Does ownership make a difference in primary care practice?

Stephan Lindner, Leif I. Solberg, William L. Miller, Bijal A. Balasubramanian, Miguel Marino, K. John McConnell, Samuel T. Edwards, Kurt C. Stange, Rachel J. Springer, Deborah J. Cohen

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Purpose: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices. Methods: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based practice characteristic measures, 9 survey-based quality improvement process measures, and 4 electronic health record-based cardiovascular disease prevention quality measures, namely, aspirin prescription, blood pressure control, cholesterol management, and smoking cessation support (ABCS). Results: Physician-owned practices were more likely to be solo (45.0% compared with 8.1%, P < .001 for health system practices and 12.8%, P = .009 for FQHCs) and less likely to have experienced a major change (eg, moved to a new location) in the last year (43.1% vs 65.4%, P = .01 and 72.1%, P = .001, respectively). FQHCs reported the highest use of quality improvement processes, followed by health system practices. ABCS performance was similar across ownership type, with the exception of smoking cessation support (51.0% for physician-owned practices vs 67.3%, P = .004 for health system practices and 69.3%, P = .004 for FQHCs). Conclusions: Primary care practice ownership was associated with differences in quality improvement process measures, with FQHCs reporting the highest use of such quality-improvement strategies. ABCS were mostly unrelated to ownership, suggesting a complex path between quality improvement strategies and outcomes.

Original languageEnglish (US)
Pages (from-to)398-407
Number of pages10
JournalJournal of the American Board of Family Medicine
Issue number3
StatePublished - 2019


  • Cardiovascular diseases
  • Cross sectional analysis
  • Delivery of health care
  • Group practice
  • Ownership
  • Primary health care
  • Process measures
  • Quality improvement

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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