s

Published: September 10, 2014

Program Results Report

Grant ID: 36275, 38690, 40087, 41540, 50789, 58680

51573, 65937, 67235, 68847, 70440, 71110, 71934

How Physician Groups Manage Their Patients’ Chronic Illnesses

A long-term study of physician organizations and their use of care management processes

SUMMARY

From 1999 to 2013, the National Study of Physician Organizations and the National

Study of Small- and Medium-Sized Physician Practices analyzed the extent to which

physicians used care management processes to treat patients with asthma, congestive

heart failure, depression, and diabetes—and the factors promoting or impeding that use.

Several studies have shown that such practices bolster patient outcomes.

Stephen M. Shortell, PhD, MPH, MBA, Blue Cross of California distinguished professor

of health policy and management; director, Center for Healthcare Organizational and

Innovation Research (CHOIR); and dean emeritus of the School of Public Health at the

University of California-Berkeley, and Lawrence P. Casalino, MD, PhD, Livingston

Farrand professor of public health at Weill Cornell Medical College, New York, directed

the studies.

Key Findings

The research team cited these findings in articles published in the Journal of the

American Medical Association (JAMA), Health Affairs, New England Journal of

Medicine (NEJM), Medical Care, and other journals, and in reports to the Robert Wood

Johnson Foundation (RWJF); see the Bibliography for full citations:

● The use of care management processes among physician organizations is low but has

been rising. Organizations with 20 or more physicians used 46 percent of such

processes in 2006–2007, for example—up from 32 percent in 2001–2002 (JAMA and

Medical Care).

● Physician organizations subject to external incentives—such as public reporting on

measures of health care quality and pay for performance—used more care

management processes (Journal of the American Medical Informatics Association).

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 2

● Adoption of features of patient-centered medical homes1 among a subset of surveyed

physician groups was low. Very large groups were much more likely to have adopted

such features than smaller groups. (Health Affairs, September 2008 and August 2011)

Among the surveyed organizations:

— Less than half relied on patient-centered efforts to improve quality and safety,

such as using patient educators and sending reminders to patients to schedule

mammograms, immunizations, flu shots, and other screenings and treatments.

— One-third of the physician groups used primary care teams at most sites.

— Less than one-third used patient registries,2 which enable providers to track

patients with chronic diseases, for at least three of the four chronic diseases.

Funding

Shortell received 10 grants from RWJF totaling $7,053,290 from April 1, 1999 through

December 31, 2014. Casalino received three grants totaling $1,600,255 from February

15, 2007 through June 14, 2010. See the Appendix for details about the RWJF grants.

The Commonwealth Fund and the California HealthCare Foundation contributed

$500,737 and $350,000 to these studies, respectively.

CONTEXT

In 2009, 145 million Americans—almost half of the country’s citizens—lived with a

chronic health condition, according to an RWJF-commissioned report from Johns

Hopkins University.3 By 2040, some 21 percent of the U.S. population will be over age

65, and 90 percent of people over 65 will have at least one chronic condition.4

Asthma, congestive heart failure, depression, and diabetes are especially prevalent,

debilitating, and costly. Asthma, depression, and diabetes each affect about 15 million

Americans, while chronic heart failure affects 5 million. Many of the top 20 priorities for

1 The patient-centered medical home model emphasizes a strong system of primary care, practice

innovation, and new systems of payment. Key principles include a personal physician for each patient, a

whole-person orientation, coordinated and integrated care, a focus on quality and safety, and payment

reform. 2 A disease registry is a collection of secondary data about patients with specific diagnoses, conditions, and

procedures provided. Registries are most commonly used for patients with chronic illnesses. They can be in

paper or electronic format. 3 Gerard Anderson, PhD. Chronic Care: Making the Case for Ongoing Care. Baltimore: Johns Hopkins

Bloomberg School of Public Health, 2010. Available online. Anderson directed RWJF’s program,

Partnership for Solutions. See Program Results Report for more information. 4 Chronic Care in America: A 21st Century Challenge. Institute for Health & Aging, University of

California, San Francisco, for RWJF, November 1996. Available online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 3

improving U.S. health care tagged by a 2003 report from the Institute of Medicine related

to chronic illnesses.5

Studies have shown that several new approaches to managing these four conditions can

bolster patient outcomes, lower costs, and reduce the use of services. They include:

● Care management processes used by medical groups, such as registries tracking

patients with chronic diseases, clinical practice guidelines, case managers, and patient

education and self-management

● Feedback to physicians from their practice organizations on whether and how they

use specific practices, such as prescribing anti-inflammatory medication for asthma

patients, and ensuring that diabetic patients receive retinal screening

● The use of information technology, such as electronic medical records

Yet research has suggested that physicians have not been using these approaches—

perhaps because they require clinicians to restructure the way they deliver care. For

example, a 1998 study from RWJF’s Health Tracking initiative reported, “Perhaps most

disconcerting was physician organizations’ difficulty in developing the infrastructure

necessary to manage financial risk and streamline and improve clinical care delivery.”6

THE PROJECT

For the National Study of Physician Organizations (NSPO) and the National Study of

Small- and Medium-Sized Physician Practices, a research team completed four surveys of

medical groups and independent practice associations from 1999 to 2013, to determine

the extent to which they used evidence-based care management processes.7 Most of these

were based on the Chronic Care Model developed by Ed Wagner, MD, and colleagues at

the Group Health Cooperative of Puget Sound.

To participate in the survey, physician organizations had to treat patients with asthma,

diabetes, congestive heart failure, and depression. To obtain the names and contact

information of potential participant organizations, the researchers worked with several

databases. Because the information was in flux and sometimes inaccurate, the team had

to review, cull, and clean the resulting list of thousands of organizations.

5 Priority Areas for National Action: Transforming Health Care Quality, Institute of Medicine, January 7,

2003. Available online. 6 Health Tracking was a multifaceted initiative aimed at informing policymakers about changes over time

in the health care system and their effects on people. Read the Program Results Report. 7 The American Medical Association defines a medical group as an entity that shares business, clinical, and

administrative facilities, records, and personnel with commonly defined practice goals, objectives, and

values. Income from medical services provided by the group are treated as receipts of the group and

distributed according to a prearranged plan. An independent practice association is a legal entity organized

and directed by physicians that negotiates contracts with insurance companies, among other functions,

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 4

Researchers then interviewed the medical director, president, or chief executive officer of

each qualifying organization. The surveys involved 45-minute telephone interviews. Near

the end of the third round of the study, respondents could elect to respond by internet, and

98 percent of them did so.

The researchers asked whether the organization used 16 or 17 practices (depending on the

survey) within five categories of care management processes:

● Case management. Case managers are available at physician request or assigned to all

severely ill patients with a chronic condition.

● Physician feedback: Physicians receive feedback from their practice organizations on

specific practices related to these conditions.

● Disease registry. The practice maintains disease registries of patients with the chronic

conditions.

● Clinical practice guidelines: The practice has adopted such guidelines; physicians

receive training in them; and patient charts, clinician reminder systems, and order-

entry systems reflect them.

● Self-management skills: The organization teaches patients how to manage chronic

illnesses.

The researchers also asked respondents about their organization’s ownership, financial

management, use of electronic databases, physician compensation (base salary as well as

extra payments based on productivity and patient satisfaction), relationships with health

plans, involvement in pay-for-performance programs, quality improvement activities, and

public reporting of performance data.

The team subcontracted with three research organizations to conduct the surveys: NORC

at the University of Chicago, Population Research Systems (San Francisco), and RTI

International (Research Triangle Park, N.C).

Diane Rittenhouse, MD, MPH, associate professor of family and community medicine at

the University of California, San Francisco; Andy Ryan, PhD, assistant professor of

public health at Weill Cornell Medical College; and James Robinson, PhD, Thomas

Rundall, PhD, and Helen Halpin, PhD, all professors at the University of California,

Berkeley School of Public Health, served as core members of the research team at

various stages of the research over the years. Robin Gillies and Patty Ramsay served as

study directors.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 5

THE STUDIES & THEIR FINDINGS

National Study of Physician Organizations (NSPO) 1

For its first survey, from September 2000 to September 2001, the team contacted

organizations with at least 20 physicians. NSPO 1 aimed to create a national database of

such organizations, as well as to examine their use of care management and quality

improvement processes. Organizations received $150 for completing the survey, which

was funded as part of RWJF’s Health Tracking initiative.

Some 70 percent of the roughly 1,500 physician organizations contacted responded to the

survey, yielding a national database of 1,040 organizations. The mean number of

physicians per organization was 227, including 136 for medical groups and 408 for

independent practice organizations. Most of the organizations (834) were multispecialty.

To gather more in-depth information on organizations in areas where managed care was

common, the researchers also interviewed seven to 10 staff members during two-day

visits to such organizations in Boston, Cleveland, Indianapolis, Orange County, Calif.,

Phoenix, and Seattle. The team also conducted 90-minute telephone interviews with a

senior staff member at organizations in areas where managed care was less common,

including Greenville, S.C.; Lansing, Mich.; Little Rock, Ark.; Miami; northern New

Jersey; and Syracuse, N.Y.8

Findings from NSPO 1

Several journals, including the Joint Commission Journal on Quality and Patient Safety,

JAMA, Health Affairs, and NEJM, published the research team’s findings from this study.

(See Bibliography for details.)

In an article in JAMA,9 the team reported:

● The use of care management processes among these physician organizations was

low: they used 5 of 16 processes, on average.

● Two-thirds of the organizations had external incentives to use care management

practices, such as requirements from payers to publicly report on measures of

health care quality, and pay-for-performance contracts with insurers.

● Half of these organizations did not have information technology for clinical

aspects of the practice, such as information on patients’ progress, medications,

and lab results.

8 Most of these areas participated in the Community Tracking Study, a component of the Health Tracking

program. 9 Casalino LP, Gillies RR, Shortell SM, et.al. “External Incentives, Information Technology, and Organized

Process to Improve Health Care Quality for Patients with Chronic Diseases.” Journal of the American

Medical Association, 289(4): 434-441, 2003. Available online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 6

● Organizations with more external incentives and more information technology

used more care management processes.

In “What Are the Facilitators and Barriers” in the Joint Commission Journal on Quality

and Patient Safety,10 the team reported:

● Strong leadership and an organizational culture that valued the quality of care

were the top drivers of the use of care management processes. The most common

barriers were a poor financial situation, reimbursement that did not reward quality,

inadequate information technology, and physician resistance and workload.

● Of 15 organizations that participated in site visits, about half (seven) used care

management processes either minimally or not at all. The organizations used these

processes most often for patients with diabetes and least often for patients with

depression.

The Impact of Care Management Processes on Patients

In a supplemental study to NSPO 1, the researchers explored whether patients 65 and

over with asthma, diabetes, congestive heart failure, and depression had better outcomes

in physician organizations that used more care management processes. The team did so

by trying to link information on the use of such processes to information on health care

quality, such as hospital discharges, gleaned from Medicare claims. The team noted that a

comprehensive database linking the use of care management processes and clinical

outcomes does not exist.

National Study of Physician Organizations 2

To track progress in the use of care management processes among large physician

organizations, the research team conducted NSPO 2 from March 2006 to March 2007.

The team used a survey similar to that for NSPO 1, but added questions on the use of

rapid-cycle quality improvement and participation in quality improvement collaboratives.

Some 538 of 892 physician organizations responded to the survey. Of those, 369 had also

participated in NSPO 1. The team further analyzed information from 291 participating

organizations on their use of features of patient-centered medical homes, as interest in

that approach to medical care was growing.

The researchers also tried to find information on patient outcomes, and link it to the use

of evidence-based care management practices among these organizations. However, the

team concluded that the limited information on outcomes and links between patients and

physicians made such an analysis unfeasible.

10 Bodenheimer T, Wang MC, Rundall TG, Shortell SM, Gillies RR, Oswald N, Casalino L, Robinson JC,

“What Are the Facilitators and Barriers in Physician Organizations’ Use of Care Management Processes?”

Joint Commission Journal on Quality and Patient Safety, 30(9): 505–514, 2004. Abstract available online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 7

Findings from NSPO 2

The team cited these findings in journals such as Health Affairs and Medical Care (see

the Bibliography for details) and in a report to RWJF:

In “Improving Chronic Illness Care” in Medical Care11 and a report to RWJF, Shortell et

al. reported:

● Large physician organizations used 46 percent of 17 care management processes,

on average, in 2006–2007, compared with 32 percent of such processes in 2000–

2001.

— The most commonly used processes were disease registries, specially trained

patient educators, and feedback from the organization to physicians on their

performance.

— These organizations used the most care management processes for patients with

diabetes, and the fewest for patients with depression.

● Independent practice associations and very large medical groups used more care

management processes than smaller organizations.

● Organizations with quality improvement programs and a patient-centered focus

used more care management processes, as did organizations owned by a hospital

or health maintenance organization. In contrast to NSPO 1, this study did not find a

link between the use of clinical information technology and such processes.

In “Measuring the Medical Home Infrastructure in Large Medical Groups” in Health

Affairs,12 the research team reported:

● Among the subset of 291 organizations, adoption of features of patient-centered

medical homes was low. Very large physician organizations were much more likely

to have adopted such features than smaller organizations. Of these 291 groups:

— Less than half relied on patient-centered efforts to improve quality and safety,

such as using patient educators and sending reminders to patients about follow-up

appointments and treatment.

— One-third used primary care teams at most sites.

— Less than one-third used patient registries for at least three of the four chronic

diseases.

11 Shortell S, Gillies R, Siddique J, Casalino LP, et.al. “Improving Chronic Illness Care: A Longitudinal

Cohort Analysis of Large Physician Organizations.” Medical Care. 47(9): 932–939, 2009. Abstract

available online. 12 Rittenhouse DR, Casalino, LP, Gillies RR, Shortell SM, Lau, B. “Measuring the Medical Home

Infrastructure in Large Medical Groups.” Health Affairs. 27(5): 1246–1258, 2008. Available online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 8

— Thirty percent used group visits for patients with chronic illnesses at most of their

sites.

— Twenty-five percent routinely used nurse care managers (nurses who coordinate

patient care delivered by multiple care providers).

— Forty-one percent said most of their physicians used electronic medical records—

and nearly half of those used them to collect information on health care quality.

— Sixty-five percent participated in quality improvement collaboratives.

National Study of Small- and Medium-Sized Physician Practices

While NSPO 1 and 2 surveyed practices of 20 or more physicians, almost half of all

physicians worked in practices of five or fewer physicians in 2008. Researchers knew

little about these practices, or the processes they used to improve the quality and control

the cost of care. To help close that gap, the research team surveyed 1,765 small- and

medium-sized practices—those with 1 to 19 physicians—from July 2007 to March 2009.

Participating organizations received $175.

The team also surveyed another 184 small physician organizations in Boston,

Indianapolis, and New Mexico from January to June 2010. These communities are

important to Aligning Forces for Quality, a $131 million RWJF initiative in 16 areas

across the United States aimed at achieving measurable health improvements by 2015.

(Funding for this project came from that initiative beginning in 2007. Read a 2012 Report

on the program.)

Project Co-Director Shortell cited these results in a report to RWJF:

● The research team was able to link Medicare claims on individual patients to the

physicians who provided their care, and then to the 104 medical groups where those

physicians practiced. However, that approach proved very labor intensive—although

it was much less costly than examining the charts of individual patients, according to

Shortell.

● The use of care management processes among these medical groups was not strongly

associated with the quality of care.

● The fact that the use of these care management processes among physician

organizations was low, and usually in its early stages, may help explain these

findings.

Findings from the Study

The team reported findings from this study in Health Affairs, Health Services

Research, JAMA, and other journals. (See the Bibliography.)

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 9

In “Independent Practice Associations and Physician-Hospital Organizations Can

Improve Care Management for Smaller Practices” in Health Affairs,13 Casalino et al.

reported:

● Smaller organizations participating in an independent practice association or a

physician-hospital alliance used nearly three times as many care management

processes as organizations that did not participate. Only 23.8 percent of surveyed

practices participated in such groups.

In “When Does Adoption of Health Information Technology” in Journal of the American

Medical Informatics Association,14 the research team reported:

● Small- to medium-sized organizations that publicly report on measures of health

care quality, and those subject to financial incentives such as pay for

performance, use more care management practices.

— Practices with both public reporting and financial incentives used more care

management processes than practices with just one of those.

— Some 61.2 percent of practices participated in at least one public reporting or pay-

for-performance program.

— Only 19.2 percent of these practices participated in more than one program.

● Only 34.1 percent of smaller practices had adopted at least one care

management process that entailed the use of information technology. However,

86.2 percent of physicians in practices with an IT-related process used it.

In “Small and Medium-Size Physician Practices Use Few Patient-Centered Medical

Home Processes” in Health Affairs,15 the research team reported:

● Small- and medium-sized organizations used just 20 percent of care

management processes linked to patient-centered medical homes, on average.

Organizations with more resources—such as those owned by hospitals and those

receiving financial incentives—used more such processes.

● “Major changes will be required if the patient-centered medical home is to be

widely adopted” among smaller practices, the team concluded in a 2011 article

in Health Affairs. Such changes could include:

13 Casalino LP, Wu FM, Ryan AM, Copeland K, Rittenhouse DR, Ramsay PP, Shortell SM. “Independent

Practice Associations and Physician-Hospital Organizations Can Improve Care Management for Smaller

Practices.” Health Affairs. 32(8): 1376–1382, 2013. Abstract available online. 14 McClellan SR, Casalino LP, Shortell SM, Rittenhouse R. “When Does Adoption of Health Information

Technology by Physician Practices Lead to Use by Physicians Within the Practice?” Journal of the

American Medical Informatics Association. 20(e1): e26–e32, 2013. Abstract available online. 15 Rittenhouse DR, Casalino LP, Shortell SM, et.al. “Small and Medium-Size Physician Practices Use Few

Patient-Centered Medical Home Processes.” Health Affairs. 30(8): 1575–1585, 2011. Abstract available

online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 10

— Training physicians and staff in leadership development, the use of health

information technology, data collection, and team-based care

— Encouraging small practices to share resources, such as care managers and

information technology, through independent practice associations

— Expanding external incentives—such as public reporting on quality measures, pay

for performance, and shared-risk approaches to payment—to smaller practices

— Preparing the next generation of physicians to practice in new types of

organizations

National Study of Physician Organizations 3

The research team surveyed physician organizations of all sizes in NSPO 3. The team

also refocused the survey somewhat to reflect provisions of the 2010 Affordable Care

Act. For example, the researchers asked physician groups whether they had joined

accountable care organizations, and whether they used processes linked to the chronic

care model and the patient centered medical home.16

The team contacted 3,977 organizations and conducted 1,397 interviews from January

2012 to November 2013. Practices received $200 for participating.

Findings from NSPO 3

The team is still analyzing the information from this study. However, Health Services

Research published their findings on participation in accountable care organizations in

March 2014:17

● Some 23.7 percent of physician groups reported joining an accountable care

organization, and 15.7 percent said they were planning to join one within 12

months. The rest—60.6 percent—said they were not planning to join.

● Practices joining an accountable care organization were more likely to:

— Be larger

— Be physician owned rather than hospital or health system owned

— Receive patients from an independent practice association or a physician-hospital

organization

16 Accountable care organizations are groups of providers that agree to be accountable for both the costs

and quality of care for a defined population of patients. The chronic care model identifies some of the most

important processes found to be associated with better outcomes of care. 17 Shortell SM, McClellan SR, Ramsay LP, et al. “Physician Practice Participation in Accountable Care

Organizations: The Emergence of the Unicorn.” Health Services Research. doi: 10.1111/1475-6773.12167,

March 2014 (published online prior to publication). Available online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 11

— Be located in New England

— Use more care management processes linked to patient-centered medical homes

● Physician organizations participating in accountable care organizations tend to

have more information technology and more resources for managing care.

Conclusions from All the Studies

● Physician organizations “are making progress in the use of care management

processes, but it is not dramatic—it is not what it should be,” said Shortell in a

March 2014 interview. The team’s findings suggest that the use of such processes “is

very difficult work. It requires changes in physician behavior, the ability to work in

teams and delegate to nurses and other staff, and knowledge of how to use electronic

health records.”

● “Policies that tie health care payments to performance and require organizations

to publicly report on measures of health care quality are making a difference in

promoting the use of care management practices,” he noted, and those

approaches have become more common since NSPO began.

Communications Results

An NSPO website includes brief descriptions of each survey and information on gaining

access to the data, as well as links to the team’s journal articles. Besides publishing

journal articles, the research team presented its findings at national meetings and

seminars, and to various health care associations and federal agencies, including the

National Institutes of Health.

According to Shortell, “The work of the researchers has been drawn on my policymakers

in developing the Accountable Care Organization (ACO) concept in the Affordable Care

Act and also in the development of research agendas by the federal Agency for

Healthcare Research and Quality (AHRQ) and others.”

See the Bibliography for information on the articles.

LESSONS LEARNED

1. Use a larger survey firm with experience in contacting physicians, even if it costs

more than a smaller firm. The decision to hire a small firm with limited experience

to survey small and medium-sized practices was “penny wise and pound foolish”

Casalino observed. NORC—a larger, more experienced, although more costly firm—

produced a better response rate in a shorter timeframe. A larger firm is also less likely

to fall behind when facing turnover among its key personnel. (Project

Directors/Casalino, Shortell)

2. Developing an accurate list of physician organizations is challenging. The team

could find no single source of physician organizations and contact information. The

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 12

IMS Health database—the best available—sometimes proved inaccurate and out of

date, so the researchers had to spend a lot of time determining whether organizations

qualified for the surveys and who to contact at them. (Project Co-Director/Casalino)

3. Enlisting physicians to participate in a survey is difficult. Phone surveys are

especially challenging and costly, partly because large practices have gatekeepers

who prevent access to physicians. To surmount that barrier, researchers sent a written

appeal from Casalino—formerly a practicing physician—to a physician at each

organization. National medical organizations and many state medical organizations

also sent letters to potential respondents asking them to participate. As clinicians

learned about the study, some offered to help convince colleagues to participate.

The research team suggested these steps to boost the response rate among physician

organizations:

— Send a financial incentive to an individual from the start.

— As a last-ditch effort, use an abbreviated survey.

— Consider using a Web-based survey. In NSPO 3, near the conclusion of the study,

researchers offered approximately 200 responding organizations the option of

using the Web-based version of the survey, and 98 percent did so. Comparisons

with the phone-based respondents revealed no observable biases.

AFTERWARD

In July 2014, Shortell received an RWJF grant18 to:

● Write five journal articles based on the NSPO 3 findings and cohort analysis of those

organizations that have responded to all three of the recent surveys

● Prepare a report about methodological issues involved in conducting the surveys

● Work with Foundation staff on ideas relevant to the Foundation’s Culture of Health

agenda, including, but not limited to, how best to involve and link the health care

delivery system with the community and with the social services sector that together

address the underlying social and behavioral determinants of health.

The team is using a grant from the Commonwealth Fund to examine links between

avoidable hospital admissions among Medicare enrollees and different types of physician

organizations and care management processes.

Shortell is also working with evaluators of RWJF’s Aligning Forces for Quality to use

NSPO findings to improve care in Aligning Forces communities.

18 ID# 71934 ($249,949, July 1, 2014 through December 31, 2014).

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 13

Prepared by: Mary Nakashian

Reviewed by: Sandra Hackman and Molly McKaughan

Program Officers: C. Tracy Orleans, Katherine Hempstead, Claire Gibbons

Grant ID#: 07110

Project Director: Stephen Shortell (510) 643-5346; shortell@berkeley.edu

Project Director: Lawrence P. Casalino (646) 962-8044; lac2021@med.cornell.edu

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 14

APPENDIX

RWJF Grants for the Studies

Grants to Stephen M. Shortell

● ID# 36275 (April 1, 1999 through June 30, 2000) $72,834

For planning NSPO 1

● ID# 38690 (July 1, 2000 through June 30, 2002) $2,139,934

For implementing NSPO 1

● ID# 40087 (February 1, 2001 through September 30, 2001) $296,555

For continuing implementation of NSPO 1

● ID# 41540 (April 1, 2003 through September 30, 2004) $145,503

For the supplemental study of patient outcomes (using NSPO 1 data)

● ID# 50789 (July 1, 2004 through April 30, 2005) $50,000

For planning NSPO 2

● ID# 51573 (May 1, 2005 through April 30, 2010) $1,399,873

For implementing NSPO 2

● ID# 68847 (May 15, 2011 through July 31, 2013) $2,200,000

For implementing NSPO 3

● ID# 70440 (December 1, 2012 through November 30, 2013) $298,789

For continuing implementation of NSPO 3

● ID# 71110 (July 1, 2013 through November 30, 2013) $199,853

For continuing implementation of NSPO 3

● ID# 71934 (July 1, 2014 through December 31, 2014) $249,949

For preparing journal articles and reports, and convening stakeholders

Grants to Lawrence P. Casalino

● ID# 58680 (February 15, 2007 through February 14, 2009) $987,942

For implementing the study of small- and medium-sized practices. Project continued

under transfer grant ID# 65937

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 15

● ID# 65937 (March 1, 2009 through February 28, 2010) $383,725

For continuing implementation of the study of small- and medium-sized practices

● ID# 67235 (January 15, 2010 through June 14, 2010) $228,588

For additional surveys of small- and medium-sized practices

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 16

BIBLIOGRAPHY

(Current as of date of the report; as provided by the grantee organization; not verified by RWJF; items not

available from RWJF.)

Articles

Alexander JA, Maeng D, Casalino LP, Rittenhouse DR. “Use of Care Management

Practices in Small- and Medium-Sized Physician Groups: Do Public Reporting of

Physician Quality and Financial Incentives Matter?” Health Services Research. 48(2)Part

1: 376–397, 2013. Abstract available online.

Bellows NM, McManamin SB, Halpin HA. “Adoption of Health Promotion in a Cohort

of US Physician Organizations.” American Journal of Preventive Medicine. 39(6): 555–

558, 2010. Abstract available online.

Bodenheimer T, Wang MC, Rundall TG, Shortell SM, Gillies RR, Casalino L, Robinson

JC. “What Are the Facilitators and Barriers in Physician Organizations’ Use of Care

Management Processes?” Joint Commission Journal on Quality and Patient Safety.

30(9): 505–514, 2004. Abstract available online.

Casalino LP, Gillies RR, Shortell SM, Schmittdiel JA, Bodenheimer T, Robinson JC,

Rundall TG, Oswald N, Schauffler H, Wang MC. “External Incentives, Information

Technology, and Organized Processes to Improve Health Care Quality for Patients with

Chronic Diseases.” Journal of the American Medical Association. 289(4): 434–441,

2003. Available online.

Casalino LP, Rittenhouse DR, Gillies RR, Shortell SM. “Specialist Physician Practices as

Patient-Centered Medical Homes.” New England Journal of Medicine. 362:17: 1555–

1558, 2010. Available online.

Casalino LP, Wu FM, Ryan AM, Copeland K, Rittenhouse DR, Ramsay PR, Shortell

SM. “Independent Practice Associations and Physician-Hospital Organizations Can

Improve Care Management for Smaller Practices.” Health Affairs. 32(8): 1376–1382,

2013. Abstract available online.

Damberg CL, Shortell SM, Raube K, Gillies RR, Casalino LP, Rittenhouse DR,

McCurdy PK and Adams J. “Relationship Between Quality Improvement Processes and

Clinical Performance.” American Journal of Managed Care. 16(8): 601–606, 2010.

Abstract available online.

Gillies RR, Chenok KE, Shortell SM, Pawlson G, Wimbush JJ. “The Impact of Health

Plan Delivery System Organization on Clinical Quality and Patient Satisfaction.” Health

Services Research. 41(4 Part 1): 1181–1199, 2006. Available online.

Gillies RR, Shortell SM, Casalino LP, Robinson JC, Rundall TG. “How Different is

California? A Comparison of U.S. Physician Organizations.” Health Affairs, Web

Exclusive. W3.492–502, October 15, 2003 (published online prior to publication).

Available online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 17

Halpin HA, McMenamin SB, Schmittdiel J, Gillies RR, Shortell SM, Rundall T, Casalino

LP. “The Routine Use of Health Risk Appraisals: Results From a National Study of

Physician Organizations.” American Journal of Health Promotion. 20(1): 34–38, 2005.

Abstract available online.

Hearld LR, Alexander JA, Shi Y, Casalino LP. “Pay-for-Performance and Public

Reporting Program Participation and Administrative Challenges Among Small- and

Medium-Sized Physician Practices.” Medical Care Research and Review. 7(3): 299–312,

2013. Abstract available online.

Klabunde CN, Willis GB, Casalino LP. “Facilitators and Barriers to Survey Participation

by Physicians: A Call to Action for Researchers.” Evaluation & the Health Professions.

36: 279–295, 2013. Abstract available online.

Li R, Simon J, Bodenheimer T, Gillies RR, Casalino LP, Schmittdiel J, Shortell SM.

“Organizational Factors Affecting the Adoption of Diabetes Care Management Processes

in Physician Organizations.” Diabetes Care. 27(10): 2312–2316, 2004. Available online.

Martsolf GR, Alexander JA, Shi Y, Casalino LP, Rittenhouse DR, Scanlon DP, Shortell

SM. “The Patient-Centered Medical Home and Patient Experience.” Health Services

Research. 47(6): 2273–2295, 2012. Abstract available online.

McClellan SR, Casalino LP, Shortell SM, Rittenhouse DR. “When Does Adoption of

Health Information Technology by Physician Practices Lead to Use by Physicians Within

the Practice?” Journal of the American Medical Informatics Association. 20(e1): e26–

e32, 2013. Abstract available online.

McLeod CC, Klabunde CN, Willis GB, Stark D. “Health Care Provider Surveys in the

United States, 2000–2010: A Review.” Evaluation & the Health Professions. 36(1): 106–

126, 2013. Abstract available online.

McMenamin SB, Bellows NM, Halpin HA, Rittenhouse DR, Casalino LP, Shortell SM.

“Adoption of Policies to Treat Tobacco Dependence in U.S. Medical Groups.” American

Journal of Preventive Medicine. 39(5): 449–456, 2010. Abstract available online.

McMenamin SB, Schauffler HH, Shortell SM, Rundall TG, Gillies RR. “Support for

Smoking Cessation Interventions in Physician Organizations: Results from a National

Survey.” Medical Care. 41(12): 1396–1406, 2003. Abstract available online.

McMenamin SB, Schmittdiel J, Halpin (formerly Schauffler) HA, Gillies RR, Rundall

TG, Shortell SM. “Health Promotion in Physician Organizations: Results from a National

Study.”American Journal of Preventive Medicine. 26(4): 259–264, 2004. Available

online.

Rittenhouse DR, Casalino LP, Gillies RR, Shortell SM, Lau B. “Measuring the Medical

Home Infrastructure in Large Medical Groups.” Health Affairs. 27(5): 1246–1258, 2008.

Available online.

Rittenhouse DR, Casalino LR, Shortell SM, McClellan SR, Gillies RR, Alexander JA,

Drum ML. “Small And Medium-Size Physician Practices Use Few Patient-Centered

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 18

Medical Home Processes.” Health Affairs. 30(8): 1575–1584, 2011. Abstract available

online.

Rittenhouse DR and Shortell SM. “The Patient-Centered Medical Home: Will It Stand

the Test of Health Reform?” Journal of the American Medical Association. 301(19):

2038–2040, 2009. Available online.

Rittenhouse DR, Shortell SM, Gillies RR, Casalino LP, Robinson JC, McCurdy RK,

Siddique J. “Improving Chronic Illness Care: Findings from a National Study of Care

Management Processes in Large Physician Practices.” Medical Care Research and

Review. 67(3): 301–320, 2010. Abstract available online.

Robinson JC, Casalino LP, Gillies R, Rittenhouse DR, Shortell SM, Fernandes-Taylor S.

“Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical

Information Technology.” Medical Care. 47(4): 411–417, 2009. Abstract available

online.

Robinson JC, Shortell SM, Li R, Casalino LP, Rundall TG. “The Alignment and

Blending of Payment Incentives within Physician Organizations.” Health Services

Research. 39(5): 1589–1606, 2004. Available online.

Robinson JC, Shortell SM, Rittenhouse DR, Fernandes-Taylor S, Gillies RR, Casalino

LP. “Quality-Based Payment for Medical Groups and Individual Physicians,” Inquiry.

46(2): 172–181, Summer 2009. Abstract available online.

Rundall TG, Shortell SM, Wang MC, Casalino LP, Bodenheimer T, Gillies RR,

Schmittdiel, JA, Oswald N, Robinson JC. “As Good as It Gets? Chronic Care

Management in Nine Leading U.S. Physician Organizations.” British Medical Journal.

325(7370): 958–961, 2002. Abstract available online.

Schmittdiel JA, Bodenheimer T, Solomon NA, Gillies RR, Shortell SM. “Brief Report:

The Prevalence and Use of Chronic Disease Registries in Physician Organizations: A

National Survey.” Journal of General Internal Medicine. 20(9): 855–858, 2005. Abstract

available online.

Schmittdiel JA, McMenamin SB, Halpin HA, Gillies RR, Bodenheimer T, Shortell SM,

Rundall TG, Casalino LP. “The Use of Patient and Physician Reminders for Preventive

Services: Results from a National Study of Physician Organizations.” Preventive

Medicine. 39(5): 1000–1006, 2004. Abstract available online.

Schmittdiel JA, Shortell SM, Rundall TG, Bodenheimer T, Selby JV. “Effect of Primary

Health Care Orientation on Chronic Care Management.” Annals of Family Medicine.

4(2): 117–123, 2006. Available online.

Shortell SM, Gillies R, Siddique J, Casalino LP, Rittenhouse D, Robinson JC, McCurdy

RK. “Improving Chronic Illness Care: A Longitudinal Cohort Analysis of Large

Physician Organizations.” Medical Care. 47(9): 932–939, 2009. Abstract available

online.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 19

Shortell SM, McClellan SR, Ramsay PP, Casalino LP, Ryan AM, Copeland KR.

“Physician Practice Participation in Accountable Care Organizations: The Emergence of

the Unicorn.” Health Services Research. DOI: 10.1111/1475–6773.12167, March 14,

2014 (published online prior to publication). Available online,

Shortell SM, Schmittdiel J, Wang MC, Li R, Gillies RR, Casalino LP, Bodenheimer T,

Rundall TG. “An Empirical Assessment of High-Performing Medical Groups: Results

from a National Study.” Medical Care Research and Review. 62(4): 407–434, 2005.

Abstract available online.

Simon JS, Rundall TG, Shortell SM. “Drivers of Electronic Medical Record Adoption

Among Medical Groups.” Joint Commission Journal on Quality and Patient Safety.

31(11): 631–639, 2005. Abstract available online.

Solberg LI, Asche SE, Shortell SM, Gillies RR, Taylor N, Pawlson LG, Scholle SH,

Young MR. “Is Integration in Large Medical Groups Associated with Quality?”

American Journal of Managed Care. 15(6): e34–41, 2009. Available online.

Books & Chapters

Shortell SM and Schmittdiel J. “Prepaid Groups and Organized Delivery Systems:

Promise, Performance, and Potential.” In Toward a 21st Century Health System: The

Contributions and Promise of Prepaid Group Practice. Enthoven AC and Tollen LA

(eds). San Francisco: Jossey-Bass, 2004.

Reports

Shortell SM and Gillies RR. The Impact of Medical Groups’ Use of Care Management

Processes on HCUP Quality Indicators for Patients with Chronic Illness. 2005.

Unpublished report to RWJF.

Survey Instruments

“National Survey of Physician Organizations and the Management of Chronic Illness

(Medical Groups).” (NSPO 1) Fielded April 2000 to October 2001. Available online.

“National Survey of Physician organizations and the Management of Chronic Illness

(Independent Practice Associations).” (NSPO 1) Fielded April 2000 to October 2001.

Survey date October 2000. Available online.

“National Survey of Physician Organizations and the Management of Chronic Illness II

(Medical Groups).” Fielded March 2006 to March 2007. Available online.

“National Survey of Physician Organizations and the Management of Chronic Illness II

(Independent Practice Associations).” Fielded March 2006 to March 2007. Available

online.

“National Survey of Small-Medium Sized Physician Practices.” Fielded July 2007 to

March 2009 and January 2010 to June 2010.

RWJF Program Results Report—How Physician Groups Manage Their Patients’ Chronic Illnesses 20

“National Survey of Physician Organizations III” Fielded January 2012 to November

2013.

Communications or Promotions

http://nspo.berkeley.edu. Includes survey instruments, data, and publications. Berkeley,

CA: University of California.