BACKGROUND There is little empirical research examining the effects of burnout on objective measures of primary care physicians' behaviour in the medical encounter. OBJECTIVES We studied possible associations between primary care physicians' burnout and the rates of referrals. We conceptualized referral rate as a negative outcome of burnout because high and unnecessary referral rates incur ex...

British Journal of General Practice, March 2005 companies are now established offering an n-of-1 trial service to HMOs so that costeffectiveness studies can be established in individual patients seeking long-term medical treatment. Barriers to the wider dissemination and implementation of n-of-1 trials include a lack of intellectual and administrative experience. The effort of setting up an n-o...

OBJECTIVE To (a) determine if converting patients on simvastatin to lovastatin affects whether they meet their low-density lipoprotein cholesterol (LDL-C) goals as defined by the National Cholesterol Education Program Adult Treatment Panel III (ATP III) clinical practice guidelines and (b) assess the change in health care expenditures associated with such a conversion. METHODS Primary and sec...

BACKGROUND Little is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization's costs. The purpose of this study was to determine whether joining an ACO is associated with an increase in a Rural Health Clinic's (RHC's) cost per visit. METHODS The analyses focused on cost per visit in 2012 and 2013 for RHCs that joined an ACO in 2012 and co...

OBJECTIVES This study examined the association between type of health insurance coverage and quality of primary care as measured by its distinguishing attributes--first contact, longitudinality, comprehensiveness, and coordination. METHODS The household component of the 1996 Medical Expenditure Panel Survey was used for this study. The analysis primarily focused on subjects aged younger than ...

OBJECTIVES To use the administrative capacity of a health maintenance organization to enroll uninsured patients at an academic health center into a coordinated care program in which patients were assigned to community primary care physicians over 3 years. STUDY DESIGN Observational case study of a cohort of 2389 patients enrolled for at least 1 year and cross-sectional observations for all en...

This paper investigates how hospital affiliation in a multi-hospital system (contract managed, owned, sponsored), the number of system hospitals, HMO and PPO contracts, and other factors, impacts hospital cost efficiency. Using a 1996-1999 panel of 248 hospitals, results show that for urban hospitals, increasing the number of hospitals in the system, system ownership and contract management/spo...

BACKGROUND The integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to ...

Lessons from community-oriented primary care in the United States can offer insights into how we could improve population health by integrating the public health, social service, and health care sectors to form accountable communities for health (ACHs). Unlike traditional accountable care organizations (ACOs) that address population health from a health care perspective, ACHs address health fro...

OBJECTIVE To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK). DESIGN Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK). SETTING Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizat...