Background
Methods
Settings
Clinician sample
Patient sample
Primary care clinician survey
Clinician and organizational variables from the survey
Clinician behaviors, beliefs, characteristics
Clinician-reported organizational measures
Electronic health record-derived variables
Main outcome: preventive care-gap rate
Statistical analyses
Results
KPNW n = 113 (45.4%) | CHCs n = 136 (54.6%) |
p
| |||
---|---|---|---|---|---|
Total N | No. (%) | Total N | No. (%) | ||
Provider characteristics | |||||
Gender (female) | 107 | 44.9 | 132 | 65.9 | .001b |
Race/ethnicity (non-White) | 107 | 24.3 | 128 | 15.6 | .095 |
M(SD) | M(SD) | ||||
Age | 104 | 47.83(8.62) | 130 | 45.44(10.39) | .061 |
Years in practice | 107 | 15.71(9.11) | 132 | 12.76(10.10) | .202 |
Provider beliefs/behaviors | |||||
Consult with mental health providerc | 109 | 2.22(.79) | 132 | 2.46(.88) | .026d |
Lack of patient interest affects preventive care deliverye | 108 | 1.98(.74) | 131 | 1.85(.73) | .160 |
Likely to make preventive recommendations when patients not experiencing symptomsf | |||||
--Smoking | 111 | 3.59(.64) | 136 | 3.32(.78) | .005g |
--Diet/nutrition | 110 | 3.30(.71) | 136 | 3.16(.76) | .122 |
--Exercise | 111 | 3.44(.66) | 136 | 3.18(.80) | .005g |
--Alcohol/drug use | 111 | 3.44(.75) | 135 | 3.48(.70) | .665 |
--Getting a mammogram | 111 | 3.62(.52) | 135 | 3.33(.72) | .001b |
--Getting laboratory work | 110 | 3.62(.54) | 136 | 3.54(.62) | .325 |
--Getting a flu shot | 111 | 3.62(.57) | 136 | 3.63(.58) | .964 |
--Completing colon cancer screening | 111 | 3.62(.56) | 135 | 3.19(.81) | <.001b |
Likelihood of providing care absent symptoms (composite)f | 111 | 3.53(.49) | 136 | 3.35(.57) | .010g |
Organizational characteristics | No. (%) | No. (%) | |||
Availability of co-located of medical and mental health services | 113 | 41 (36.3) | 136 | 106 (77.9) | <.001b |
Team-based care approach | 113 | 59 (52.2) | 136 | 116 (85.3) | <.001b |
Availability of a case manager | 113 | 72 (63.7) | 136 | 86 (63.2) | .937 |
Availability of a care navigator | 113 | 9 (8.0) | 136 | 60 (44.1) | <.001b |
M(SD) | M(SD) | ||||
Co-located laboratory services facilitates careh | 107 | 2.23(.95) | 131 | 2.47 (.83) | .046d |
Emphasis on quality of carei | 107 | 1.84(.37) | 131 | 1.54(.50) | <.001b |
HEDIS screening increases likelihood of delivering carej | 107 | 2.54(.57) | 132 | 1.95(.70) | <.001b |
Provider panel characteristics | Total N | M(SD) | Total N | M(SD) |
P
|
Number of patients | |||||
Schizophrenia spectrum disorder | 105 | 3.78(2.08) | 131 | 9.75(7.93) | <.001b |
Bipolar disorder | 113 | 16.48(6.91) | 134 | 18.75(13.47) | .090 |
Major depressive disorder | 113 | 121.05(32.59) | 134 | 63.81(34.06) | <.001b |
Anxiety disorder | 113 | 50.65(19.48) | 134 | 24.25(16.06) | <.001b |
Total number of patients represented | 19,782 | 14,551 | |||
Mean patient care gap scorek | |||||
Schizophrenia spectrum disorder | 105 | 16.12(10.65) | 131 | 25.24(9.49) | - |
Bipolar disorder | 113 | 16.15(4.34) | 134 | 28.05(7.08) | - |
Major depressive disorder | 113 | 14.84(3.02) | 134 | 29.25(5.98) | - |
Anxiety disorder | 113 | 17.95(3.04) | 134 | 29.65(6.47) | - |
Differences between clinician populations
Characteristics that predict preventive services
Provider-Level Variables | KPNW | CHCs | ||
---|---|---|---|---|
Coeff. |
p
| Coeff. |
p
| |
Gender (Female) | −.07 |
.011
b
| −.01 | .754 |
Years practice | .00 | .756 | −.004 |
.010
c
|
HEDIS goals increase likelihood of services | .03 | .231 | −.06 | .006 |
Likelihood of providing care absent symptoms | −.05 |
.041
b
| −.05 |
.033
b
|
Case manager | −.02 | .444 | .06 |
.028
b
|
Care navigator | .03 | .506 | .05 | .062 |