Differences in the mix of patients among medical specialties and systems of care: results from the Medical Outcomes Study

Patients who are older, sicker and have chronic medical conditions are more likely to be under the care of specialists in a solo or small single-specialty group practice than younger, healthier patients. A survey of 20,158 adults in three large cities who visited a physician's office during the study found that those with a chronic medical condition made more visits to physicians' offices, took more prescription drugs and were hospitalized more often than patients without a chronic medical condition. Patients treated by a family practitioner were younger and had better health with fewer chronic medical conditions, compared to patients treated by a specialist. Patients who visited a cardiologist were older with poorer health and more chronic medical conditions than those who visited a general internist. Patients treated by a solo practitioner were older and sicker with more chronic medical conditions than those who were treated at a health maintenance organization.
Objective. - To determine differences in the mix of patients among medical specialties and among organizational systems of care. Study Design. - Cross-sectional analysis of 20 158 adults ([is greater than or equal to] 18 years of age who visited providers' offices during 9-day screening periods in 1986. Patient and physician information was obtained by self-administered, standardized questionnaires. Setting. - Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo or small single-specialty group practices in three major US cities. Outcome Measures. - Demographic characteristics, prevalence of chronic disease, disease-specific severity of illness, and functional status and well-being. Results. - Among patients with selected physician-reported chronic illnesses (diabetes, hypertension, recent myocardial infarction, or congestive heart failure), increasing levels of severity were associated with decreasing levels of functional status and well-being and with increased hospitalizations, more physician visits, and higher numbers of prescription drugs. Compared with patients of general internists, patients of cardiologists were older (56 vs 47 years, P