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Patient–Physician Connectedness and Quality of Primary Care

Steven J. Atlas, MD, MPH; Richard W. Grant, MD, MPH; Timothy G. Ferris, MD; Yuchiao Chang, PhD; and Michael J. Barry, MD
[+] Article, Author, and Disclosure Information

From Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Acknowledgment: The authors thank Jeffrey Ashburner, MPH, for manuscript preparation and statistical analyses.

Grant Support: By the National Cancer Institute (grant NCI 1 R21 CA121908) and institutional funding from the Massachusetts General Hospital Primary Care Operations Improvement Program. Dr. Grant is supported by a National Institute of Diabetes and Digestive and Kidney Diseases Career Development Award (K23 DK067452), and Dr. Ferris was supported in part by the Agency for Healthcare Research and Quality (grant 5R01 HS015002).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol: Patient–physician connected algorithm and methods available from Dr. Atlas (e-mail, satlas@partners.org). Statistical code: Available from Dr. Atlas (e-mail, satlas@partners.org). Data set: Not available.

Requests for Single Reprints: Steven J. Atlas, MD, MPH, General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, satlas@partners.org.

Current Author Addresses: Drs. Atlas, Grant, Chang, and Barry: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.

Dr. Ferris: Massachusetts General Hospital, 55 Fruit Street, Bulfinch 205, Boston, MA 02114.

Author Contributions: Conception and design: S.J. Atlas, R.W. Grant, T.G. Ferris, M.J. Barry.

Analysis and interpretation of the data: S.J. Atlas, R.W. Grant, T.G. Ferris, Y. Chang, M.J. Barry.

Drafting of the article: S.J. Atlas, T.G. Ferris.

Critical revision of the article for important intellectual content: R.W. Grant, T.G. Ferris, M.J. Barry.

Final approval of the article: S.J. Atlas, R.W. Grant, T.G. Ferris, Y. Chang, M.J. Barry.

Provision of study materials or patients: S.J. Atlas.

Statistical expertise: Y. Chang.

Obtaining of funding: S.J. Atlas, M.J. Barry.

Administrative, technical, or logistic support: M.J. Barry.

Ann Intern Med. 2009;150(5):325-335. doi:10.7326/0003-4819-150-5-200903030-00008
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We examined the relationship between physician connectedness and measures of physician performance by categorizing all patients seen in a large primary care network on the basis of their connectedness to a specific primary care physician. Our results indicate that many patients did not have a close continuous relationship with their designated primary care physician, the prevalence of physician-connected patients was variably distributed between practices, patients without a close relationship with a specific physician were less likely to complete recommended testing for preventive and chronic illness care, and differences in performance measures by race or ethnicity were smaller than differences in patient–physician connectedness within racial or ethnic groups. Controlling for patient–physician connectedness attenuated some differences among racial and ethnic groups in the receipt of guideline-recommended care.

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Figure 1.
Method of connecting patients with specific primary care physicians or practices.

MGH = Massachusetts General Hospital; PCP = primary care physician. The square boxes represent the patient population seen in the MGH primary care network and their initial assessment based on listed provider. The hexagonal boxes represent the algorithms that connect patients to a specific physician or practice. The rounded boxes represent the disposition of the primary care population based on patient–physician connectedness.

* Patients younger than 18 years and those who were deceased are also included in this category.

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Figure 2.
Patient connectedness in the 13 practice sites.

* Community health center.

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Figure 3.
Patient connectedness, by race or ethnicity.
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Figure 4.
Breast cancer screening rates, by patient connectedness and by race or ethnicity.

Adjusted rates of breast cancer screening with mammography in the previous 2 years among eligible women age 42 to 69 years.

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Summary for Patients

Patient–Doctor Connectedness and the Quality of Primary Care

The summary below is from the full report titled “Patient–Physician Connectedness and Quality of Primary Care.” It is in the 3 March 2009 issue of Annals of Internal Medicine (volume 150, pages 325–335). The authors are S.J. Atlas, R.W. Grant, T.G. Ferris, Y. Chang, and M.J. Barry.


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