Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

Cohen, Deborah J.; Dorr, David A.; Knierim, Kyle; DuBard, C. Annette; Hemler, Jennifer R.; Hall, Jennifer; Marino, Miguel; Solberg, Leif I.; McConnell, K. John; Nichols, Len M.; Nease, Donald E.; Edwards, Samuel T.; Wu, Winfred; Pham-Singer, Hang; Kho, Abel N.; Phillips, Robert L.; Rasmussen, Luke V.; Duffy, F. Daniel; Balasubramanian, Bijal A.

doi:10.1377/hlthaff.2017.1254

Cited by 73 publications

(86 citation statements)

References 25 publications

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“…Due to the disparate incentives to use EHRs meaningfully , hospitals’ EHR systems often do not communicate with each other, and many social service providers have been excluded altogether . Further, EHR systems in the United States lack functionality to capture social needs adequately or to support quality improvement initiatives . Some states and territories have made more progress than others, but for adequate care across systems, federal mandates and incentives for interoperability and technical assistance are critical.…”

Section: Model Requirementsmentioning

confidence: 99%

Connecting Social, Clinical, and Home Care Services for Persons with Serious Illness in the Community

Golden

Emery-Tiburcio

Post³

et al. 2019

J American Geriatrics Society

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The medical, psychological, cognitive, and social needs of older adults with serious illness are best met by coordinated and team-based services and support. These services are best provided in a seamless care model anchored by integrated biopsychosocial assessments focused on what matters to older adults and their social determinants of health; individualized care plans with shared goals; care provision and management; and quality measurement with continuous improvement. This model requires (1) racially and ethnically diverse healthcare professionals, including mental health and direct service workers, with training in aging and team collaboration; (2) an integrated network of community-based organizations (CBOs) providing in-home services; (3) an electronic communication platform that spans the system of providers and organizations with skilled technology staff; and (4) payment models that incentivize team-based care across the continuum of services, including CBOs, with adequate salaries and academic loan forgiveness to recruit and retain highquality team members. Assuring that this model is effective requires ongoing quality assurance measures that include not only quality of care and utilization data to demonstrate cost offsets of service integration, but also quality of life for both the older adults and the family members caring for them. Although this may seem a lofty ideal in comparison with our current fragmented system, we review models that provide the key elements effectively and cost efficiently. We then propose an Essential Care Model that defines best practice in meeting the needs of older adults with serious illness and their families. J Am Geriatr Soc 67:S412-S418, 2019.

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Section: Model Requirementsmentioning

confidence: 99%

Connecting Social, Clinical, and Home Care Services for Persons with Serious Illness in the Community

Golden

Emery-Tiburcio

Post³

et al. 2019

J American Geriatrics Society

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“…Currently, all primary care practices in the United States can receive special paymentsthrough Chronic Care Management codes or similar programs-to identify and care manage high-needs patients; this work could inform their processes but would need to be revalidated among those practices. Furthermore, recent work has highlighted that not all high-needs patients have the same risks or should receive the same interventions 12,25 and that there are differences in nominal and ordinal assignments of risk. Most practices we interviewed employed categories: they stopped at identifying high risk patients, but did not further segment patients into additional groups.…”

Section: Limitationsmentioning

confidence: 99%

“…In addition, primary care practices often lack adequate reporting and analytic tools, thus creating another barrier in adopting stratification approaches. 12 In primary care settings, risk stratification remains relatively new. Few practices have substantial experience in the process.…”

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confidence: 99%

Implementing Risk Stratification in Primary Care: Challenges and Strategies

et al. 2019

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Introduction: Primary care risk stratification (RS) has been shown to help practices better understand their patient populations' needs and may improve health outcomes and reduce expenditures by targeting and tailoring care to high-need patients. This study aims to understand key considerations practices faced and practice experiences as they began to implement RS models. Methods: We conducted semistructured interviews about experiences in RS with 34 stakeholders from 15 primary care practices in Oregon and Colorado and qualitatively analyzed the data. Results: Three decisions were important in shaping practices' experiences with RS: choosing established versus self-created algorithms or heuristics, clinical intuition, or a combination; selecting mechanisms for assigning risk scores; determining how to integrate RS approaches into care delivery. Practices using clinical intuition found stratification time-consuming and difficult to incorporate into existing workflows, but trusted risk scores more than those using algorithms. Trust in risk scores was influenced by data extraction capabilities; practices often lacked sufficient data to calculate their perceived optimal risk score. Displaying the scores to the care team was a major issue. Finally, obtaining buy-in from care team members was challenging, requiring repeated cycles of improvement and workflow integration. Discussion: Practices used iterative approaches to RS implementation. As a result, procedural and algorithmic changes were introduced and were influenced by practices' health IT, staffing, and resource capacities. Practices were most successful when able to make iterative changes to their approaches, incorporated both automation and human process in RS, educated staff on the importance of RS, and had readily accessible risk scores.

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“…12,13 They also often lack the health IT infrastructure, training, resources and time required to build their capacity to do QI well. 11,[14][15][16][17] Given the shortage of primary care providers, clinicians in these practices often have large patient panels requiring a focus on day-to-day patient care activities rather than continually improving the way care is delivered. These factors have led to calls for external support infrastructure to build QI capacity in primary care practice settings.…”

Section: Introductionmentioning

confidence: 99%

Assessing Quality Improvement Capacity in Primary Care Practices

Parchman

Anderson

Coleman

et al. 2019

Preprint

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Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. Results: The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r=0.16, p=0.049) and blood pressure control (r=0.18, p=0.013). Rural practices and those with 2-5 clinicians had lower QICA scores. PFs notes provide examples of high scoring practices devoting time and attention to quality improvement whereas low scoring practices did not. Conclusions: The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.

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Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

Cited by 73 publications

References 25 publications

Connecting Social, Clinical, and Home Care Services for Persons with Serious Illness in the Community

Connecting Social, Clinical, and Home Care Services for Persons with Serious Illness in the Community

Implementing Risk Stratification in Primary Care: Challenges and Strategies

Assessing Quality Improvement Capacity in Primary Care Practices

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