FitzHenry F, Reichelt PA, Salmon JW; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Fern FitzHenry, R.N., Ph.D., Information Services Consultant, Vanderbilt University Medical Center, 1161 21st Ave., VUH, B-131, Nashville, TN 37232-7330, Tel: 615-322-2115, Fax: 615-343-1214, E-mail: fernfitzhenry@mcmail.vanderbilt.edu.
Research Objective: Information systems, protocols, and non-physician providers have had a lackluster reception in physician group practice organizations. Financial incentives to manage care may change this. This paper examines the impact of managed care on civilian and military physician organizational adoption of information systems, protocols, and non-physician providers. Study Design: The data collected was via a mailed survey to a single informant, the administrator or chief of the practice for the group. The survey measured the following dependent variables: number of applications (34 items), physician "hands-on" use of systems (4 items), protocol development activities (20 items), number of protocols in use, proportion of non-physician providers, and opposition to adopting those innovations (18 items). The survey had an overall content validity index of .98. Cronbach's alpha was .91 for the opposition scale and test-retest was positive on the remaining scales-significant on protocol development activities and "hands-on" use. Interstudy's HMO penetration and conversion to TRICARE funding served as the dependent measure of managed care type financial incentives for civilian and military groups, respectively. Population Studied: Military clinics (n=92, response rate=74%) and civilian office based specialty physician practices of 5 physicians or more (n=97, response rate=38%, weighted n=306). Principal Findings: For scale totals, in civilian practices there was a correlation between managed care type reimbursement and protocol development activities and number of protocols as well as decreased opposition to information systems, protocols, and non-physician providers, r=.10, .10, and -.11, respectively. Physician opposition, number of protocols in use, and number of applications were significantly related to greater utilization of non-physician providers with standardized correlation coefficients of -.18, .17, and .15. Military clinics showed no relationship between conversion to TRICARE funding and information systems, protocols, non-physician providers, or opposition to these innovations on the summary scales. However, military clinics showed both lower levels of opposition and higher levels of adoption of these innovations on five of the six scales and the differences from civilian organizations were significant. Conclusions: For civilian practices, the findings are consistent with a theory that managed care reimbursement reduces opposition to and influences the adoption of protocols. The effect was not found in military clinics where physicians are salaried and financial incentives are less direct. However, military clinics were effective in influencing the adoption of information systems, protocols, and non-physician providers by other means. Implications for Policy, Delivery, or Practice: Financial incentives appear effective in improving acceptance of protocols for civilian groups. Over the long term they may be effective increasing acceptance of information systems and non-physician providers. However, in the military model the influence of financial incentives is not direct. Managing the facility budget is the responsibility of commanders who can more directly sway adoption such innovations as evidenced in the lower levels of physician opposition. Both models offer promise. The findings suggest that an explicit assessment of potential user opposition would be worthwhile to organizations contemplating adoption. In terms of civilian policy, a centralized push for these innovations may be worth considering. Primary Funding Source: Internal.
Publication Types:
Keywords:
- Administrative Personnel
- Adoption
- Data Collection
- Group Practice
- Health Maintenance Organizations
- Information Systems
- Logical Observation Identifiers Names and Codes
- Managed Care Programs
- Military Personnel
- Motivation
- Physicians
- economics
- hsrmtgs
Other ID:
UI: 102272558
From Meeting Abstracts