Performance Measurement Accelerating Improvement (2006) / Chapter Skim
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Appendix C Case Studies
Appendix C Case Studies
Pages 144-165
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From page 144... ...
Along with this redesign of health care delivery, a coordinated system will entail public reporting of performance measures in addition to a greater emphasis on shared accountability among providers and patients for improving the quality of care delivered. Many providers will need assistance as they undertake performance measurement activities.
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. Obtain Physician Support The first step in implementing performance measurement within clinical practices is to obtain physicians' agreement to participate.
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From page 146... ...
146 APPENDIX C TABLE C-1 Key Themes for Implementing Performance Measurement Case Studya Key Themes A B C D E F G Seek physician support · Use of practice guidelines to reach X X X X X X X consensus on measures · Provider ownership of data X X X X X X X · Prior exposure to performance X X X X X measurement and quality improvement through professional organizations · Participation in federal, state, and local X X X X X collaboratives · Use of pay for performance X X X Obtain resources Human (hiring new staff) · Additional clinical staff, such as X X X X X X physician assistants and nurses, for internal quality improvement efforts · Outside vendors for system maintenance X X X · Full-time technicians for data system X X X X management or part-time staff to help with data collection Technical assistance · Recruiting of staff with prior training X X X X X in quality improvement, such as a quality assurance coordinator · Provider assistance received from an X X X X X outside organization -- e.g., an academic health center helps with data collection and interpretation · Provider collaboration with federal, X X X state, and local organizations for assistance with data collection and feedback Information technology · Purchase of hardware and software X X X X X X X within the practice · Implementation of EHRs X X X X X X Financial · Up-front investments to get the X X X X X X X practice ready for performance measurement · Cost sharing through affiliations or X X X X partnerships with local collaboratives · Grants for performance measurement X activities
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From page 147... ...
bBarriers were not included in the committee's initial list of questions; however, the practices indicated they had overcome these difficulties over the past 35 years, when they began using performance measurement.
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From page 148... ...
A common issue is that a focus on performance measurement activities may result in a lower volume of patients because the focus of care is on providing quality, not on increasing office visits. Sustain Change Results of the committee's case studies indicated that participation in performance measurement based on temporary support, such as a shortterm grant or individual experimentation within a practice, does not lead to successful implementation of performance measurement.
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From page 149... ...
· Several providers mentioned that their reputation in their community for providing high-quality care is important to them and is an important reason for their wanting to continue with performance measurement. They like having quality data that can demonstrate that they provide quality care.
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From page 150... ...
150 APPENDIX C BOX C-1 Barriers to Performance Measurement in Small Practices · Large cost of setting up the infrastructure; difficulty of hiring and retaining physicians and other staff who understand the goals of quality improvement. · Lack of standard software that can collect data for multiple purposes (often gathered using multiple paper forms to respond to different requests)
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From page 151... ...
This is a clear example of the improved patient care that can result from access to performance measurement data, without which providers would have been unaware of and thus unable to address the problem. The case study practices also shared with the committee nonfinancial motivators that attract providers to participate in pay-for-performance arrangements, such as clinician satisfaction, data available for innovative tracking of patients, improvement of one's local reputation, increased billing compliance, and decreased liability.
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From page 152... ...
In addition to tracking performance on individual measures, HealthPartners calculates a composite score for a set of critical aspects of care received by the patient for a given condition. Data for these composite measures -- addressing diabetes, cardiovascular disease, preventive care, and depression -- are derived from administrative data and chart abstraction based on either electronic or paper records.
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TABLE C-3 Total Cost Estimate per Review for Commercial Plan Members Performance Measure No.
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HealthPartners' performance measurement focuses on medical groups and comparative public reporting. Many, though not all, medical groups also report individual provider performance on the same measures internally but not publicly.
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· The physician and staff must remain very flexible in the face of un expected technical problems. · A learning network such as ATRIP permits expansion of the capa bilities of electronic medical records and performance measurement, allowing serial analysis and comparison with national benchmarks.
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Performance measurement has been demonstrated for Dr. Wilson's practice among patients with diabetes and cardiovascular disease.
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From page 157... ...
To address this problem, the practice scheduled times for its patients to receive mammograms at the local hospital every Friday, resulting in a 100 percent referral rate. The practice is expanding its quality improvement efforts based on its experience with diabetes to address other chronic care areas, such as pain management and depression, in collaboration with other organizations.
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From page 158... ...
. Measures are collected using administrative data, and validation testing has shown them to be 9295 percent accurate.
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· Make measure specifications available. · Develop the performance measurement program with the advice and guidance of multispecialty physician committees.
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Currently, GreenField incorporates performance measurement as a part of its routine clinical practice to improve patient care. Data for performance measures are generated by claims data linked to EHRs.
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From page 161... ...
, a panel of experts in primary and preventive care that systematically reviews and develops recommendations for clinical preventive services.1 CMA's preventive care and quality review committees convene annually to review and set performance measurement criteria guided by USPSTF practice goals. All measures are based on chart review, with the exception of adult immunizations, for which data are collected by a statewide registry.
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From page 162... ...
, database maintenance, and support costs. Table C-4 shows CMA's improvement on performance measures for patients with heart disease and diabetes mellitus.
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, quality indicators (10 percent) , and unit cost-efficiency (10 percent)
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From page 164... ...
Additionally, the practice achieved a 6 percent improvement from 2002 to 2004 in the number of patients diagnosed with diabetes, hypertension, dyslipidemia, or coronary disease who had their cholesterol measured in the preceding year. North Texas Medical Group does not publicly report its data and uses its performance measurement activities exclusively for internal quality improvement purposes.
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From page 165... ...
1. What kinds of data have you used for your performance measures in physician practices (i.e., claims data, chart review, paper-based registries, computer based registries, full EHR)
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