256407 Network contagion influences on chronic illness care in large physician practices

Wednesday, October 31, 2012 : 12:30 PM - 12:50 PM

Rodney McCurdy, PhD MHA , School of Health and Human Services, Department of Kinesiology and Health Science, California State University, Sacramento, Sacramento, CA
Objectives: Care management processes (CMPs) are evidenced-based methods of physician practice redesign consistent with principles of the Chronic Care Model. National surveys have found minimal use of these processes in large multi-specialty physician organizations. Physician groups enter into interorganizational relationships and little is known regarding the impact these relationships on CMP use in the practice. This study examined the influence of shared ties in a managed care network on similarity of practice behavior in the treatment of patients with asthma, congestive heart failure, diabetes and depression in physician organizations.

Methods: Network analysis methods examined the exchange relationships of physician organizations in the managed care network in California in 2006. Physician group ties with other physicians, hospitals, and health maintenance organizations were analyzed using affiliation matrices for each year. Multivariate regression analyses examined associations of network relationships and similarity in practice behavior between physician organization dyads.

Findings: Network effects were found to influence CMP prevalence and homogeneity in their use. CMP use was positively associated with ties to other physicians and with hospitals. Dyads with shared hospital system affiliations were more similar in their practice for chronic illness care than non-connected dyads. Shared HMO ties were negatively associated with similarity in CMP use.

Conclusion: Findings provide support to the current quality reform discussions surrounding the development of Accountable Care Organizations (ACOs). Greater interorganizational linkages among providers of health care services may encourage diffusion of quality practices in the care of patients with chronic conditions.

Learning Areas:
Administration, management, leadership
Chronic disease management and prevention
Provision of health care to the public
Public health administration or related administration
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify the types of physician group interorganizational relationships that influence the use of care management processes (CMP) in large physician practices. Differentiate between structural and contagion network influences that are associated with CMP use. Compare CMP use and homogeneity between core and periphery physician group members of a managed care network.

Keywords: Health Care Managed Care, Health Care Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This was part of my dissertation work on examining the managed care network in California for my PhD in Health Services and Policy Analysis at UC Berkeley
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.