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Why Do We Observe a Limited Impact of Primary Care Access Measures on Clinical Quality Indicators?

Chung, Sukyung PhD; Panattoni, Laura PhD; Hung, Dorothy PhD; Johns, Nicole MPH; Trujillo, Laurel MD; Tai-Seale, Ming PhD

Journal of Ambulatory Care Management: April/June 2014 - Volume 37 - Issue 2 - p 155–163
doi: 10.1097/JAC.0000000000000026
Original Articles

The study assessed the effects of enhanced primary care access and continuity on clinical quality in a large, multipayer, multispecialty ambulatory care organization with fee-for-service provider incentives. The difference-in-differences estimates indicate that access to own primary care physician is a statistically significant predictor of improved clinical quality, although the effect size is small such that clinical significance may be negligible. Reduced time for own primary care physician appointment and increased enrollment in electronic personal health record are positive predictors of chronic disease management processes and preventive screening but are inconsistently associated with clinical outcomes. Challenges in identifying relationships between access and quality outcomes in a real-world setting are also discussed.

Research Institute, Palo Alto Medical Foundation, Palo Alto, California.

Correspondence: Sukyung Chung, PhD, Palo Alto Medical Foundation, Ames Bldg, 795 El Camino Real, Palo Alto, CA 94301 (

This research was funded by the Agency for Healthcare Research and Quality (R18 HS019167, PI: Dr Tai-Seale; K01 HS019815, PI: Dr Chung).

The authors declare they have no conflict of interest disclosures.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins