QUALITY ASSURANCE IN CAPITATED PHYSICIAN GROUPS - WHERE IS THE EMPHASIS

Objective.-To describe quality assurance (QA) programs implemented by capitated physician groups; to measure their relative emphasis on moni toring of overuse compared with underuse and monitoring and improving preventive services compared with chronic disease care; and to examine how group characteristics influence QA activity. Design.-Cross-sectio nal questionnaire. Setting.-A large network-model health maintenance o rganization in California (133 contracting physician groups). Particip ants.-Ninety-four physician groups (71%) caring for 2.9 million capita ted patients. Main outcome Measures.-Self-reported use of quality moni toring and improvement methods. Results.-All capitated physician group s conducted some QA, Groups' QA programs monitored areas subject to ov eruse, such as cesarean delivery and angioplasty rates, more than area s subject to underuse, such as childhood immunization rates and perfor mance of retinal examinations for diabetic patients (64% vs 43%, P<.00 1). They monitored underuse of preventive services more than followup services for chronic diseases (54% vs 31%, P<.001), Groups also used r eminders For preventive services more than they monitored follow-up se rvices for chronic diseases (26% vs 15%, P<.01). Physician group chara cteristics independently associated with higher overall QA activity we re greater number of years in existence, higher profitability, and cap itated care penetration, Conclusion.-Capitation places a large share o f responsibility for QA in the hands of physician groups, but not ail aspects of QA are being equally addressed, The emphasis on overuse may result from financial incentives inherent in capitation, while the fo cus on preventive services may stem from lack of adequate quality meas urement tools for monitoring chronic disease care, Further research ef forts should address how capitated physician groups might expand their QA programs to include monitoring of underuse, especially for patient s with chronic disease.