Pham Hoangmai H, O'Malley Ann S, Bach Peter B, Saiontz-Martinez Cynthia, Schrag Deborah
Center for Studying Health System Change, Washington, DC 20024, USA.
Ann Intern Med. 2009 Feb 17;150(4):236-42. doi: 10.7326/0003-4819-150-4-200902170-00004.
Primary care physicians are expected to coordinate care for their patients.
To assess the number of physician peers providing care to the Medicare patients of a primary care physician.
Cross-sectional analysis of claims data.
Fee-for-service Medicare in 2005.
2284 primary care physicians who responded to the 2004 to 2005 Community Tracking Study Physician Survey.
Primary patients for each physician were defined as beneficiaries for whom the physician billed for more evaluation and management visits than any other physician in 2005. The number of physician peers for each physician was the sum of other unique physicians that the index physician's primary patients visited plus other unique physicians who served as the primary physician for each of the index physician's nonprimary patients during 2005.
The typical primary care physician has 229 (interquartile range, 125 to 340) other physicians working in 117 (interquartile range, 66 to 175) practices with which care must be coordinated, equivalent to an additional 99 physicians and 53 practices for every 100 Medicare beneficiaries managed by the primary care physician. When only the 31% of a primary care physician's primary patients who had 4 or more chronic conditions was considered, the median number of peers involved was still substantial (86 physicians in 36 practices). The number of peers varied with geographic region, practice type, and reliance on Medicaid revenues.
Estimates are based only on fee-for-service Medicare patients and physician peers, and the number of peers is therefore probably an underestimate. The modest response rate of the Community Tracking Study Physician Survey may bias results in unpredictable directions.
In caring for his or her own primary and nonprimary patients during a single year, each primary care physician potentially must coordinate with a large number of individual physician colleagues who also provide care to these patients.
National Institute on Aging, American Medical Group Association, and the Robert Wood Johnson Foundation.
基层医疗医生应协调为其患者提供的护理。
评估为基层医疗医生的医疗保险患者提供护理的同行医生数量。
对索赔数据进行横断面分析。
2005年按服务收费的医疗保险。
对2004年至2005年社区追踪研究医生调查做出回应的2284名基层医疗医生。
每位医生的主要患者被定义为2005年该医生为其开具的评估和管理就诊账单多于其他任何医生的受益人。每位医生的同行医生数量是该索引医生的主要患者就诊的其他独特医生数量加上2005年作为该索引医生的非主要患者的每位主要医生的其他独特医生数量之和。
典型的基层医疗医生有229名(四分位间距为125至340名)其他医生在117家(四分位间距为66至175家)诊所工作,需要与之协调护理,这相当于该基层医疗医生管理的每100名医疗保险受益人额外有99名医生和53家诊所。仅考虑基层医疗医生31%的患有4种或更多慢性病的主要患者时,涉及的同行医生中位数仍然相当可观(36家诊所中有86名医生)。同行医生数量因地理区域、诊所类型以及对医疗补助收入的依赖程度而异。
估计仅基于按服务收费的医疗保险患者和同行医生,因此同行医生数量可能被低估。社区追踪研究医生调查的适度回应率可能会使结果产生不可预测方向的偏差。
在一年中照顾自己的主要和非主要患者时,每位基层医疗医生可能必须与大量也为这些患者提供护理的个体医生同事进行协调。
美国国立衰老研究所、美国医学集团协会和罗伯特·伍德·约翰逊基金会。