Annals of Internal Medicine tip sheet for December 5, 2006

December 04, 2006

1. Type of Physician Organization Impacts Quality of Care

A study of 119 physician groups in 1999-2000 found that integrated medical groups (IMGs) delivered higher quality on four of six care measures than individual practice associations (IPAs), with both groups performing well on the remaining two measures (Improving Patient Care, p. 826).

IMGs used electronic medical records and quality improvement strategies more often than IPAs, but this use did not explain differences in quality of care.

An editorial writer says that the study actually shows that large IMGs perform better on the selected measures (since all the IMGs in the study were large), and that since the study was observational and cross-sectional, "we cannot infer that the size and structure of an integrated group cause the differences in quality" (Editorial, p. 860).

But the study is important, the writer says, because it contributes to the "Holy Grail" of physician-quality studies: to determine the relationships between physician organization structure, quality improvement processes, and outcomes.




2. Screening All Adults for HIV -- Not Just Those at Risk -- Is Cost Effective

A mathematical decision model study found that screening all adults for HIV with a same-day rapid test was cost effective when the prevalence of HIV in the community was as low as 0.20 percent (Article, p. 797).

Authors recommend routine, voluntary rapid HIV testing for all adults, except in settings where evidence shows that the prevalence of undiagnosed HIV infection is below 0.2 percent.

This study "entirely supports the shift from targeted screening based on patient risk factors to routine screening based on prevalence and incidence thresholds," the authors say. The findings support the Centers for Disease Control and Prevention (CDC) recommendation calling for routine HIV screening of all adults and adolescents and is stronger than the U.S. Preventive Services current recommendations to screen individuals at increased risk for HIV infection.

An editorial writer reviews the history of HIV screening and discusses the CDC's recommendation of opt-out screening without pretest counseling or separate, written consent (Editorial, p. 857).

"Eventually, reminiscent of successful screening programs for syphilis and tuberculosis, the cost-effectiveness question for HIV will change from whether we should screen for HIV to when we should stop."
-end-


American College of Physicians

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