Medical Group Structural Integration May Not Ensure That Care Is Integrated, From The Patient's Perspective

Published in: Health Affairs 36, no.5 (May 2017):885-892. doi: 10.1377/hlthaff.2016.0909

Posted on RAND.org on May 05, 2017

by Michaela J. Kerrissey, Jonathan R. Clark, Mark W. Friedberg, Wei Jiang, Ashley-Kay Fryer, Molly Frean, Stephen M. Shortell, Patricia P. Ramsay, Lawrence P. Casalino, Sara J. Singer

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Structural integration is increasing among medical groups, but whether these changes yield care that is more integrated remains unclear. We explored the relationships between structural integration characteristics of 144 medical groups and perceptions of integrated care among their patients. Patients' perceptions were measured by a validated national survey of 3,067 Medicare beneficiaries with multiple chronic conditions across six domains that reflect knowledge and support of, and communication with, the patient. Medical groups' structural characteristics were taken from the National Study of Physician Organizations and included practice size, specialty mix, technological capabilities, and care management processes. Patients' survey responses were most favorable for the domain of test result communication and least favorable for the domain of provider support for medication and home health management. Medical groups' characteristics were not consistently associated with patients' perceptions of integrated care. However, compared to patients of primary care groups, patients of multispecialty groups had strong favorable perceptions of medical group staff knowledge of patients' medical histories. Opportunities exist to improve patient care, but structural integration of medical groups might not be sufficient for delivering care that patients perceive as integrated.

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