Associations Between Structural Capabilities of Primary Care Practices and Performance on Selected Quality Measures

Friedberg, Mark W.; Coltin, Kathryn L.; Safran, Dana Gelb; Dresser, Marguerite; Zaslavsky, Alan M.; Schneider, Eric C.

doi:10.7326/0003-4819-151-7-200910060-00006

Cited by 129 publications

(118 citation statements)

References 26 publications

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“…[6][7][8][9][10] Others found modest effects for some, but not all, of the quality measures considered. [11][12][13] Still others were positive, but took place mostly in academic medical centers or integrated delivery systems with home-grown, rather than commercially available, EHRs. 5,14 Few studies have taken place in communities with multiple payers and commercially available EHRs, which are typical of most American communities.…”

Section: Introductionmentioning

confidence: 99%

“…5,14 Few studies have taken place in communities with multiple payers and commercially available EHRs, which are typical of most American communities. 15 Previous studies have also been limited by nonuniversal use of concurrent control groups, 12 lack of adjustment for patient case mix, [6][7][8][9][10][11][12][13] and small or unknown sample sizes of patients per quality measure per physician. [6][7][8][9][10][11][12][13] We sought to determine the effect of commercially available EHRs on ambulatory quality in a multi-payer community, while addressing many of the other limitations of the previous literature.…”

Section: Introductionmentioning

confidence: 99%

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Electronic Health Records and Ambulatory Quality of Care

et al. 2012

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CONTEXT: The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs). However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect. OBJECTIVE: To determine the effect of EHRs on ambulatory quality in a community-based setting. DESIGN: Cross-sectional study, using data from 2008. SETTING: Ambulatory practices in the Hudson Valley of New York, with a median practice size of four physicians. PARTICIPANTS:We included all general internists, pediatricians and family medicine physicians who: were members of the Taconic Independent Practice Association, had patients in a data set of claims aggregated across five health plans, and had at least 30 patients per measure for at least one of nine quality measures selected by the health plans. IINTERVENTION: Adoption of an EHR. MAIN OUTCOME MEASURES: We compared physicians using EHRs to physicians using paper on performance for each of the nine quality measures, using t-tests. We also created a composite quality score by standardizing performance against a national benchmark and averaging standardized performance across measures. We used generalized estimation equations, adjusting for nine physician characteristics. KEY RESULTS: We included 466 physicians and 74,618 unique patients. Of the physicians, 204 (44 %) had adopted EHRs and 262 (56 %) were using paper. Electronic health record use was associated with significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening. Effect sizes ranged from 3 to 13 percentage points per measure. When all nine measures were combined into a composite, EHR use was associated with higher quality of care (sd 0.4, p= 0.008). CONCLUSIONS: This is one of the first studies to find a positive association between EHRs and ambulatory quality in a community-based setting.KEY WORDS: electronic health records; primary health care; quality of health care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electronic Health Records and Ambulatory Quality of Care

et al. 2012

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“…9 This original survey instrument underwent cognitive testing and validation with practice site visits, as described previously. 9,10 For the current project, we modified the original survey by adding items in consultation with the conveners of the PACCI. These new items were intended to assess capabilities that were specifically encouraged by the PACCI intervention (e.g., systems to contact patients after hospitalizations).…”

Section: Practice Surveysmentioning

confidence: 99%

Categories of Practice Transformation in a Statewide Medical Home Pilot and their Association with Medical Home Recognition

et al. 2015

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BACKGROUND: Healthcare purchasers have created financial incentives for primary care practices to achieve medical home recognition. Little is known about how changes in practice structure vary across practices or relate to medical home recognition. OBJECTIVE: We aimed to characterize patterns of structural change among primary care practices participating in a statewide medical home pilot. DESIGN: We surveyed practices at baseline and year 3 of the pilot, measured associations between changes in structural capabilities and National Committee for Quality Assurance (NCQA) medical home recognition levels, and used latent class analysis to identify distinct classes of structural transformation. PARTICIPANTS: Eighty-one practices that completed surveys at baseline and year 3 participated in the study. MAIN MEASURES: Study measures included overall structural capability score (mean of 69 capabilities); eight structural subscale scores; and NCQA recognition levels. RESULTS: Practices achieving higher year-3 NCQA recognition levels had higher overall structural capability scores at baseline (Level 1: 28.4 % of surveyed capabilities, Level 2: 40.9 %, Level 3: 48.7 %; p value=0.001). We found no association between NCQA recognition level and change in structural capability scores (Level 1: 33.2 % increase, Level 2: 30.8 %, Level 3: 33.7 %; p value=0.88). There were four classes of practice transformation: 27 % of practices underwent "minimal" transformation (changing little on any scale); 20 % underwent "provider-facing" transformation (adopting electronic health records, patient registries, and care reminders); 26 % underwent "patient-facing" transformation (adopting shared systems for communicating with patients, care managers, referral to community resources, and after-hours care); and 26 % underwent "broad" transformation (highest or secondhighest levels of transformation on each subscale). CONCLUSIONS AND RELEVANCE: In a large, statebased medical home pilot, multiple types of practice transformation could be distinguished, and higher levels of medical home recognition were associated with practices' capabilities at baseline, rather than transformation over time. By identifying and explicitly incentivizing the most effective types of transformation, program designers may improve the effectiveness of medical home interventions.

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“…As such, the PCMH empowers patients and their families as active participants in the care process, partnering with them to understand and address their needs and preferences. "New Model" practice involves the adoption of electronic health records; implementation of the chronic care model including use of disease registries, guidelines, and patient self management support programs [8][9][10] ; and active participation in continuous quality improvement initiatives. These "tools" enable the PCMH to track patient referrals, treatments, and information across providers.…”

Section: Patient-centered Medical Homementioning

confidence: 99%

United States Innovations in Healthcare Delivery

Shortell

Gillies

2010

Public Health Rev

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Population aging, rapidly increasing costs of healthcare and the growing burden of chronic disease are challenges to health systems worldwide. To meet these challenges will require new approaches to healthcare delivery and comprehensive population health management. Within the context of healthcare reform initiatives, important innovations in delivery system organization in the United States are discussed. The innovations focused on are the Patient-Centered Medical Home (PCMH), the Accountable Care Organization (ACO) and the Population Health Management System (PHMS) combined with new payment arrangements that reward for health outcomes achieved rather than paying a fee for each service rendered. For each of these innovations, the evidence on its performance, the challenges involved, and the factors that might promote greater adoption and diffusion of successful models are reviewed. Finally, the role played by a country's political system and its associated culture, structural barriers, size and resources, incentive alignment, and leadership are discussed.

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Associations Between Structural Capabilities of Primary Care Practices and Performance on Selected Quality Measures

Abstract: The Commonwealth Fund.

Cited by 129 publications

References 26 publications

Electronic Health Records and Ambulatory Quality of Care

Electronic Health Records and Ambulatory Quality of Care

Categories of Practice Transformation in a Statewide Medical Home Pilot and their Association with Medical Home Recognition

United States Innovations in Healthcare Delivery

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