In West Coast Study, Structure of Medical Organizations is Significant Predictor of Care Processes
From 2000 to 2002, researchers at the University of California at Los Angeles (UCLA) conducted the UCLA Validation Project to study the impact of three factors on patient health outcomes:
- The patient's baseline health status, including preferences for care.
- The processes of care delivered by physicians, nurses and other health care providers.
- The structure of the medical organizations that provide care.
Chronically ill patients visited clinicians an average of 22 times over two years. Visit frequency varied by disease, with patients with diabetes making the most visits (24.9) and patients with low back pain making the fewest visits (18.1).
On average, chronically ill patients saw 5.7 clinicians over two years. Patients with diabetes saw the most providers (6) and patients with low back pain saw the fewest providers (5.2).
Patients in independent practice associations appear to visit providers more frequently than those in medical groups.
The level of agreement between information reported by the patient and information abstracted from the medical record varied by diagnosis and procedure.
Chronically ill patients have many contacts with the health care system, not all of which are office visits with a physician.
Since no one can know in advance where critical quality of care events might occur, medical record abstraction systems designed to collect data to measure the quality of care should consider the types of settings, sometimes unpredictable timing, and multiple providers and provider types that make up the patient's health care experience.