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Dartmouth Links Primary Care Quality to Actions, Not Numbers of Doctors

Cheryl Clark, for HealthLeaders Media, May 27, 2011

It's long been assumed that the more primary care doctors serve a geographic population, the fewer avoidable hospitalizations and the lower rate of death for Medicare patients.

But a Dartmouth report published this week says that mortality and hospitalizations are significantly lower in areas where there are more primary care doctors who actually work full time taking care of patients in ambulatory care office or clinic settings. This points to the importance of preventive healthcare to avoid acute care. 

Currently many clinicians licensed and counted as primary care doctors actually work in hospitals, emergency departments, in research, or in public health, or may not take care of Medicare beneficiaries at all. In some cases, they have gone on to specialize in other fields such as cardiology.

It's not just having more physicians trained in primary care, wrote Chiang-Hua Chang and David Goodman, MD, of the Dartmouth Institute for Health Policy and Clinical Practice. What's more important, they wrote, is that ambulatory care be delivered by primary care physicians who actually work "in an office or clinic setting by physicians trained in primary care."

The Dartmouth report is published in the Journal of the American Medical Association. The researchers based their findings on a sample of more than five million Medicare beneficiaries in 2007 in 6,542 primary care service areas and their hospitalization claims for 12 conditions that can be avoided when good care is provided with a clinic or office visit.

The research compared two ways of measuring primary care physicians, the American Medical Association's Masterfile dataset of doctors who list themselves as primary care providers, and a list of physicians who submit claims for reimbursement of Medicare beneficiaries, the latter being a better measure of doctors who actually treat ambulatory patients.

Primary care physicians per 100,000 population vary as much as five fold across these service areas, so the researchers had much to compare.

In the researchers extrapolation spending would not decline, however.

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