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Editor's Correspondence
November 25, 2002

Primary Care Quality

Arch Intern Med. 2002;162(21):2493. doi:

In their article "Primary Care Quality in the Medicare Program," Safran et al1 describe their findings from an analysis of a large data set using a validated survey tool that asks beneficiaries about their experience with primary care. They conclude that " . . . beneficiaries [in the fee-for-service Medicare program vs Medicare-qualified health maintenance organizations] are increasingly left with a trade-off involving differences in cost and quality." We disagree. Derived from an Institute of Medicine study of primary care, the analytic tool used by Safran et al is conceptually bound by an older model of care delivery. Within Kaiser Permanente, we have developed team-based care using the primary care physician as the center and coordinator of care. Members may see their physician or their physician's team members, including such professionals as advanced practice nurses, registered nurse practitioners, physical therapists, behaviorists, health educators, and nutritionists. Our members may access care via the telephone, standard clinic visits, and the World Wide Web. We have also instituted a strong hospitalist program throughout our facilities that allows for both higher quality of care in the acute care setting and more consistent staffing and availability in the office. Acceptance of this model is supported by our very low voluntary termination rate of 2% and our generally steady growth of Medicare membership.

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