Bishop Tara F, Shortell Stephen M, Ramsay Patricia P, Copeland Kennon R, Casalino Lawrence P
Department of Public Health, Weill Cornell Medical College, 402 E. 67th St, Rm LA-218, New York, NY 10065. E-mail:
Am J Manag Care. 2016 Mar;22(3):172-6.
Reports suggest a trend for physician practices to change ownership from physicians to hospitals. It remains unclear how this change affects quality of patient care. We report the effect of a change to hospital ownership on the use of care management processes (CMPs) and health information technology (IT) among practices in the United States.
Trend analyses of 3 large national surveys of physician practices.
We included 2 cohorts of practices: large practices with 20 or more physicians and small/medium practices with fewer than 20 physicians. The main outcomes were the changes in CMP and health IT indices among practices that were acquired by hospitals. We used multivariate logistic regression to assess these changes.
Large practices acquired by hospitals had larger increases in their CMP index than those that remained physician-owned (11.0-point increase vs 7.0-point decrease; adjusted P = .03). Small/medium practices acquired by hospitals had smaller but significantly higher increases in their CMP score (3.8 points vs 2.6 points; adjusted P = .04). Among all practices, there were no significant differences in the change of the health IT index.
We found a significant increase in the use of CMPs among practices that were acquired by hospitals and no difference in health IT use. These findings suggest that a trend for hospitals to own physician practices may have a positive effect on chronic disease management and quality of care.
报告显示医师执业机构的所有权有从医师转向医院的趋势。目前尚不清楚这种转变如何影响患者护理质量。我们报告了美国执业机构中所有权变更为医院所有对护理管理流程（CMP）和健康信息技术（IT）使用情况的影响。
对3项大型全国性医师执业机构调查进行趋势分析。
我们纳入了两组执业机构：拥有20名或更多医师的大型执业机构以及医师人数少于20名的小型/中型执业机构。主要结果是被医院收购的执业机构中CMP和健康IT指数的变化。我们使用多变量逻辑回归来评估这些变化。
被医院收购的大型执业机构的CMP指数增幅大于仍为医师所有的机构（增加11.0分与下降7.0分；校正P = 0.03）。被医院收购的小型/中型执业机构的CMP得分增幅较小但显著更高（3.8分与2.6分；校正P = 0.04）。在所有执业机构中，健康IT指数的变化没有显著差异。
我们发现被医院收购的执业机构中CMP的使用显著增加，而在健康IT使用方面没有差异。这些发现表明医院拥有医师执业机构的趋势可能对慢性病管理和护理质量产生积极影响。
