Margaret C. Wang, M.P.H.

Edwin L. Crosby Memorial Fund 2003 Recipient: Margaret C. Wang, M.P.H.

A third-year doctoral candidate at the University of California, Berkeley, Margaret Wang is currently conducting research on how environmental, organizational and individual factors influence the delivery of health care services and affect health outcomes, especially for patients with chronic conditions.

As part of this work, Wang is assisting the research team for the National Study of Physician Organizations and the Management of Chronic Illness (NSPO), under the direction of Dr. Stephen Shortell at UC-Berkeley. Funded by the Robert Wood Johnson Foundation, this study was undertaken primarily to determine the relationship between the characteristics of physician organizations (POs) and the extent to which they have implemented care management processes (CMPs) for patients with chronic illnesses (e.g., disease registry, reminder systems, physician feedback, clinical practice guidelines and case management).

The significance of this research is borne out by the numbers:

  • Nearly one out of two Americans is affected by at least one chronic condition.
  • Chronic diseases such as diabetes, congestive heart failure and depression were directly responsible for approximately 140,000 deaths in 1999.
  • Health care expenditures related to these conditions were at least $173 billion.

Research suggests that the most effective guide for improving the quality of chronic care management and reducing health care costs is the Chronic Care Model (CCM), developed by Dr. Ed Wagner of the Group Health Cooperative at Puget Sound.

Wang's research explores how the ownership structure of a PO influences its implementation of the CCM. Specifically, it addresses two questions:

1. How does a PO’s ownership structure (i.e., whether it is freestanding physician-owned or system-affiliated/hospital-owned) affect the extent to which it implements the CCM? Specifically, how does ownership structure affect the capabilities and availability of resources for CCM?

2. How does ownership structure interact with the presence of external incentives (i.e., legitimacy- and status-related vs. financially-based) to affect the degree to which Pos implement the CCM?

Results from the first nationwide survey of POs with 20 or more physicians identified hospital/HMO ownership of POs as a significant factor associated with greater implementation of CMPs. In addition, the presence of external incentives was found to influence the implementation of CMPs.

However, the mechanisms for these relationships have not yet been examined empirically. Wang’s Ph.D. dissertation is the first empirical analysis of these complex relationships. It examines a large sample of POs to quantitatively compare the quality of chronic care delivery in freestanding POs and system-affiliated POs.