Résumé :
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[BDSP. Notice produite par INIST-CNRS PNR0x1wD. Diffusion soumise à autorisation]. Context Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. Objectives To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). Design, Setting, and Participants One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. Main Outcome Measures Extent of use of CMPs as calculated on the basis of a measure, a PO care management index (POCMI ; range, 0-6) and factors associated with CMP use. Results Physician organizations'mean use of CMPs was 5.1 of a possible 16 ; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<. and p="007)." each additional it capability was associated with cmps however of pos reported no external incentives clinical capability. conclusions the use varies greatly among but is low on average. government private purchasers health care may increase cmp by providing for improvement quality to assisting them in improving their>
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