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Background: Quality improvement collaboratives (QICs) have emerged as an important strategy to improve processes and outcomes of clinical care through interorganizational learning. Little is known about the organizational factors that support or deter physician practice participation in QICs. Purpose: The aim of this study was to examine organizational influences on physician practices' propensity to participate in QICs. We hypothesized that practice affiliation with an accountable care organization (ACO) and practice ownership by a system or community health center (CHC) would increase the propensity of physician practices to participate in a QIC. Methodology: Data from the third wave of the National Study of Physician Organizations, a nationally representative sample of medical practices ( n = 1,359), were analyzed. Weighted multivariate regression analyses were estimated to examine the association of ACO affiliation, ownership, and QIC participation, controlling for practice size, health information technology capacity, public reporting participation, and practice revenue from Medicaid and uninsured patients. The Sobel–Goodman Test was used to explore the extent to which practice use of quality improvement (QI) methods such as Lean, Six Sigma, and use of plan-do-study-act cycles mediates the relationship between ACO affiliation and QIC participation. Findings: Only 13.6% of practices surveyed in 2012–2013 participated in a QIC. In adjusted analyses, ACO affiliation (odds ratio [ OR ] = 1.51, p < .01), CHC ownership ( OR = 6.57, p < .001), larger practice size ( OR = 14.72, p < .001), and health information technology functionality ( OR = 1.15, p < .001) were positively associated with QIC participation. Practice use of QI methods partially mediated (13.1%–46.7%) the association of ACO affiliation with QIC participation. Practice Implications: ACO-affiliated practices are more likely than non-ACO practices to participate in QICs. Practice size rather than system ownership appears to influence QIC participation. QI methods often promoted and used by health care systems such as CHCs and ACOs may promote QIC participation.
A causal model of health services which includes patient and provider variables, perceived access to care, utilization of services, continuity of care, technical quality of the care process, technical quality of the care outcome, and patient satisfaction is applied to a group of diabetic patients enrolled in the Seattle Prepaid Health Care Project. The enrollees received comprehensive health services at zero out-of-pocket cost from either a prepaid group practice plan or an independent practice plan. Surveys were periodically conducted to determine health status, satisfaction, and demographic characteristics of the enrollees; utilization of services was monitored throughout the experiment. The causal model is operationalized through the use of path analysis. Significant relationships (p less than or equal to .10) were established between satisfaction and perceived access to care, family size, sex, and professional qualifications of the provider; between outcome of care and health status, female education, and physician performance; between physician performance and professional qualifications; between continuity of care and health status and female education; between utilization and perceived access, specialty of provider, and provider system; and between access to care and provider system. The policy implications of the results are discussed.
In compositionally complex refractory alloys, the formation of chemical short-range order has been calculated to flatten the spatial distribution of dislocation core energies. This study examines the extent to which such ``narrowing'' effects are unique to many-component systems, or if these results are more generally applicable. The authors computationally investigate how system chemistry, compositional complexity, and the presence of chemical short-range order affect dislocation energy distributions in subsystems of the NbMoTaW alloy. Order-induced narrowing is ultimately found to depend more on chemistry than the number of components.
ADVERTISEMENT RETURN TO ISSUEPREVArticleNEXTPreface - Symposium on Catalytic Reaction Engineering for Environmentally Benign Processes and US-Russia Workshop on Environmental CatalysisM. Dudukovic, P. Mills, A. Bell, and L. ManzerCite this: Ind. Eng. Chem. Res. 1994, 33, 12, 2885–2886Publication Date (Print):December 1, 1994Publication History Published online22 December 2003Published inissue 1 December 1994https://pubs.acs.org/doi/10.1021/ie00036a600https://doi.org/10.1021/ie00036a600research-articleACS PublicationsRequest reuse permissionsArticle Views81Altmetric-Citations3LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InRedditEmail Other access optionsGet e-Alertsclose Get e-Alerts