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The American Journal of Managed Care October 2006
Implementation of Evidence-based Alcohol Screening in the Veterans Health Administration
Katherine A. Bradley, MD, MPH; Emily C. Williams, MPH; Carol E. Achtmeyer, MN; Bryan Volpp, MD; Bonny J. Collins, PA-C, MPA; and Daniel R. Kivlahan, PhD
Low-density Lipoprotein Cholesterol Goal Attainment Among High-risk Patients: Does a Combined Intervention Targeting Patients and Providers Work?
Nelia M. Afonso, MD; George Nassif, MD; Anil N. F. Aranha, PhD; Bonnie DeLor, PharmD; and Lavoisier J. Cardozo, MD
Outpatient Medication Use and Health Outcomes in Post-Acute Coronary Syndrome Patients
Zhou Yang, PhD, MPH; Ade Olomu, MD; William Corser, PhD; David R. Rovner, MD; and Margaret Holmes-Rovner, PhD
Low-density Lipoprotein Cholesterol Goal Attainment Among High-risk Patients: Does a Combined Intervention Targeting Patients and Providers Work?
Nelia M. Afonso, MD; George Nassif, MD; Anil N. F. Aranha, PhD; Bonnie DeLor, PharmD; and Lavoisier J. Cardozo, MD
Association of Income and Prescription Drug Coverage With Generic Medication Use Among Older Adults With Hypertension
Alex D. Federman, MD, MPH; Ethan A. Halm, MD, MPH; Carolyn Zhu, PhD; Tsivia Hochman, MA; and Albert L. Siu, MD, MSPH
Outpatient Medication Use and Health Outcomes in Post-Acute Coronary Syndrome Patients
Zhou Yang, PhD, MPH; Ade Olomu, MD; William Corser, PhD; David R. Rovner, MD; and Margaret Holmes-Rovner, PhD
Implementation of Evidence-based Alcohol Screening in the Veterans Health Administration
Katherine A. Bradley, MD, MPH; Emily C. Williams, MPH; Carol E. Achtmeyer, MN; Bryan Volpp, MD; Bonny J. Collins, PA-C, MPA; and Daniel R. Kivlahan, PhD
Association of Income and Prescription Drug Coverage With Generic Medication Use Among Older Adults With Hypertension
Alex D. Federman, MD, MPH; Ethan A. Halm, MD, MPH; Carolyn Zhu, PhD; Tsivia Hochman, MA; and Albert L. Siu, MD, MSPH
Increasing Primary Care Physician Productivity: A Case Study
Steven Lewandowski, BSS; Patrick J. O'Connor, MD, MPH; Leif I. Solberg, MD; Thomas Lais, BS; Mary Hroscikoski, MD; and JoAnn M. Sperl-Hillen, MD
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Increasing Primary Care Physician Productivity: A Case Study
Steven Lewandowski, BSS; Patrick J. O'Connor, MD, MPH; Leif I. Solberg, MD; Thomas Lais, BS; Mary Hroscikoski, MD; and JoAnn M. Sperl-Hillen, MD

Increasing Primary Care Physician Productivity: A Case Study

Steven Lewandowski, BSS; Patrick J. O'Connor, MD, MPH; Leif I. Solberg, MD; Thomas Lais, BS; Mary Hroscikoski, MD; and JoAnn M. Sperl-Hillen, MD

A number of factors limit the interpretation of these data. First, the joint effects of the multiple interventions cannot be separated.22,23 Second, the granularity of the data was not sufficient to analyze intervals of time shorter than a year, or to support time series analysis. Third, generalization of our findings to other medical groups should be done with great caution because of contextual differences. Similar interventions in other organizations with different cultures and levels of productivity or access may not yield the same results.24-26

Despite these limitations, we believe that the results are interesting and important. First, the data show that a coordinated set of planned changes increased physician production efficiency in a short period of time, without compromising patient satisfaction. Second, compensation changes created concordance between the economic realities facing the medical group and the economic incentives facing individual physicians.19,27 Third, the experience we have reported suggests that a coherent set of complementary changes may benefit most parties involved–patients obtained timely access and better continuity of care; physicians worked harder but received increased income; and the medical group reduced costs of delivering care, thereby improving its position in a competitive market. The anticipated benefits to multiple stakeholders helped to create the momentum needed to initiate change and helped sustain changes once made.

CONCLUSIONS

Our results support the hypothesis that when a high priority for change is combined with an effective change process and with the right types of changes, medical groups can transform themselves, and collectively can address many of the challenges posed by the Institute of Medicine.




From HealthPartners Research Foundation, Minneapolis, Minn. This work was supported by Robert Wood Johnson Foundation, grant #041868, from the Improving Chronic Illness Care Initiative.

Address correspondence to: Patrick J. O'Connor, MD, MPH, Senior Clinical Investigator, HealthPartners Research Foundation, 8100 34th Ave S, MC 21111R, Minneapolis, MN 55440-1524. E-mail: patrick.j.oconnor@healthpartners.com.


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