Does size matter? A review of evidence for effects of practice size on quality of care in primary care. Charis, N. & Ping, N. K. Annals of the Academy of Medicine Singapore, 41(9 SUPPL. 1):S246, 2012. ![Does size matter? A review of evidence for effects of practice size on quality of care in primary care [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper abstract bibtex Background and Hypothesis: There is a trend towards consolidating small primary care practices into larger practices, which have economies of scales for staff employment and use of information technologies. However, the effects of practice size on quality of care remain unclear. The objective of this review was to appraise the effects of practice size on the quality of care in primary care. Method(s): All studies that focused on primary care practices or practitioners were considered. Independent variables were team or list size; outcome variables were measures of clinical processes, clinical outcomes, or patient-reported outcomes. Databases were searched for studies in the English language from 1990 to 2010. A narrative synthesis was conducted. Result(s): Thirteen studies were included in the review. Of 10 studies on clinical processes, 3 found larger practices to have higher specialist referral rates for eating disorder, better adherence to guidelines, and better pneumococcal vaccination coverage. Three found associations in selected process measures, while 4 found no association between practice size and clinical processes. Two studies on clinical outcomes found no association with practice size. Of 3 studies on patient-reported outcomes, 1 reported smaller practices to have better satisfaction with access; 2 found associations in selected patient-reported outcomes. Discussion and Conclusion(s): There is limited evidence to support an association between practice size and quality of care in primary care. Although larger practices performed better in certain process measures, smaller practices have better satisfaction in certain patient-reported outcomes. With the trend towards larger primary care practices, there may be a trade-off between quality clinical care and interpersonal care.
@article{charis_does_2012,
title = {Does size matter? {A} review of evidence for effects of practice size on quality of care in primary care},
volume = {41},
issn = {0304-4602},
url = {http://www.annals.edu.sg/pdf/41VolNo9SupplSep2012/SHBC2012-AAMSPublish.pdf http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed13&NEWS=N&AN=71799146},
abstract = {Background and Hypothesis: There is a trend towards consolidating small primary care practices into larger practices, which have economies of scales for staff employment and use of information technologies. However, the effects of practice size on quality of care remain unclear. The objective of this review was to appraise the effects of practice size on the quality of care in primary care. Method(s): All studies that focused on primary care practices or practitioners were considered. Independent variables were team or list size; outcome variables were measures of clinical processes, clinical outcomes, or patient-reported outcomes. Databases were searched for studies in the English language from 1990 to 2010. A narrative synthesis was conducted. Result(s): Thirteen studies were included in the review. Of 10 studies on clinical processes, 3 found larger practices to have higher specialist referral rates for eating disorder, better adherence to guidelines, and better pneumococcal vaccination coverage. Three found associations in selected process measures, while 4 found no association between practice size and clinical processes. Two studies on clinical outcomes found no association with practice size. Of 3 studies on patient-reported outcomes, 1 reported smaller practices to have better satisfaction with access; 2 found associations in selected patient-reported outcomes. Discussion and Conclusion(s): There is limited evidence to support an association between practice size and quality of care in primary care. Although larger practices performed better in certain process measures, smaller practices have better satisfaction in certain patient-reported outcomes. With the trend towards larger primary care practices, there may be a trade-off between quality clinical care and interpersonal care.},
language = {English},
number = {9 SUPPL. 1},
journal = {Annals of the Academy of Medicine Singapore},
author = {Charis, N. and Ping, N. K.},
year = {2012},
keywords = {*Singapore, *health, *primary medical care, data base, eating disorder, economic aspect, employment, human, hypothesis, independent variable, information technology, language, medical specialist, narrative, outcome variable, patient, physician, satisfaction, synthesis, vaccination},
pages = {S246},
}
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Method(s): All studies that focused on primary care practices or practitioners were considered. Independent variables were team or list size; outcome variables were measures of clinical processes, clinical outcomes, or patient-reported outcomes. Databases were searched for studies in the English language from 1990 to 2010. A narrative synthesis was conducted. Result(s): Thirteen studies were included in the review. Of 10 studies on clinical processes, 3 found larger practices to have higher specialist referral rates for eating disorder, better adherence to guidelines, and better pneumococcal vaccination coverage. Three found associations in selected process measures, while 4 found no association between practice size and clinical processes. Two studies on clinical outcomes found no association with practice size. Of 3 studies on patient-reported outcomes, 1 reported smaller practices to have better satisfaction with access; 2 found associations in selected patient-reported outcomes. Discussion and Conclusion(s): There is limited evidence to support an association between practice size and quality of care in primary care. Although larger practices performed better in certain process measures, smaller practices have better satisfaction in certain patient-reported outcomes. 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