schmittdiel J A, Quesenberry C P
University of California, Primary Care Research Center, Department of Family and Community Medicine, Institute for Health Policy Studies, and Center for California Health Workforce Studies, San Francisco 94143-1364, USA.
Health Serv Res. 1999 Jun;34(2):485-502.
To determine whether physician specialty was associated with differences in the quality of primary care practice and patient satisfaction in a large, group model HMO.
DATA SOURCES/STUDY SETTING: 10,608 patients ages 35-85 years, selected using stratified probability sampling from the primary care panels of 60 family physicians (FPs), 245 general internists (GIMs), and 55 subspecialty internists (SIMs) at 13 facilities in the Kaiser Permanente Medical Care Program of Northern California. Patients were surveyed in 1995.
A cross-sectional patient survey measured patient reports of physician performance on primary care measures of coordination, comprehensiveness, and accessibility of care, preventive care procedures, and health promotion. Additional items measured patient satisfaction and health values and beliefs.
Patients were remarkably similar across physician specialty groups in their health values and beliefs, ratings of the quality of primary care, and satisfaction. Patients rated GIMs higher than FPs on coordination (adjusted mean scores 68.0 and 58.4 respectively, p<.001) and slightly higher on accessibility and prevention; GIMs were rated more highly than SIMs on comprehensiveness (adjusted mean scores 76.4 and 73.8, p<.01). There were no significant differences between specialty groups on a variety of measures of patient satisfaction.
Few differences in the quality of primary care were observed by physician specialty in the setting of a large, well-established group model HMO. These similarities may result from the direct influence of practice setting on physician behavior and organization of care or, indirectly, through the types of physicians attracted to a well-established group model HMO. In some settings, practice organization may have more influence than physician specialty on the delivery of primary care.
确定在一个大型的团体模式健康维护组织（HMO）中，医生的专业是否与初级保健服务质量及患者满意度的差异相关。
数据来源/研究背景：从北加利福尼亚凯撒医疗计划的13个机构中，60名家庭医生（FPs）、245名普通内科医生（GIMs）和55名专科内科医生（SIMs）的初级保健名单中，采用分层概率抽样选取了10608名年龄在35 - 85岁之间的患者。患者于1995年接受调查。
一项横断面患者调查，测量患者对医生在初级保健的协调、全面性和可及性、预防保健程序以及健康促进等方面表现的报告。其他项目测量患者满意度、健康价值观和信念。
不同专业医生组的患者在健康价值观和信念、初级保健质量评分及满意度方面非常相似。患者对GIMs在协调方面的评分高于FPs（调整后平均得分分别为68.0和58.4，p<0.001），在可及性和预防方面略高；GIMs在全面性方面的评分高于SIMs（调整后平均得分76.4和73.8，p<0.01）。在各种患者满意度测量指标上，专业组之间没有显著差异。
在一个大型、成熟的团体模式HMO环境中，未观察到医生专业在初级保健质量方面有显著差异。这些相似性可能源于实践环境对医生行为和护理组织的直接影响，或者间接源于吸引到成熟团体模式HMO的医生类型。在某些情况下，实践组织对初级保健的提供可能比医生专业有更大影响。
