How Physician Groups Manage Their Patients' Chronic...
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Published: September 10, 2014
Program Results Report
Grant ID: 36275, 38690, 40087, 41540, 50789, 58680
51573, 65937, 67235, 68847, 70440, 71110, 71934
How Physician Groups Manage Their Patients’ Chronic Illnesses
A long-term study of physician organizations and their use of care management processes
SUMMARY
From 1999 to 2013, the National Study of Physician Organizations and the National
Study of Small- and Medium-Sized Physician Practices analyzed the extent to which
physicians used care management processes to treat patients with asthma, congestive
heart failure, depression, and diabetes—and the factors promoting or impeding that use.
Several studies have shown that such practices bolster patient outcomes.
Stephen M. Shortell, PhD, MPH, MBA, Blue Cross of California distinguished professor
of health policy and management; director, Center for Healthcare Organizational and
Innovation Research (CHOIR); and dean emeritus of the School of Public Health at the
University of California-Berkeley, and Lawrence P. Casalino, MD, PhD, Livingston
Farrand professor of public health at Weill Cornell Medical College, New York, directed
the studies.
Key Findings
The research team cited these findings in articles published in the Journal of the
American Medical Association (JAMA), Health Affairs, New England Journal of
Medicine (NEJM), Medical Care, and other journals, and in reports to the Robert Wood
Johnson Foundation (RWJF); see the Bibliography for full citations:
● The use of care management processes among physician organizations is low but has
been rising. Organizations with 20 or more physicians used 46 percent of such
processes in 2006–2007, for example—up from 32 percent in 2001–2002 (JAMA and
Medical Care).
● Physician organizations subject to external incentives—such as public reporting on
measures of health care quality and pay for performance—used more care
management processes (Journal of the American Medical Informatics Association).
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 2
● Adoption of features of patient-centered medical homes1 among a subset of surveyed
physician groups was low. Very large groups were much more likely to have adopted
such features than smaller groups. (Health Affairs, September 2008 and August 2011)
Among the surveyed organizations:
— Less than half relied on patient-centered efforts to improve quality and safety,
such as using patient educators and sending reminders to patients to schedule
mammograms, immunizations, flu shots, and other screenings and treatments.
— One-third of the physician groups used primary care teams at most sites.
— Less than one-third used patient registries,2 which enable providers to track
patients with chronic diseases, for at least three of the four chronic diseases.
Funding
Shortell received 10 grants from RWJF totaling $7,053,290 from April 1, 1999 through
December 31, 2014. Casalino received three grants totaling $1,600,255 from February
15, 2007 through June 14, 2010. See the Appendix for details about the RWJF grants.
The Commonwealth Fund and the California HealthCare Foundation contributed
$500,737 and $350,000 to these studies, respectively.
CONTEXT
In 2009, 145 million Americans—almost half of the country’s citizens—lived with a
chronic health condition, according to an RWJF-commissioned report from Johns
Hopkins University.3 By 2040, some 21 percent of the U.S. population will be over age
65, and 90 percent of people over 65 will have at least one chronic condition.4
Asthma, congestive heart failure, depression, and diabetes are especially prevalent,
debilitating, and costly. Asthma, depression, and diabetes each affect about 15 million
Americans, while chronic heart failure affects 5 million. Many of the top 20 priorities for
1 The patient-centered medical home model emphasizes a strong system of primary care, practice
innovation, and new systems of payment. Key principles include a personal physician for each patient, a
whole-person orientation, coordinated and integrated care, a focus on quality and safety, and payment
reform. 2 A disease registry is a collection of secondary data about patients with specific diagnoses, conditions, and
procedures provided. Registries are most commonly used for patients with chronic illnesses. They can be in
paper or electronic format. 3 Gerard Anderson, PhD. Chronic Care: Making the Case for Ongoing Care. Baltimore: Johns Hopkins
Bloomberg School of Public Health, 2010. Available online. Anderson directed RWJF’s program,
Partnership for Solutions. See Program Results Report for more information. 4 Chronic Care in America: A 21st Century Challenge. Institute for Health & Aging, University of
California, San Francisco, for RWJF, November 1996. Available online.
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improving U.S. health care tagged by a 2003 report from the Institute of Medicine related
to chronic illnesses.5
Studies have shown that several new approaches to managing these four conditions can
bolster patient outcomes, lower costs, and reduce the use of services. They include:
● Care management processes used by medical groups, such as registries tracking
patients with chronic diseases, clinical practice guidelines, case managers, and patient
education and self-management
● Feedback to physicians from their practice organizations on whether and how they
use specific practices, such as prescribing anti-inflammatory medication for asthma
patients, and ensuring that diabetic patients receive retinal screening
● The use of information technology, such as electronic medical records
Yet research has suggested that physicians have not been using these approaches—
perhaps because they require clinicians to restructure the way they deliver care. For
example, a 1998 study from RWJF’s Health Tracking initiative reported, “Perhaps most
disconcerting was physician organizations’ difficulty in developing the infrastructure
necessary to manage financial risk and streamline and improve clinical care delivery.”6
THE PROJECT
For the National Study of Physician Organizations (NSPO) and the National Study of
Small- and Medium-Sized Physician Practices, a research team completed four surveys of
medical groups and independent practice associations from 1999 to 2013, to determine
the extent to which they used evidence-based care management processes.7 Most of these
were based on the Chronic Care Model developed by Ed Wagner, MD, and colleagues at
the Group Health Cooperative of Puget Sound.
To participate in the survey, physician organizations had to treat patients with asthma,
diabetes, congestive heart failure, and depression. To obtain the names and contact
information of potential participant organizations, the researchers worked with several
databases. Because the information was in flux and sometimes inaccurate, the team had
to review, cull, and clean the resulting list of thousands of organizations.
5 Priority Areas for National Action: Transforming Health Care Quality, Institute of Medicine, January 7,
2003. Available online. 6 Health Tracking was a multifaceted initiative aimed at informing policymakers about changes over time
in the health care system and their effects on people. Read the Program Results Report. 7 The American Medical Association defines a medical group as an entity that shares business, clinical, and
administrative facilities, records, and personnel with commonly defined practice goals, objectives, and
values. Income from medical services provided by the group are treated as receipts of the group and
distributed according to a prearranged plan. An independent practice association is a legal entity organized
and directed by physicians that negotiates contracts with insurance companies, among other functions,
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 4
Researchers then interviewed the medical director, president, or chief executive officer of
each qualifying organization. The surveys involved 45-minute telephone interviews. Near
the end of the third round of the study, respondents could elect to respond by internet, and
98 percent of them did so.
The researchers asked whether the organization used 16 or 17 practices (depending on the
survey) within five categories of care management processes:
● Case management. Case managers are available at physician request or assigned to all
severely ill patients with a chronic condition.
● Physician feedback: Physicians receive feedback from their practice organizations on
specific practices related to these conditions.
● Disease registry. The practice maintains disease registries of patients with the chronic
conditions.
● Clinical practice guidelines: The practice has adopted such guidelines; physicians
receive training in them; and patient charts, clinician reminder systems, and order-
entry systems reflect them.
● Self-management skills: The organization teaches patients how to manage chronic
illnesses.
The researchers also asked respondents about their organization’s ownership, financial
management, use of electronic databases, physician compensation (base salary as well as
extra payments based on productivity and patient satisfaction), relationships with health
plans, involvement in pay-for-performance programs, quality improvement activities, and
public reporting of performance data.
The team subcontracted with three research organizations to conduct the surveys: NORC
at the University of Chicago, Population Research Systems (San Francisco), and RTI
International (Research Triangle Park, N.C).
Diane Rittenhouse, MD, MPH, associate professor of family and community medicine at
the University of California, San Francisco; Andy Ryan, PhD, assistant professor of
public health at Weill Cornell Medical College; and James Robinson, PhD, Thomas
Rundall, PhD, and Helen Halpin, PhD, all professors at the University of California,
Berkeley School of Public Health, served as core members of the research team at
various stages of the research over the years. Robin Gillies and Patty Ramsay served as
study directors.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 5
THE STUDIES & THEIR FINDINGS
National Study of Physician Organizations (NSPO) 1
For its first survey, from September 2000 to September 2001, the team contacted
organizations with at least 20 physicians. NSPO 1 aimed to create a national database of
such organizations, as well as to examine their use of care management and quality
improvement processes. Organizations received $150 for completing the survey, which
was funded as part of RWJF’s Health Tracking initiative.
Some 70 percent of the roughly 1,500 physician organizations contacted responded to the
survey, yielding a national database of 1,040 organizations. The mean number of
physicians per organization was 227, including 136 for medical groups and 408 for
independent practice organizations. Most of the organizations (834) were multispecialty.
To gather more in-depth information on organizations in areas where managed care was
common, the researchers also interviewed seven to 10 staff members during two-day
visits to such organizations in Boston, Cleveland, Indianapolis, Orange County, Calif.,
Phoenix, and Seattle. The team also conducted 90-minute telephone interviews with a
senior staff member at organizations in areas where managed care was less common,
including Greenville, S.C.; Lansing, Mich.; Little Rock, Ark.; Miami; northern New
Jersey; and Syracuse, N.Y.8
Findings from NSPO 1
Several journals, including the Joint Commission Journal on Quality and Patient Safety,
JAMA, Health Affairs, and NEJM, published the research team’s findings from this study.
(See Bibliography for details.)
In an article in JAMA,9 the team reported:
● The use of care management processes among these physician organizations was
low: they used 5 of 16 processes, on average.
● Two-thirds of the organizations had external incentives to use care management
practices, such as requirements from payers to publicly report on measures of
health care quality, and pay-for-performance contracts with insurers.
● Half of these organizations did not have information technology for clinical
aspects of the practice, such as information on patients’ progress, medications,
and lab results.
8 Most of these areas participated in the Community Tracking Study, a component of the Health Tracking
program. 9 Casalino LP, Gillies RR, Shortell SM, et.al. “External Incentives, Information Technology, and Organized
Process to Improve Health Care Quality for Patients with Chronic Diseases.” Journal of the American
Medical Association, 289(4): 434-441, 2003. Available online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 6
● Organizations with more external incentives and more information technology
used more care management processes.
In “What Are the Facilitators and Barriers” in the Joint Commission Journal on Quality
and Patient Safety,10 the team reported:
● Strong leadership and an organizational culture that valued the quality of care
were the top drivers of the use of care management processes. The most common
barriers were a poor financial situation, reimbursement that did not reward quality,
inadequate information technology, and physician resistance and workload.
● Of 15 organizations that participated in site visits, about half (seven) used care
management processes either minimally or not at all. The organizations used these
processes most often for patients with diabetes and least often for patients with
depression.
The Impact of Care Management Processes on Patients
In a supplemental study to NSPO 1, the researchers explored whether patients 65 and
over with asthma, diabetes, congestive heart failure, and depression had better outcomes
in physician organizations that used more care management processes. The team did so
by trying to link information on the use of such processes to information on health care
quality, such as hospital discharges, gleaned from Medicare claims. The team noted that a
comprehensive database linking the use of care management processes and clinical
outcomes does not exist.
National Study of Physician Organizations 2
To track progress in the use of care management processes among large physician
organizations, the research team conducted NSPO 2 from March 2006 to March 2007.
The team used a survey similar to that for NSPO 1, but added questions on the use of
rapid-cycle quality improvement and participation in quality improvement collaboratives.
Some 538 of 892 physician organizations responded to the survey. Of those, 369 had also
participated in NSPO 1. The team further analyzed information from 291 participating
organizations on their use of features of patient-centered medical homes, as interest in
that approach to medical care was growing.
The researchers also tried to find information on patient outcomes, and link it to the use
of evidence-based care management practices among these organizations. However, the
team concluded that the limited information on outcomes and links between patients and
physicians made such an analysis unfeasible.
10 Bodenheimer T, Wang MC, Rundall TG, Shortell SM, Gillies RR, Oswald N, Casalino L, Robinson JC,
“What Are the Facilitators and Barriers in Physician Organizations’ Use of Care Management Processes?”
Joint Commission Journal on Quality and Patient Safety, 30(9): 505–514, 2004. Abstract available online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 7
Findings from NSPO 2
The team cited these findings in journals such as Health Affairs and Medical Care (see
the Bibliography for details) and in a report to RWJF:
In “Improving Chronic Illness Care” in Medical Care11 and a report to RWJF, Shortell et
al. reported:
● Large physician organizations used 46 percent of 17 care management processes,
on average, in 2006–2007, compared with 32 percent of such processes in 2000–
2001.
— The most commonly used processes were disease registries, specially trained
patient educators, and feedback from the organization to physicians on their
performance.
— These organizations used the most care management processes for patients with
diabetes, and the fewest for patients with depression.
● Independent practice associations and very large medical groups used more care
management processes than smaller organizations.
● Organizations with quality improvement programs and a patient-centered focus
used more care management processes, as did organizations owned by a hospital
or health maintenance organization. In contrast to NSPO 1, this study did not find a
link between the use of clinical information technology and such processes.
In “Measuring the Medical Home Infrastructure in Large Medical Groups” in Health
Affairs,12 the research team reported:
● Among the subset of 291 organizations, adoption of features of patient-centered
medical homes was low. Very large physician organizations were much more likely
to have adopted such features than smaller organizations. Of these 291 groups:
— Less than half relied on patient-centered efforts to improve quality and safety,
such as using patient educators and sending reminders to patients about follow-up
appointments and treatment.
— One-third used primary care teams at most sites.
— Less than one-third used patient registries for at least three of the four chronic
diseases.
11 Shortell S, Gillies R, Siddique J, Casalino LP, et.al. “Improving Chronic Illness Care: A Longitudinal
Cohort Analysis of Large Physician Organizations.” Medical Care. 47(9): 932–939, 2009. Abstract
available online. 12 Rittenhouse DR, Casalino, LP, Gillies RR, Shortell SM, Lau, B. “Measuring the Medical Home
Infrastructure in Large Medical Groups.” Health Affairs. 27(5): 1246–1258, 2008. Available online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 8
— Thirty percent used group visits for patients with chronic illnesses at most of their
sites.
— Twenty-five percent routinely used nurse care managers (nurses who coordinate
patient care delivered by multiple care providers).
— Forty-one percent said most of their physicians used electronic medical records—
and nearly half of those used them to collect information on health care quality.
— Sixty-five percent participated in quality improvement collaboratives.
National Study of Small- and Medium-Sized Physician Practices
While NSPO 1 and 2 surveyed practices of 20 or more physicians, almost half of all
physicians worked in practices of five or fewer physicians in 2008. Researchers knew
little about these practices, or the processes they used to improve the quality and control
the cost of care. To help close that gap, the research team surveyed 1,765 small- and
medium-sized practices—those with 1 to 19 physicians—from July 2007 to March 2009.
Participating organizations received $175.
The team also surveyed another 184 small physician organizations in Boston,
Indianapolis, and New Mexico from January to June 2010. These communities are
important to Aligning Forces for Quality, a $131 million RWJF initiative in 16 areas
across the United States aimed at achieving measurable health improvements by 2015.
(Funding for this project came from that initiative beginning in 2007. Read a 2012 Report
on the program.)
Project Co-Director Shortell cited these results in a report to RWJF:
● The research team was able to link Medicare claims on individual patients to the
physicians who provided their care, and then to the 104 medical groups where those
physicians practiced. However, that approach proved very labor intensive—although
it was much less costly than examining the charts of individual patients, according to
Shortell.
● The use of care management processes among these medical groups was not strongly
associated with the quality of care.
● The fact that the use of these care management processes among physician
organizations was low, and usually in its early stages, may help explain these
findings.
Findings from the Study
The team reported findings from this study in Health Affairs, Health Services
Research, JAMA, and other journals. (See the Bibliography.)
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 9
In “Independent Practice Associations and Physician-Hospital Organizations Can
Improve Care Management for Smaller Practices” in Health Affairs,13 Casalino et al.
reported:
● Smaller organizations participating in an independent practice association or a
physician-hospital alliance used nearly three times as many care management
processes as organizations that did not participate. Only 23.8 percent of surveyed
practices participated in such groups.
In “When Does Adoption of Health Information Technology” in Journal of the American
Medical Informatics Association,14 the research team reported:
● Small- to medium-sized organizations that publicly report on measures of health
care quality, and those subject to financial incentives such as pay for
performance, use more care management practices.
— Practices with both public reporting and financial incentives used more care
management processes than practices with just one of those.
— Some 61.2 percent of practices participated in at least one public reporting or pay-
for-performance program.
— Only 19.2 percent of these practices participated in more than one program.
● Only 34.1 percent of smaller practices had adopted at least one care
management process that entailed the use of information technology. However,
86.2 percent of physicians in practices with an IT-related process used it.
In “Small and Medium-Size Physician Practices Use Few Patient-Centered Medical
Home Processes” in Health Affairs,15 the research team reported:
● Small- and medium-sized organizations used just 20 percent of care
management processes linked to patient-centered medical homes, on average.
Organizations with more resources—such as those owned by hospitals and those
receiving financial incentives—used more such processes.
● “Major changes will be required if the patient-centered medical home is to be
widely adopted” among smaller practices, the team concluded in a 2011 article
in Health Affairs. Such changes could include:
13 Casalino LP, Wu FM, Ryan AM, Copeland K, Rittenhouse DR, Ramsay PP, Shortell SM. “Independent
Practice Associations and Physician-Hospital Organizations Can Improve Care Management for Smaller
Practices.” Health Affairs. 32(8): 1376–1382, 2013. Abstract available online. 14 McClellan SR, Casalino LP, Shortell SM, Rittenhouse R. “When Does Adoption of Health Information
Technology by Physician Practices Lead to Use by Physicians Within the Practice?” Journal of the
American Medical Informatics Association. 20(e1): e26–e32, 2013. Abstract available online. 15 Rittenhouse DR, Casalino LP, Shortell SM, et.al. “Small and Medium-Size Physician Practices Use Few
Patient-Centered Medical Home Processes.” Health Affairs. 30(8): 1575–1585, 2011. Abstract available
online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 10
— Training physicians and staff in leadership development, the use of health
information technology, data collection, and team-based care
— Encouraging small practices to share resources, such as care managers and
information technology, through independent practice associations
— Expanding external incentives—such as public reporting on quality measures, pay
for performance, and shared-risk approaches to payment—to smaller practices
— Preparing the next generation of physicians to practice in new types of
organizations
National Study of Physician Organizations 3
The research team surveyed physician organizations of all sizes in NSPO 3. The team
also refocused the survey somewhat to reflect provisions of the 2010 Affordable Care
Act. For example, the researchers asked physician groups whether they had joined
accountable care organizations, and whether they used processes linked to the chronic
care model and the patient centered medical home.16
The team contacted 3,977 organizations and conducted 1,397 interviews from January
2012 to November 2013. Practices received $200 for participating.
Findings from NSPO 3
The team is still analyzing the information from this study. However, Health Services
Research published their findings on participation in accountable care organizations in
March 2014:17
● Some 23.7 percent of physician groups reported joining an accountable care
organization, and 15.7 percent said they were planning to join one within 12
months. The rest—60.6 percent—said they were not planning to join.
● Practices joining an accountable care organization were more likely to:
— Be larger
— Be physician owned rather than hospital or health system owned
— Receive patients from an independent practice association or a physician-hospital
organization
16 Accountable care organizations are groups of providers that agree to be accountable for both the costs
and quality of care for a defined population of patients. The chronic care model identifies some of the most
important processes found to be associated with better outcomes of care. 17 Shortell SM, McClellan SR, Ramsay LP, et al. “Physician Practice Participation in Accountable Care
Organizations: The Emergence of the Unicorn.” Health Services Research. doi: 10.1111/1475-6773.12167,
March 2014 (published online prior to publication). Available online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 11
— Be located in New England
— Use more care management processes linked to patient-centered medical homes
● Physician organizations participating in accountable care organizations tend to
have more information technology and more resources for managing care.
Conclusions from All the Studies
● Physician organizations “are making progress in the use of care management
processes, but it is not dramatic—it is not what it should be,” said Shortell in a
March 2014 interview. The team’s findings suggest that the use of such processes “is
very difficult work. It requires changes in physician behavior, the ability to work in
teams and delegate to nurses and other staff, and knowledge of how to use electronic
health records.”
● “Policies that tie health care payments to performance and require organizations
to publicly report on measures of health care quality are making a difference in
promoting the use of care management practices,” he noted, and those
approaches have become more common since NSPO began.
Communications Results
An NSPO website includes brief descriptions of each survey and information on gaining
access to the data, as well as links to the team’s journal articles. Besides publishing
journal articles, the research team presented its findings at national meetings and
seminars, and to various health care associations and federal agencies, including the
National Institutes of Health.
According to Shortell, “The work of the researchers has been drawn on my policymakers
in developing the Accountable Care Organization (ACO) concept in the Affordable Care
Act and also in the development of research agendas by the federal Agency for
Healthcare Research and Quality (AHRQ) and others.”
See the Bibliography for information on the articles.
LESSONS LEARNED
1. Use a larger survey firm with experience in contacting physicians, even if it costs
more than a smaller firm. The decision to hire a small firm with limited experience
to survey small and medium-sized practices was “penny wise and pound foolish”
Casalino observed. NORC—a larger, more experienced, although more costly firm—
produced a better response rate in a shorter timeframe. A larger firm is also less likely
to fall behind when facing turnover among its key personnel. (Project
Directors/Casalino, Shortell)
2. Developing an accurate list of physician organizations is challenging. The team
could find no single source of physician organizations and contact information. The
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 12
IMS Health database—the best available—sometimes proved inaccurate and out of
date, so the researchers had to spend a lot of time determining whether organizations
qualified for the surveys and who to contact at them. (Project Co-Director/Casalino)
3. Enlisting physicians to participate in a survey is difficult. Phone surveys are
especially challenging and costly, partly because large practices have gatekeepers
who prevent access to physicians. To surmount that barrier, researchers sent a written
appeal from Casalino—formerly a practicing physician—to a physician at each
organization. National medical organizations and many state medical organizations
also sent letters to potential respondents asking them to participate. As clinicians
learned about the study, some offered to help convince colleagues to participate.
The research team suggested these steps to boost the response rate among physician
organizations:
— Send a financial incentive to an individual from the start.
— As a last-ditch effort, use an abbreviated survey.
— Consider using a Web-based survey. In NSPO 3, near the conclusion of the study,
researchers offered approximately 200 responding organizations the option of
using the Web-based version of the survey, and 98 percent did so. Comparisons
with the phone-based respondents revealed no observable biases.
AFTERWARD
In July 2014, Shortell received an RWJF grant18 to:
● Write five journal articles based on the NSPO 3 findings and cohort analysis of those
organizations that have responded to all three of the recent surveys
● Prepare a report about methodological issues involved in conducting the surveys
● Work with Foundation staff on ideas relevant to the Foundation’s Culture of Health
agenda, including, but not limited to, how best to involve and link the health care
delivery system with the community and with the social services sector that together
address the underlying social and behavioral determinants of health.
The team is using a grant from the Commonwealth Fund to examine links between
avoidable hospital admissions among Medicare enrollees and different types of physician
organizations and care management processes.
Shortell is also working with evaluators of RWJF’s Aligning Forces for Quality to use
NSPO findings to improve care in Aligning Forces communities.
18 ID# 71934 ($249,949, July 1, 2014 through December 31, 2014).
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 13
Prepared by: Mary Nakashian
Reviewed by: Sandra Hackman and Molly McKaughan
Program Officers: C. Tracy Orleans, Katherine Hempstead, Claire Gibbons
Grant ID#: 07110
Project Director: Stephen Shortell (510) 643-5346; [email protected]
Project Director: Lawrence P. Casalino (646) 962-8044; [email protected]
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 14
APPENDIX
RWJF Grants for the Studies
Grants to Stephen M. Shortell
● ID# 36275 (April 1, 1999 through June 30, 2000) $72,834
For planning NSPO 1
● ID# 38690 (July 1, 2000 through June 30, 2002) $2,139,934
For implementing NSPO 1
● ID# 40087 (February 1, 2001 through September 30, 2001) $296,555
For continuing implementation of NSPO 1
● ID# 41540 (April 1, 2003 through September 30, 2004) $145,503
For the supplemental study of patient outcomes (using NSPO 1 data)
● ID# 50789 (July 1, 2004 through April 30, 2005) $50,000
For planning NSPO 2
● ID# 51573 (May 1, 2005 through April 30, 2010) $1,399,873
For implementing NSPO 2
● ID# 68847 (May 15, 2011 through July 31, 2013) $2,200,000
For implementing NSPO 3
● ID# 70440 (December 1, 2012 through November 30, 2013) $298,789
For continuing implementation of NSPO 3
● ID# 71110 (July 1, 2013 through November 30, 2013) $199,853
For continuing implementation of NSPO 3
● ID# 71934 (July 1, 2014 through December 31, 2014) $249,949
For preparing journal articles and reports, and convening stakeholders
Grants to Lawrence P. Casalino
● ID# 58680 (February 15, 2007 through February 14, 2009) $987,942
For implementing the study of small- and medium-sized practices. Project continued
under transfer grant ID# 65937
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 15
● ID# 65937 (March 1, 2009 through February 28, 2010) $383,725
For continuing implementation of the study of small- and medium-sized practices
● ID# 67235 (January 15, 2010 through June 14, 2010) $228,588
For additional surveys of small- and medium-sized practices
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 16
BIBLIOGRAPHY
(Current as of date of the report; as provided by the grantee organization; not verified by RWJF; items not
available from RWJF.)
Articles
Alexander JA, Maeng D, Casalino LP, Rittenhouse DR. “Use of Care Management
Practices in Small- and Medium-Sized Physician Groups: Do Public Reporting of
Physician Quality and Financial Incentives Matter?” Health Services Research. 48(2)Part
1: 376–397, 2013. Abstract available online.
Bellows NM, McManamin SB, Halpin HA. “Adoption of Health Promotion in a Cohort
of US Physician Organizations.” American Journal of Preventive Medicine. 39(6): 555–
558, 2010. Abstract available online.
Bodenheimer T, Wang MC, Rundall TG, Shortell SM, Gillies RR, Casalino L, Robinson
JC. “What Are the Facilitators and Barriers in Physician Organizations’ Use of Care
Management Processes?” Joint Commission Journal on Quality and Patient Safety.
30(9): 505–514, 2004. Abstract available online.
Casalino LP, Gillies RR, Shortell SM, Schmittdiel JA, Bodenheimer T, Robinson JC,
Rundall TG, Oswald N, Schauffler H, Wang MC. “External Incentives, Information
Technology, and Organized Processes to Improve Health Care Quality for Patients with
Chronic Diseases.” Journal of the American Medical Association. 289(4): 434–441,
2003. Available online.
Casalino LP, Rittenhouse DR, Gillies RR, Shortell SM. “Specialist Physician Practices as
Patient-Centered Medical Homes.” New England Journal of Medicine. 362:17: 1555–
1558, 2010. Available online.
Casalino LP, Wu FM, Ryan AM, Copeland K, Rittenhouse DR, Ramsay PR, Shortell
SM. “Independent Practice Associations and Physician-Hospital Organizations Can
Improve Care Management for Smaller Practices.” Health Affairs. 32(8): 1376–1382,
2013. Abstract available online.
Damberg CL, Shortell SM, Raube K, Gillies RR, Casalino LP, Rittenhouse DR,
McCurdy PK and Adams J. “Relationship Between Quality Improvement Processes and
Clinical Performance.” American Journal of Managed Care. 16(8): 601–606, 2010.
Abstract available online.
Gillies RR, Chenok KE, Shortell SM, Pawlson G, Wimbush JJ. “The Impact of Health
Plan Delivery System Organization on Clinical Quality and Patient Satisfaction.” Health
Services Research. 41(4 Part 1): 1181–1199, 2006. Available online.
Gillies RR, Shortell SM, Casalino LP, Robinson JC, Rundall TG. “How Different is
California? A Comparison of U.S. Physician Organizations.” Health Affairs, Web
Exclusive. W3.492–502, October 15, 2003 (published online prior to publication).
Available online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 17
Halpin HA, McMenamin SB, Schmittdiel J, Gillies RR, Shortell SM, Rundall T, Casalino
LP. “The Routine Use of Health Risk Appraisals: Results From a National Study of
Physician Organizations.” American Journal of Health Promotion. 20(1): 34–38, 2005.
Abstract available online.
Hearld LR, Alexander JA, Shi Y, Casalino LP. “Pay-for-Performance and Public
Reporting Program Participation and Administrative Challenges Among Small- and
Medium-Sized Physician Practices.” Medical Care Research and Review. 7(3): 299–312,
2013. Abstract available online.
Klabunde CN, Willis GB, Casalino LP. “Facilitators and Barriers to Survey Participation
by Physicians: A Call to Action for Researchers.” Evaluation & the Health Professions.
36: 279–295, 2013. Abstract available online.
Li R, Simon J, Bodenheimer T, Gillies RR, Casalino LP, Schmittdiel J, Shortell SM.
“Organizational Factors Affecting the Adoption of Diabetes Care Management Processes
in Physician Organizations.” Diabetes Care. 27(10): 2312–2316, 2004. Available online.
Martsolf GR, Alexander JA, Shi Y, Casalino LP, Rittenhouse DR, Scanlon DP, Shortell
SM. “The Patient-Centered Medical Home and Patient Experience.” Health Services
Research. 47(6): 2273–2295, 2012. Abstract available online.
McClellan SR, Casalino LP, Shortell SM, Rittenhouse DR. “When Does Adoption of
Health Information Technology by Physician Practices Lead to Use by Physicians Within
the Practice?” Journal of the American Medical Informatics Association. 20(e1): e26–
e32, 2013. Abstract available online.
McLeod CC, Klabunde CN, Willis GB, Stark D. “Health Care Provider Surveys in the
United States, 2000–2010: A Review.” Evaluation & the Health Professions. 36(1): 106–
126, 2013. Abstract available online.
McMenamin SB, Bellows NM, Halpin HA, Rittenhouse DR, Casalino LP, Shortell SM.
“Adoption of Policies to Treat Tobacco Dependence in U.S. Medical Groups.” American
Journal of Preventive Medicine. 39(5): 449–456, 2010. Abstract available online.
McMenamin SB, Schauffler HH, Shortell SM, Rundall TG, Gillies RR. “Support for
Smoking Cessation Interventions in Physician Organizations: Results from a National
Survey.” Medical Care. 41(12): 1396–1406, 2003. Abstract available online.
McMenamin SB, Schmittdiel J, Halpin (formerly Schauffler) HA, Gillies RR, Rundall
TG, Shortell SM. “Health Promotion in Physician Organizations: Results from a National
Study.”American Journal of Preventive Medicine. 26(4): 259–264, 2004. Available
online.
Rittenhouse DR, Casalino LP, Gillies RR, Shortell SM, Lau B. “Measuring the Medical
Home Infrastructure in Large Medical Groups.” Health Affairs. 27(5): 1246–1258, 2008.
Available online.
Rittenhouse DR, Casalino LR, Shortell SM, McClellan SR, Gillies RR, Alexander JA,
Drum ML. “Small And Medium-Size Physician Practices Use Few Patient-Centered
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 18
Medical Home Processes.” Health Affairs. 30(8): 1575–1584, 2011. Abstract available
online.
Rittenhouse DR and Shortell SM. “The Patient-Centered Medical Home: Will It Stand
the Test of Health Reform?” Journal of the American Medical Association. 301(19):
2038–2040, 2009. Available online.
Rittenhouse DR, Shortell SM, Gillies RR, Casalino LP, Robinson JC, McCurdy RK,
Siddique J. “Improving Chronic Illness Care: Findings from a National Study of Care
Management Processes in Large Physician Practices.” Medical Care Research and
Review. 67(3): 301–320, 2010. Abstract available online.
Robinson JC, Casalino LP, Gillies R, Rittenhouse DR, Shortell SM, Fernandes-Taylor S.
“Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical
Information Technology.” Medical Care. 47(4): 411–417, 2009. Abstract available
online.
Robinson JC, Shortell SM, Li R, Casalino LP, Rundall TG. “The Alignment and
Blending of Payment Incentives within Physician Organizations.” Health Services
Research. 39(5): 1589–1606, 2004. Available online.
Robinson JC, Shortell SM, Rittenhouse DR, Fernandes-Taylor S, Gillies RR, Casalino
LP. “Quality-Based Payment for Medical Groups and Individual Physicians,” Inquiry.
46(2): 172–181, Summer 2009. Abstract available online.
Rundall TG, Shortell SM, Wang MC, Casalino LP, Bodenheimer T, Gillies RR,
Schmittdiel, JA, Oswald N, Robinson JC. “As Good as It Gets? Chronic Care
Management in Nine Leading U.S. Physician Organizations.” British Medical Journal.
325(7370): 958–961, 2002. Abstract available online.
Schmittdiel JA, Bodenheimer T, Solomon NA, Gillies RR, Shortell SM. “Brief Report:
The Prevalence and Use of Chronic Disease Registries in Physician Organizations: A
National Survey.” Journal of General Internal Medicine. 20(9): 855–858, 2005. Abstract
available online.
Schmittdiel JA, McMenamin SB, Halpin HA, Gillies RR, Bodenheimer T, Shortell SM,
Rundall TG, Casalino LP. “The Use of Patient and Physician Reminders for Preventive
Services: Results from a National Study of Physician Organizations.” Preventive
Medicine. 39(5): 1000–1006, 2004. Abstract available online.
Schmittdiel JA, Shortell SM, Rundall TG, Bodenheimer T, Selby JV. “Effect of Primary
Health Care Orientation on Chronic Care Management.” Annals of Family Medicine.
4(2): 117–123, 2006. Available online.
Shortell SM, Gillies R, Siddique J, Casalino LP, Rittenhouse D, Robinson JC, McCurdy
RK. “Improving Chronic Illness Care: A Longitudinal Cohort Analysis of Large
Physician Organizations.” Medical Care. 47(9): 932–939, 2009. Abstract available
online.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 19
Shortell SM, McClellan SR, Ramsay PP, Casalino LP, Ryan AM, Copeland KR.
“Physician Practice Participation in Accountable Care Organizations: The Emergence of
the Unicorn.” Health Services Research. DOI: 10.1111/1475–6773.12167, March 14,
2014 (published online prior to publication). Available online,
Shortell SM, Schmittdiel J, Wang MC, Li R, Gillies RR, Casalino LP, Bodenheimer T,
Rundall TG. “An Empirical Assessment of High-Performing Medical Groups: Results
from a National Study.” Medical Care Research and Review. 62(4): 407–434, 2005.
Abstract available online.
Simon JS, Rundall TG, Shortell SM. “Drivers of Electronic Medical Record Adoption
Among Medical Groups.” Joint Commission Journal on Quality and Patient Safety.
31(11): 631–639, 2005. Abstract available online.
Solberg LI, Asche SE, Shortell SM, Gillies RR, Taylor N, Pawlson LG, Scholle SH,
Young MR. “Is Integration in Large Medical Groups Associated with Quality?”
American Journal of Managed Care. 15(6): e34–41, 2009. Available online.
Books & Chapters
Shortell SM and Schmittdiel J. “Prepaid Groups and Organized Delivery Systems:
Promise, Performance, and Potential.” In Toward a 21st Century Health System: The
Contributions and Promise of Prepaid Group Practice. Enthoven AC and Tollen LA
(eds). San Francisco: Jossey-Bass, 2004.
Reports
Shortell SM and Gillies RR. The Impact of Medical Groups’ Use of Care Management
Processes on HCUP Quality Indicators for Patients with Chronic Illness. 2005.
Unpublished report to RWJF.
Survey Instruments
“National Survey of Physician Organizations and the Management of Chronic Illness
(Medical Groups).” (NSPO 1) Fielded April 2000 to October 2001. Available online.
“National Survey of Physician organizations and the Management of Chronic Illness
(Independent Practice Associations).” (NSPO 1) Fielded April 2000 to October 2001.
Survey date October 2000. Available online.
“National Survey of Physician Organizations and the Management of Chronic Illness II
(Medical Groups).” Fielded March 2006 to March 2007. Available online.
“National Survey of Physician Organizations and the Management of Chronic Illness II
(Independent Practice Associations).” Fielded March 2006 to March 2007. Available
online.
“National Survey of Small-Medium Sized Physician Practices.” Fielded July 2007 to
March 2009 and January 2010 to June 2010.
RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 20
“National Survey of Physician Organizations III” Fielded January 2012 to November
2013.
Communications or Promotions
http://nspo.berkeley.edu. Includes survey instruments, data, and publications. Berkeley,
CA: University of California.