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Comparing Comprehensiveness in Primary Care Specialties and Their Effects on Healthcare Costs and Hospitalizations in Medicare Beneficiaries

  • Tracey L. HenryEmail author
  • Stephen Petterson
  • Russell S. Phillips
  • Robert L. PhillipsJr.
  • Andrew Bazemore
Concise Research Report
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INTRODUCTION

Four essential features of primary care, identified by Barbara Starfield, include the following: first contact, continuity, coordination, and comprehensiveness.1 Comprehensiveness, defined as offering a “range of services broad enough to care for all health needs except those too uncommon to maintain competence,” includes meeting the large majority of each patient’s physical and mental healthcare needs.1 However, while comprehensiveness is thought to be in decline among primary care physicians (PCPs), little has been done to capture its value in policy-relevant terms such as cost and quality, important in this era of value-based purchasing.2 A recent study developed and tested a measure of comprehensiveness among family physicians revealed a modest association with lower healthcare utilization and costs among Medicare patients.3 This paper extends this work by comparing family physicians and general internists in comprehensiveness and its impact on similar outcomes.

METHODS

Notes

Compliance with Ethical Standards

The American Academy of Family Physicians Institutional Review Board approved this study without restrictions.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York: Oxford University Press, 1998.Google Scholar
  2. 2.
    O’Malley AS and Rich EC. Measuring Comprehensiveness of Primary Care: Challenges and Opportunities. J Gen Intern Med 2015; 30 (Suppl 3): 568–575.CrossRefGoogle Scholar
  3. 3.
    Bazemore A, Petterson S, Peterson L, Phillips RL. More comprehensive care among Family Physicians is associated with lower costs and fewer hospitalizations. Ann Fam Med. 2015;13(3).Google Scholar
  4. 4.
    Phillips RL, Dodoo MS, Green LA, Fryer GE, Bazemore, AW, McCoy KI, Petterson SM. Usual Source of Care: An Important Source of Variation in Health Care Spending. Health Aff, 2009; 28 (2):567–77.CrossRefGoogle Scholar
  5. 5.
    O'Malley AS, Rich EC, Shang L, et al. New approaches to measuring the comprehensiveness of primary care physicians. Health Serv Res 2019;00:1–11.Google Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Tracey L. Henry
    • 1
    Email author
  • Stephen Petterson
    • 2
  • Russell S. Phillips
    • 3
  • Robert L. PhillipsJr.
    • 4
  • Andrew Bazemore
    • 2
  1. 1.Division of General Medicine and GeriatricsEmory University School of MedicineAtlantaUSA
  2. 2.Robert Graham Center Policy Studies in Family Medicine & Primary CareWashington, DCUSA
  3. 3.Center for Primary CareGlobal Health and Social Medicine Harvard Medical SchoolBostonUSA
  4. 4.The American Board of Family MedicineWashington DCUSA

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