Patient-Physician Connectedness and Measuring Quality of Primary Care

A few of my colleagues in the Dept of General Medicine at MGH published this interesting article today in the Annals of Internal Medicine.

Patient-Physician Connectedness and Quality of Primary Care -- Atlas et al. 150 (5): 325 -- Annals of Internal Medicine

They examined the "connectedness" patients have to a particular physician. They found that of 155k patients, ~40% were not connected to a physician. Those who were had better outcomes (and were more likely to be following EBM guidelines of care).

P4P and quality metrics hinge on the premise that patients have a "home" and a patient can be mapped back to a particular physician. The reality is that patients are constantly shifting between doctors - they are "doctor shopping", their insurance changes so they switch doctors, etc. - so it'll be important to find a way to find out which patients are truly yours versus just the occasional patient who variably sees you. And for those who are not "connected" to a physician - given the better outcomes, it'll be important to find ways to plug those patients into the system.

Anecdote - I remember reviewing my outpatient panel, and finding a good hundred patients that were "assigned" to me and I was conceivably their primary doctor, but I had seen them once (or never) over three years. I would want to know there would be a safeguard to ensure that those "fly-by-night" patients are associated with my performance, and those that I truly am engaged and actively manage are the ones that I'm being evaluated on.