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PatientDoctor Connectedness and the Quality of Primary Care

What is the problem and what is known about it so far? Common sense suggests that the quality of medical care would be better when a doctor knows a patient well and the patient sees the same doctor over time than when a patient sees several doctors who do not know the patient well. However, good studies are lacking to prove that care is better when a patient is connected to a specific doctor. Why did the researchers do this particular study? To see whether quality of care is better when patients and doctors are connected than when these connections are not present. Who was studied? 155 590 adults who had at least 1 visit to a doctor in a network of primary care practices. How was the study done? The researchers used data from clinical systems to identify patients who received most of their primary care from a specific doctor or from different doctors in a specific practice. Other patients were considered not connected to either a physician or a practice; usually, these patients were transitioning out of the health care network. The researchers then looked for a relationship between connectedness and several measures of quality of care: cancer screening in eligible patients, diabetes monitoring and control in patients with diabetes, and cholesterol monitoring and control in patients with diabetes and heart disease. What did the researchers find? About 60% of patients were connected to a doctor, about 34% were connected to a practice, and about 6% were not connected to a doctor or practice. Large differences in insurance status and racial and ethnic groups were found among patients were who were unconnected or connected to a physician or practice; unconnected patients were more likely to be uninsured and of an ethnic and racial minority group. Patients who were connected to a physician were most likely to receive recommended care, whereas patients connected to a practice were less likely to receive recommended care. The researchers did not assess outcomes in unconnected patients. What were the limitations of the study? This study included only 1 primary care network and looked at only a few measures of quality of care. What are the implications of the study? Patients who see a specific doctor are more likely to receive recommended care than patients who are not connected to a specific doctor.