President, Home Care Services Division, Vanderbilt University Medical Center

Dissertation Title

Assessing patient care quality from hospital employed physicians.

Dissertation Abstract

Background: Physician employment by hospitals and healthcare systems has become a growing phenomenon in America. Also the emphasis on improving patient care quality is receiving increasing attention. Moreover, recent changes in federal regulation and reimbursement have made improving patient care quality an imperative for hospitals and their medical staffs. The purpose of this study was to determine if there is a demonstrable relationship between hospital employed physicians and the quality of their patient care.

Methods: Physician quality measurements were obtained from a prominent community hospital with roughly one third of its medical staff directly employed by the hospital. A number of quality metrics are collected on a monthly basis for all the hospital's medical staff members, both employed and in independent practice. Three widely accepted quality metrics were chosen to abstract and use as dependent variables, average length of stay, adjusted mortality rates, and readmissions within 30 days for the same diagnosis. With employment as the predictor, (independent variable), fifteen quarters of quality observations were analyzed to determine if there was a relationship between employed physicians and quality care. A fixed effects panel regression model was used to test the within subject relationships over a three year period.

Results: There was no significant relationship found between employed physicians and their quality of patient care in this study. There was some marginal significance found in a few quarters of observation related to average length of stay and mortality, when compared to the base period. But the overall results did not indicate a relationship between employment and quality.

Conclusion: The study found no association between employed physicians and their patient care quality. The study did not support that there was a difference in patient care quality from employed physicians. The hypothesis that there is a positive relationship between hospital employed physicians and patient care quality was not demonstrated in this study.