This application is for a Mentored Clinical Scientist Development Award (K23) for Tara Bishop, an Assistant Professor of Public Health and Medicine at Weill Cornell Medical College. Dr. Bishop's career goal is to become a national expert on how organizational structures, external incentives, and regulatory policies affect the quality and use of ambulatory care by older adults. The K23 award will provide Dr. Bishop with the necessary resources 1) to become an expert on the organization of physician practices as they relate to the care of older patients;2) to develop the skills to perform high level statisticl and qualitative analyses;and 3) to conduct a mixed-methods study of changes in the organization of physician practices and the effects of these changes on the quality of care for older adults. Dr. Bishop has a mentorship team of established researchers: Dr. Lawrence Casalino (primary mentor) who is an Associate Professor of Public Health at Weill Cornell Medical College and an expert on the organization of physician practices and qualitative methods;Dr. Mark Lachs (co-mentor) who is a Professor of Geriatrics at Weill Cornell Medical College and an expert on the healthcare needs of older adults;Dr. Alvin Mushlin (co-mentor) who is Professor and Chair of Public Health at Weill Cornell Medical College and an expert on methods of comparative effectiveness;Dr. Stephen Shortell (co-mentor) who is Professor and Dean of the School of Public Health at the University of California, Berkeley and an expert on the organization of physician practices;Dr. Robert Strawderman (co-mentor) who is a Professor of Statistics at Cornell University and an expert on statistical methods;and Dr. Christine Cassel (advisor) who is President and Chief Executive Officer of the American Board of Internal Medicine and former Chair of Geriatrics at the Mount Sinai School of Medicine and is an expert on the healthcare needs of older adults. Older adults receive a substantial amount of their care in the ambulatory setting;however many older adults do not receive high quality ambulatory care. Organizational structure has been linked to the use of processes to improve quality and quality outcomes. Dr. Bishop's research will look at changes in the organization of physician practices, specifically a potentially emerging trend for hospitals to own physician practices (Aim 1), differences in the use of processes to improve quality in practices that are owned by hospitals versus those that are owned by physicians (Aim 2), differences in the quality of care delivered to older adults by physicians in hospital-owned practices versus physician-owned practices (Aim 3), and physician perception of the barriers of and facilitators for providing high quality care to older adults when a practice changes ownership (Aim 4). This research will be the foundation for an R01 grant application (at the end of the K award period) that will develop measures of processes to improve care for patients with geriatric syndromes and that will survey physician organizations on the use of these processes.

Public Health Relevance

The structure of a physician's practice can impact the quality of care that older adults receive. Better understanding of how the organization of physician practices is changing and how these changes impact the quality of care for older adults is critical for patients, physicians, and policymakers to know so that patients may choose, physicians may implement, and policymakers may incentivize the most effective models of care.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
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Bhattacharyya, Partha
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Weill Medical College of Cornell University
Public Health & Prev Medicine
Schools of Medicine
New York
United States
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Bishop, Tara F; Ryan, Andrew M; Chen, Melinda A et al. (2016) A Randomized, Controlled Trial of a Shared Panel Management Program for Small Practices. Health Serv Res 51:1796-813
Bishop, Tara F; Ramsay, Patricia P; Casalino, Lawrence P et al. (2016) Care Management Processes Used Less Often For Depression Than For Other Chronic Conditions In US Primary Care Practices. Health Aff (Millwood) 35:394-400
Casalino, Lawrence P; Gans, David; Weber, Rachel et al. (2016) US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures. Health Aff (Millwood) 35:401-6
Bishop, Tara F; Shortell, Stephen M; Ramsay, Patricia P et al. (2016) Trends in hospital ownership of physician practices and the effect on processes to improve quality. Am J Manag Care 22:172-6
Casalino, Lawrence P; Bishop, Tara F (2015) Symbol of health system transformation? Assessing the CMS Innovation Center. N Engl J Med 372:1984-5
Bishop, Tara F; Ryan, Mandy Smith; McCullough, Colleen M et al. (2015) Do provider attitudes about electronic health records predict future electronic health record use? Healthc (Amst) 3:5-11
Goetz, Celine; Rotman, Stephen R; Hartoularos, George et al. (2015) The effect of charge display on cost of care and physician practice behaviors: a systematic review. J Gen Intern Med 30:835-42
Ryskina, Kira L; Dine, C Jessica; Kim, Esther J et al. (2015) Effect of Attending Practice Style on Generic Medication Prescribing by Residents in the Clinic Setting: An Observational Study. J Gen Intern Med 30:1286-93
Bishop, Tara F; Pesko, Michael (2015) Does defensive medicine protect doctors against malpractice claims? BMJ 351:h5786
Rothberg, Michael B; Class, Joshua; Bishop, Tara F et al. (2014) The cost of defensive medicine on 3 hospital medicine services. JAMA Intern Med 174:1867-8

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