Primary Care Group Practice Research Articles

Evaluation of hospital-sponsored primary care group practice: a national demonstration.

Annals of the New York Academy of SciencesVolume 387, Issue 1 p. 69-89 Evaluation of Hospital-Sponsored Primary Care Group Practice: A National Demonstration* STEPHEN M. SHORTELL, STEPHEN M. SHORTELL S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorTHOMAS M. WICKIZER, THOMAS M. WICKIZER S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorNICOLE URBAN, NICOLE URBAN S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorSTEPHEN J. WILLIAMS, STEPHEN J. WILLIAMS S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorWILLIAM L. DOWLING, WILLIAM L. DOWLING S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this author STEPHEN M. SHORTELL, STEPHEN M. SHORTELL S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorTHOMAS M. WICKIZER, THOMAS M. WICKIZER S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorNICOLE URBAN, NICOLE URBAN S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorSTEPHEN J. WILLIAMS, STEPHEN J. WILLIAMS S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this authorWILLIAM L. DOWLING, WILLIAM L. DOWLING S.M. Shortell, Ph.D., T.M. Wickizer, M.P.H., N. Urban, Sc.D., S.J. Williams, Sc.D., and W.L. Dowling, Ph.D., are at the Center for Health Services Research, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195.Search for more papers by this author First published: May 1982 https://doi.org/10.1111/j.1749-6632.1982.tb17164.xCitations: 1 * This paper was originally presented in November 1979 and revised in August 1980. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume387, Issue1Science and Public Policy IIMay 1982Pages 69-89 RelatedInformation

The effect of a group practice on rural health attitudes and behavior.

The opportunity to join a group practice has been identified as a successful inducement for physicians to locate in rural areas. Less is known of the effects of group practice on the health attitudes, behavior and status of the rural communities in which they are established. A random survey of households was conducted in 1972 in a rural Midwestern area, prior to the establishment of a community-sponsored multispecialty primary care group practice, and again on the same households in 1977, after establishment of this group practice (a total of 292 households representing 829 persons). Perceived access to health services before the establishment of the group practice did not significantly predict use of the group practice. Neither previous use of medical services nor health status measured by several indices was associated with eventual use of the group practice. The apparent impact on the community of the group practice was a significant improvement in access to physician services, shown by shorter average travel time to the place of primary care and a 62 per cent improvement in the ability to make a same-day appointment. Furthermore, a significant shift in the distribution of physician services was noted over the study period. The introduction of physician assistants significantly decreased the prior positive attitudes toward them. Despite improvement in access to care, no changes in population health status or receipt of preventive services were noted. Current users of the group practice appear similar to those utilizing conventional medical care sources in regard to access to services, use of services, as well as health status, attitudes and costs.

Imapct of a primary care group practice on emergency room utilization at a community hospital.

This paper reports the effects on a community hospital's emergency room utilization that were brought about by the development of a primary care group practice. The practice, which has replaced the hospital's traditionally structured outpatient clinics, employs full-time, salaried physicians and provides evening office hours and 24-hour coverage. The primary care group appears to have effected a substantial reduction in pediatric emergency room use. To a lesser extent, utilization by former clinic users among the adult atients was also reduced. These reductions, however, created only modest impact in the context of the hospital's total emergency room use, owed in part to the relatively small size of the patient population who formerly had depended upon the hospital for primary care.

A problem-oriented approach to medical information systems: an application in a primary care group practice.

A relatively simple computer-based information system developed for a primary care group practice at the San Francisco Veterans Administration Hospital contributes to the management of the practice, to improvement of medical care for patients within the group, and to research studies on resource utilization in the management of chronic diseases and the evaluation of care of chronically ill patients. Preliminary results from the use of the information system are encouraging and demonstrate that much may be achieved by information systems that do not attempt to computerize the entire medical record.

The teaching hospital and primary care. Closing down the clinics.

Hospitals have become major providers of primary medical care by default rather than design because of the decreasing availability of primary physicians in community practice. In 1972, Beth Israel Hospital in Boston closed its traditional general clincs and estblished a primary-care group practice--Beth Israel Ambulatory Care. The practice is staffed by teams of full-time salaried physicians, other health professionals and paraprofessionals, house staff and medical students. More than 25 per cent of patient visits are managed by nonphysicians. Subspecialty clinics have been relieved of primary-care case loads and limited to referral and consultative functions. In 1973-74, the cost per visit was $20.32. Patient-visit volume in primary care has increased from a figure of 29,144 in 1971-72 to 41,650 in 1973-74. Broken appointments have declined by one third.