Features of Patient-Centered Primary Care and the Use of Ambulatory Care

摘要

This study explores the association between patients' use of ambulatory care resources and features of patient-centered primary care (PCPC), specifically clinic-level National Committee for Quality Assurance (NCQA) recognition of PCPC, continuity of care, and care team communication. Data for this study were compiled from the electronic health records of a large multispecialty group practice in California, covering the period between 2009 and 2010 for 37,042 nonelderly patients under capitated managed care plans. Regression analysis of these data was performed using a generalized linear model, comparing measures of patient-level annual resource use (in total relative value units [tRVUs]) against measures of both clinic- and patient-level PCPC, and patient-level risk (eg, age, comorbidities). Patients linked to NCQA Recognition Level III versus Level II clinics used 4.8% (P < 0.001) fewer ambulatory care tRVUs. Patients with a 1 standard deviation increase in primary care continuity used 3.9% (P < 0.001) fewer ambulatory care tRVUs. Patients who switched primary care physicians used 17.4% (P < 0.001) more ambulatory care tRVUs. These results indicate that PCPC is associated with reductions in resource use related to both clinic- and patient-level features. The patient-level associations document within-clinic heterogeneity in PCPC. Based on these findings, practices can be encouraged to perform consistent with high NCQA recognition, promote primary care continuity, and be mindful of differences at an individual patient level.