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Prevalence, Predictors, and Patient Outcomes Associated with Physician Co-management: Findings from the Los Angeles Women's Health Study

Authors


Address correspondence to Danielle E. Rose, Ph.D., M.P.H. VA HSR&D, Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA 91343-2036; e-mail: droseash@gmail.com. Diana M. Tisnado, Ph.D. and Katherine L. Kahn, M.D., are with the Department of Medicine, Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA. May L. Tao, M.D., M.S., is with The Center for Radiation Therapy of Beverly Hills, Beverly Hills, CA. Jennifer L. Malin, M.D., Ph.D., is with the VA Greater Los Angeles Healthcare System, Los Angeles, CA. John L. Adams, Ph.D., is with the RAND, Santa Monica, CA. Patricia A. Ganz, M.D., is with the UCLA Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA.

Abstract

Background

Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes.

Objectives

To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care.

Methods

We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists’ responses to patient ratings of care (physician n = 111; patient n = 411).

Results

After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care.

Conclusion

Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care).

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