Quality of primary care practice in a large HMO according to physician specialty

Objective. To determine whether physician specialty was associated with dif ferences in the quality of primary care practice and patient satisfaction i n a large, group model HMO. Data Sources/Study Setting. 10,608 patients ages 35-85 years, selected usin g stratified probability sampling from the primary care panels of 60 family physicians (FPs), 245 general internists (GIMs), and 55 subspecialty inter nists (SIMs) at 13 facilities in the Kaiser Permanente Medical Care Program of Northern California. Patients were surveyed in 1995. Study Design. A cross-sectional patient survey measured patient reports of physician performance on primary care measures of coordination, comprehensi veness, and accessibility of care, preventive care procedures, and health p romotion. Additional items measured patient satisfaction and health values and beliefs. Principal Findings. Patients were remarkably similar across physician speci alty groups in their health values and beliefs, ratings of the quality of p rimary care, and satisfaction. Patients rated GIMs higher than FPs on coord ination (adjusted mean scores 68.9 and 58.4 respectively, P < .001) and sli ghtly higher on accessibility and prevention; GIMs were rated more highly t han SIMs on comprehensiveness (adjusted mean scores 76.4 and 73.8, P < .01) . There were no significant differences between specialty groups on a varie ty of measures of patient satisfaction. Conclusions. Few differences in the quality of primary care were observed b y physician specialty in the setting of a large, well-established group mod el HMO. These similarities may result from the direct influence of practice setting on physician behavior and organization of care or, indirectly, thr ough the types of physicians attracted to a well-established. group model H MO. In some settings, practice organization may have more influence than ph ysician specialty on the delivery of primary care.