Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120
Presentation
The Effect of Physician Practice Organizational Form on Physician Behavior and Adoption of Health Information Technology
Research Objective: To examine the role of practice and physician characteristics in adopting health information technology (HIT) in office based primary care (PC) and pediatric medical practices and to explore the relationships between the presence of HIT and clinical decision making.
Study Design: While a growing body of literature identifies potential benefits from adoption of HIT in office based physician practices, there is incomplete and fragmented information on the adoption of HIT by practices or how it may impact on clinical performance. This study uses data from a 2006-7 multi-mode survey of physicians in PC and pediatric practices linking patterns of HIT adoption and physician behavior to characteristics of the physician, his/her practice and the managed care environment. Data domains include physician demographic characteristics, income, practice revenues and structure (e.g., resources, payer type, and use of HIT, including electronic medical records (EMRs) and decision support systems), and administrative controls. Physicians were also asked to respond to clinical vignettes (asthma and depression). Multivariate weighted regression and logistic regression are used to analyze HIT adoption and analyze physician treatment recommendations. Data are weighted to account for sampling design and known sources of non-response.
Population Studied: A random sample of 1600 primary care (PC) and pediatric physicians in 5 states (California, Illinois, Georgia, Pennsylvania and Texas). The sample was derived from the American Medical Association Physician Masterfile. Pediatric and minority physicians were over sampled.
Principal Findings: HIT adoption in general was relatively low in the study sample. (e.g. 56% of study PC physicians and 64% of pediatricians made no use of EMRs for their patients). Our preliminary results indicate that HIT adoption is greater for physicians in larger practices and those with higher operating revenues per physician, while adoption was less likely for older and minority physicians, and those in pediatric practices and whose practices had high Medicaid loads. Preliminary analyses also suggest that along with facility practice size, Medicaid load, and physician demographics, HIT use was related to PC physicians' propensity to follow recommended treatment guidelines for depression and asthma. Further analyses will separate the effects of endogenous HIT adoption and practice organization.
Conclusions: Preliminary findings suggest that there are significant differences between various physician practice organizations in use of HIT and that based on vignettes, HIT is associated with higher levels of compliance to practice guidelines.
Implications for Policy, Delivery or Practice: This research contributes to a better understanding of barriers to the adoption of HIT and its role in the quality of ambulatory care. Differences in patterns of HIT adoption by minority physicians and those whose practices serve low income populations, especially when coupled with findings that adherence to treatment guidelines tends to be higher in practices with high HIT use, in particular raise a range of policy issues.