More primary care physicians yielded better patient outcomes

Chang C. JAMA. 2011;305:2096-2105.

Lower mortality rates were observed among a cohort of Medicare beneficiaries in areas of the US with more primary care physicians compared with areas with fewer primary care physicians, according to study results.

Researchers from several sites in the US attempted to outline clearer links between the adult PCP work force and individual patient outcomes.

The study population included 5,132,936 fee-for-service Medicare beneficiaries aged at least 65 years. The analysis involved 6,542 primary care service areas.

The researchers used two measures of adult PCPs (including general internists and family physicians): American Medical Association Masterfile nonfederal, office-based physicians per total population; and office-based primary care clinical full-time equivalents per Medicare beneficiary derived from Medicare claims.

Outcome measures included mortality, ambulatory care sensitive condition hospitalizations and Medicare program spending. These outcomes were adjusted for individual patient characteristics and geographic area variables.

Although there was variability in the PCP work force across geographical areas, low correlation was observed between the two primary care work force measures (Spearman rank correlation coefficient=0.056; P<.001).>

Data from the AMA Masterfile counts indicated that beneficiaries in areas with the highest quintile of PCPs had fewer ambulatory care sensitive condition hospitalizations than those in areas in the lowest quintile, 74.9 vs. 79.61 per 1,000 beneficiaries (RR=0.94; 95% CI, 0.93-0.95). Lower mortality rates (5.38 vs. 5.47 per 100 beneficiaries; RR=0.98; 95% CI, 0.97-0.997) also were observed in the highest quintile compared with the lowest quintile.

No significant difference in total Medicare spending ($8,722 vs. $8,765 per beneficiary; RR=1.00; 95% CI, 0.99-1.00) was observed between the lowest quintile and the highest quintile.

In the analysis of primary care full-time equivalents per beneficiary, those residing in the highest-quintile areas had lower mortality rates compared with those residing in lowest-quintile areas, 5.19 vs. 5.49 per 100 beneficiaries (RR=0.95; 95% CI, 0.93-0.96). Also, in the full-time equivalents analysis, fewer ambulatory care sensitive condition hospitalizations (72.53 vs. 79.48 per 1,000 beneficiaries; RR=0.91; 95% CI, 0.90-0.92) and higher overall Medicare spending ($8,857 vs. $8,769 per beneficiary; RR=1.01; 95% CI, 1.004-1.02) were observed among beneficiaries residing in areas of the highest quintile compared with those in the lowest quintile.

Follow HemOncToday.com on Twitter.