Ellis Shellie D, Karim Saleema A, Vukas Rachel R, Marx Daniel, Uddin Jalal
1 University of Kansas School of Medicine, Kansas City, USA.
2 University of Arkansas for Medical Sciences, Little Rock, USA.
Inquiry. 2018 Jan-Dec;55:46958018787041. doi: 10.1177/0046958018787041.
Specialists, who represent 60% of physicians in the United States, are consolidating into large group practices, but the degree to which group practice type facilitates the delivery of high quality of care in specialty settings is unknown. We conducted a systematic literature review to identify the impact of group practice type on the quality of care among specialty providers. The search resulted in 913 articles, of which only 4 met inclusion criteria. Studies were of moderate methodological quality. From the limited evidence available, we hypothesize that solo specialists deliver care that is inferior to their peers in group practice, whether measured by patient satisfaction ratings or adherence to guideline-based care. However, solo specialists and multidisciplinary group specialists may be more likely to provide some specialized services compared with their single-specialty group peers. Insufficient research compares quality of care among different practice types in specialty care. Substantial opportunity exists to test the degree to which organizational factors, whether size of practice or the mix of providers within the practice, influence quality of care in specialty settings.
在美国，占医生总数60%的专科医生正合并为大型集团诊所，但集团诊所类型在专科环境中促进高质量医疗服务提供的程度尚不清楚。我们进行了一项系统的文献综述，以确定集团诊所类型对专科医疗服务提供者医疗质量的影响。检索结果有913篇文章，其中只有4篇符合纳入标准。这些研究的方法质量中等。根据现有有限的证据，我们推测，无论是通过患者满意度评分还是遵循基于指南的护理来衡量，个体专科医生提供的医疗服务都不如集团诊所中的同行。然而，与单一专科集团的同行相比，个体专科医生和多学科集团专科医生可能更有可能提供一些专科服务。在专科护理中，比较不同执业类型医疗质量的研究不足。有大量机会来测试组织因素，无论是诊所规模还是诊所内提供者的组合，在多大程度上影响专科环境中的医疗质量。
