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Lawrence Casalino, MD, PhD; Robin R. Gillies, PhD; Stephen M. Shortell, PhD; Julie A. Schmittdiel, MA; Thomas Bodenheimer, MD; James C. Robinson, PhD; Thomas Rundall, PhD; Nancy Oswald, PhD; Helen Schauffler, PhD; Margaret C. Wang, MPH

JAMA. 2003;289:434-441.

Context  Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use.

Objectives  To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes).

Design, Setting, and Participants  One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs.

Main Outcome Measures  Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use.

Results  Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives—public recognition and better contracts for health care quality—was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P = .007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability.

Conclusions  The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.

Author Affiliations: Department of Health Studies, University of Chicago, Chicago, Ill (Dr Casalino); Division of Health Policy and Management, School of Public Health, University of California, Berkeley (Drs Gillies, Shortell, Robinson, Rundall, and Schauffler, and Mss Schmittdiel and Wang); Department of Family and Community Medicine, University of California, San Francisco (Dr Bodenheimer); and Healthcare Consulting, Berkeley (Dr Oswald).

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