Patient-physician connectedness and quality of primary care

Ann Intern Med. 2009 Mar 3;150(5):325-35. doi: 10.7326/0003-4819-150-5-200903030-00008.


Background: Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not known.

Objective: To determine whether patient-physician connectedness affects measures of clinical performance.

Design: Population-based cohort study.

Setting: Academic network of 4 community health centers and 9 hospital-affiliated primary care practices.

Patients: 155 590 adults with 1 or more visits to a study practice from 2003 to 2005.

Measurements: A validated algorithm was used to connect patients to either 1 of 181 physicians or 1 of 13 practices in which they received most of their care. Performance measures included breast, cervical, and colorectal cancer screening in eligible patients; hemoglobin A(1c) measurement and control in patients with diabetes; and low-density lipoprotein cholesterol measurement and control in patients with diabetes and coronary artery disease.

Results: Overall, 92 315 patients (59.3%) were connected to a specific physician, whereas 53 669 patients (34.5%) were connected only to a specific practice and 9606 patients (6.2%) could not be connected to a physician or practice. The proportion of patients in a practice who could be connected to a physician varied markedly (45.6% to 71.2% of patients per practice; P < 0.001). Physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care (for example, adjusted mammography rates were 78.1% vs. 65.9% [P < 0.001] and adjusted hemoglobin A(1c) rates were 90.3% vs. 74.9% [P < 0.001]). Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity.

Limitation: Patient-physician connectedness was assessed in 1 primary care network.

Conclusion: Patients seen in primary care practices seem to be variably connected with a specific physician, and less connected patients are less likely to receive guideline-consistent care.

Funding: National Cancer Institute.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Continuity of Patient Care / standards
  • Ethnicity
  • Female
  • Humans
  • Male
  • Mammography / statistics & numerical data
  • Managed Care Programs / standards
  • Massachusetts
  • Middle Aged
  • Patients / psychology
  • Physician-Patient Relations*
  • Primary Health Care / standards*
  • Quality of Health Care*
  • Young Adult