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PURPOSE Care continuity is foundational to the clinician/patient relationship; however, little has been done to operationalize continuity of care (CoC) as a clinical quality measure. The American Board of Family Medicine developed the Primary Care CoC clinical quality measure as part of the Measures That Matter to Primary Care initiative. METHODS Using 12-month Optum Clinformatics Data Mart claims data, we calculated the Bice-Boxerman Continuity of Care Index for each patient, which we rolled up to create an aggregate, physician-level CoC score. The physician quality score is the percent of patients with a Bice-Boxerman Index [greater than or equal to] 0.7 (70%). We tested validity in 2 ways. First, we explored the validity of using 0.7 as a threshold for patient CoC within the Optum claims database to validate its use for reflecting patient-level continuity. Second, we explored the validity of the physician CoC measure by examining its association with patient outcomes. We assessed reliability using signal-to-noise methodology. RESULTS Mean performance on the measure was 27.6%; performance ranged from 0% to 100% (n = 555,213 primary care physicians). Higher levels of CoC were associated with lower levels of care utilization. The measure indicated acceptable levels of validity and reliability. CONCLUSIONS Continuity is associated with desirable health and cost outcomes as well as patient preference. The CoC clinical quality measure meets validity and reliability requirements for implementation in primary care payment and accountability. Care continuity is important and complementary to access to care, and prioritizing this measure could help shift physician and health system behavior to support continuity. https://doi.org/10.1370/afm.2880, INTRODUCTION Continuity of care (CoC) is a central tenet of primary care and is associated with fewer hospitalizations and emergency department (ED) visits, better patterns of care utilization, lower costs [...]

Because practicing medicine in 2022 looks very different than practicing medicine 40 or even 20 years ago, younger doctors are setting different priorities for their careers than their older peers. [...]

Kathleen Barry, MD, couldn't believe what she saw on an evaluation of one of her physicians. "The young woman took a cell phone call in the exam room with the [...]

The study examines the rate of exception reporting for 65 clinical activities in England and its relationship with the characteristics of patients and medical practices. Evidence suggests pay-for-performance programs can benefit from exception reporting, provided it is used appropriately.

The competence of doctors and the quality of medical care they provide in low-income countries are particularly low. The poor have access to lower-quality care than the rich in both the public and private health sectors.

The article urges benchmarks should be set in order to assess efficiency and quality provided by physicians in a scenario of rising healthcare costs.

A study analyzed claims in order to describe typical care delivery patterns in fee-for-service Medicare, to evaluate the extent to which a beneficiary's care could be assigned to a single physician or practice, and to determine the extent to which physicians can be held accountable for Medicare patients. Results demonstrated that the dispersion of patients' care among multiple physicians limits the effectiveness of pay-for-performance initiatives that rely on a single retrospective method of assigning responsibility for patient care.

Most practicing physicians have to assess the competence of trainees, peers, and other health professionals, but they may not be very comfortable using education assessment tools. A conceptual framework for commonly used and emerging methods of assessment is provided together with a discussion on the strengths and weaknesses of each method and the challenges of assessing physicians' professional competence and performance.

Ask hospital chief executive officers (CEOs) about the top 10 challenges in health care facing them today and on the list, usually in the top 5, will be at least [...]

Byline: Zbigniew Szawarski (1) Keywords: art of healing; clinical judgement; good physician; medical knowledge; trust; wisdom Abstract: The concept of the art of healing is intrinsically connected with the idea of healing powers. There are at least three possible approaches to that idea and all of them have different implications for the problem of medical wisdom. These are: the idea of the healing powers of nature, the idea of the healing powers of science, and the idea of the healing powers of physician's personality. Having critically discussed those ideas I sketch an ideal of a wise physician as someone who has a particular kind of knowledge, good judgement, and self-trust. Medical knowledge is certainly a necessary condition of being a wise doctor but it is not the sufficient one. And this is why patients generally prefer to seek help of 'naturally wise physicians'. Author Affiliation: (1) Institute of Philosophy, Warsaw University, Krak, PrzedmieoAcie 3, 00-047, Warszawa, Poland Article History: Registration Date: 18/10/2004

Many problems need to be overcome to create a system that can evaluate a doctor's performance. Most doctors are evaluated based on patient outcomes or the doctor's adherence to clinical practice guidelines. These are called outcome and process assessments. Unfortunately, there is no broad infrastructure in place to collect this data.

The publication of a new biography of George Cheyne provides an occasion to question whether he was the intended recipient of David Hume's pre-Treatise Letter to a Physician. The biography is used to show that it would be wrong to dismiss the possibility of the letter being sent to George Cheyne.

Research has shown minorities receive lower quality health care than White persons even with socioeconomic conditions controlled. This difference may partially be related to racially biased attitudes and impaired communication in interracial relationships between physicians and patients. This study investigated the effect of physicians' race and nonverbal communication style on participants' evaluations. Patients at a local health clinic were participants (N = l16: 84% Black, 16% White). Each participant viewed one of four videotapes showing varied race of a physician (Black or White) and the physician's nonverbal behavior (expressing concern or distance), and then completed a questionnaire evaluating the depicted physician. Overall, participants did not give significantly different preferences for physicians of the same race. However, participants' evaluations were significantly associated with physicians' nonverbal style. Nonverbal concern was associated with highest satisfaction, trust, self-disclosure, recall of information, likelihood of recommending the physician, and intent to comply with the physician's recommendations. When male and female participants were compared, preference for a physician of the same race was found only among male participants who viewed verbally distant physicians. Results suggest that social skills are more important than race in shaping patients' perceptions of physicians.

Objective. Health maintenance organizations and other payers increasingly use patient satisfaction data to profile physician performance. Little is known about physicians' use of patient satisfaction information or how profiles affect individual physician behaviors. The objective of this study was to examine primary care physicians' perceptions of performance profiles based on patient satisfaction data, whether physicians use profiles to change practice behaviors, and which profile components physicians think are important for assessing quality of care. Methods. A written survey was conducted in 1998 in Massachusetts with 810 primary care physicians (304 pediatricians, 201 family practitioners, 305 internists) who had at least 100 patients in a large managed care plan and had received 1 or more profiles based on patient satisfaction data. Physicians in training were excluded. Physicians' perceptions of profiles and their reported use to change practice behaviors were measured. Results. The response rate was 68%. Twenty-three percent reported that profiles were very or extremely useful for improving care. Only 7% reported using profiles often or always to change care. Although specific profile components related to interpersonal aspects of care were rated more useful, Conclusion. Although health maintenance organizations and other payers increasingly use patient satisfaction reports to profile individual physicians and guide physician compensation and health plan participation, satisfaction, physician report cards., As health care delivery systems experience unparalleled economic and competitive challenges, they have adopted quality improvement principles to improve their economic situation, with a particular focus on patient-centered care and [...]

The authors examined how racial matching between older patients and physicians relates to effectiveness of care, use of services, and satisfaction with care. In this cross-sectional, community-based cohort study, 2,867 elderly African American and White North Carolina residents with regular physicians were interviewed and screened for hypertension (HBP). African Americans were more likely than Whites to be told they had HBP, to receive HBP medication, and to take it regardless of their physician's race. White elders with African American physicians were more likely to report that they delayed care quite often. African American elders were less likely to delay care quite often, regardless of their physicians' race. These results did not support the position that African Americans require treatment by African American physicians to achieve better care. Although elders of both races who had African American physicians were less satisfied with care received, interpretation of this finding is difficult without better measurement of patient satisfaction.

A growing number of plans and business organizations are making patients' report cards public to demonstrate the efficiency of certain groups in comparison with other groups. The emerging trend is driven by employers who cannot tolerate the unexplained variations in the marketplace. Physician groups have complained in response to data which they claim are misleading. Despite the negative reactions of doctors, some groups and independent physician associations are changing their practice patterns upon realization that there are better ways to do things., Published profiles of doctors' clinical performance and patient satisfaction will soon sweep the country. Ignore them at your risk. You probably haven't sweated over report cards and grades since your [...]

I am surely not the only one who is tired of the political and social polarization that has swept over our nation. I believe that this 'if you're not with [...]

This qualitative study explored those behaviours of a general practitioner which were used by patients in their evaluations of 14 aspects of general practice care. Thirty patients were interviewed immediately after visiting their general practitioner. Interview transcripts were analyzed by two authors, who independently marked general practitioners' behaviours used by patients. Then, these text fragments were categorized into task or affective behaviours according to an existing taxonomy of doctor behaviour in consultations. The results showed that patients reported using task oriented behaviours when they evaluated task oriented aspects of general practice care. However, when they evaluated affective aspects they reported using both affective behaviours and task behaviours, although the latter to a lesser extent. The evaluations of 'tell you all you wanted to know about your illness', 'explain the purpose and the course of the treatment', 'pay attention to your feelings' and 'kind and attentive' are clearly linked to specific general practitioners' behaviour. Therefore, evaluations of these aspects can be interpreted straightforwardly. Evaluation of the aspects 'GP understands you', 'having faith in your GP' and 'were you involved in decisions about your medical treatment?' were based on a large variety of physician behaviours which may lead to interpretation problems. Thus, this study gives some important considerations for a better understanding of patients' evaluations of general practice care. Key words - patient satisfaction, general practice, evaluation