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The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox?

ABSTRACT: PURPOSE:To assess whether primary care practices with and without support from a larger organization differ in their ability to produce timely reports on cardiovascular disease quality measures. BACKGROUND:Although many primary care practices are now part of larger organizations, it is not clear whether such a shift will improve the ability of those who work in these primary care settings to easily access and use their own data for improvement. METHODS:Smaller primary care practices were enrolled in a trial of external practice support to build quality improvement (QI) capacity. A request for clinical quality measure (eCQM) data were sent to each practice and study outcomes were defined based on the date on which practices first submitted valid data for at least 1 of the 3 measures. A practice survey completed by a clinic manager captured practice characteristics, including the presence of QI support from a larger organization. RESULTS:Of the 209 enrolled practices, 205 had complete data for analysis. Practices without central QI support had higher rates of eCQM submission at 30 days (38% vs 20%) and 60 days, (63% vs 48%) than practices with central QI support. Practices with central QI support took longer to submit data (median, 57 days) compared with practices without centralized support (median, 40 days) although this difference was not significant. CONCLUSION:The ability of smaller practices without centralized QI support to report their eCQMs more quickly may have implications for their subsequent ability to improve these measures.

SUBMITTER: Parchman ML

PROVIDER: S-EPMC7453756 | biostudies-literature | 2020 Jul-Aug

REPOSITORIES: biostudies-literature

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The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox?

Parchman Michael L ML Anderson Melissa L ML Penfold Robert B RB Kuo Elena E Dorr David A DA

Journal of the American Board of Family Medicine : JABFM 20200701 4

<h4>Purpose</h4>To assess whether primary care practices with and without support from a larger organization differ in their ability to produce timely reports on cardiovascular disease quality measures.<h4>Background</h4>Although many primary care practices are now part of larger organizations, it is not clear whether such a shift will improve the ability of those who work in these primary care settings to easily access and use their own data for improvement.<h4>Methods</h4>Smaller primary care ...[more]

PMID: 32675274

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Project description:ImportanceThe capability and capacity of primary care practices to report electronic clinical quality measures (eCQMs) are questionable.ObjectiveTo determine how quickly primary care practices can report eCQMs and the practice characteristics associated with faster reporting.Design, setting, and participantsThis quality improvement study examined an initiative (EvidenceNOW Southwest) to enhance primary care practices' ability to adopt evidence-based cardiovascular care approaches: aspirin prescribing, blood pressure control, cholesterol management, and smoking cessation (ABCS). A total of 211 primary care practices in Colorado and New Mexico participating in EvidenceNOW Southwest between February 2015 and December 2017 were included.InterventionsPractices were instructed on eCQM specifications that could be produced by an electronic health record, a registry, or a third-party platform. Practices received 9 months of support from a practice facilitator, a clinical health information technology advisor, and the research team. Practices were instructed to report their baseline ABCS eCQMs as soon as possible.Main outcomes and measuresThe main outcome was time to report the ABCS eCQMs. Cox proportional hazards models were used to examine practice characteristics associated with time to reporting.ResultsPractices were predominantly clinician owned (48%) and in urban or suburban areas (71%). Practices required a median (interquartile range) of 8.2 (4.6-11.9) months to report any ABCS eCQM. Time to report differed by eCQM: practices reported blood pressure management the fastest (median [interquartile range], 7.8 [3.5-10.4] months) and cholesterol management the slowest (median [interquartile range], 10.5 [6.6 to >12] months) (log-rank P < .001). In multivariable models, the blood pressure eCQM was reported more quickly by practices that participated in accountable care organizations (hazard ratio [HR], 1.88; 95% CI, 1.40-2.53; P < .001) or participated in a quality demonstration program (HR, 1.58; 95% CI, 1.14-2.18; P = .006). The cholesterol eCQM was reported more quickly by practices that used clinical guidelines for cardiovascular disease management (HR, 1.35; 95% CI, 1.18-1.53; P < .001). Compared with Federally Qualified Health Centers, hospital-owned practices had greater ability to report blood pressure eCQMs (HR, 2.66; 95% CI, 95% CI, 1.73-4.09; P < .001), and clinician-owned practices had less ability to report cholesterol eCQMs (HR, 0.52; 95% CI, 0.35-0.76; P < .001).Conclusions and relevanceIn this study, time to report eCQMs varied by measure and practice type, with very few practices reporting quickly. Practices took longer to report a new cholesterol measure than other measures. Programs that require eCQM reporting should consider the time and effort practices must exert to produce reports. Practices may benefit from additional support to succeed in new programs that require eCQM reporting.

Project description:BackgroundIdentifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies.ObjectiveTo identify practice characteristics associated with high performance on four cardiovascular disease CQMs.DesignLongitudinal cohort study among 211 primary care practices in Colorado and New Mexico. Quarterly CQM reports were obtained from 178 (84.4%) practices. There was 100% response rate for baseline practice characteristics and implementation tracking surveys. Follow-up implementation tracking surveys were completed for 80.6% of practices.ParticipantsAdult patients, staff, and clinicians in family medicine, general internal medicine, and mixed-specialty practices.InterventionPractices received 9 months of practice facilitation and health information technology support, plus biannual collaborative learning sessions.Main measuresThis study identified practice characteristics associated with overall highest performance using area under the curve (AUC) analysis on aspirin therapy, blood pressure management, and smoking cessation CQMs.ResultsAmong 178 practices, 39 were exemplars. Exemplars were more likely to be a Federally Qualified Health Center (69.2% vs 35.3%, p = 0.0006), have an underserved designation (69.2% vs 45.3%, p = 0.0083), and have higher percentage of patients with Medicaid (p < 0.0001). Exemplars reported greater use of cardiovascular disease registries (61.5% vs 29.5%,), standing orders (38.5 vs 22.3%) or electronic health record prompts (84.6% vs 49.6%) (all p < 0.05), were more likely to have medical home recognition (74.4% vs 43.2%, p = 0.0006), and reported greater implementation of building blocks of high-performing primary care: regular quality improvement team meetings (3.0 vs 2.2), patient experience survey (3.1 vs 2.2), and resources for patients to manage their health (3.0 vs 2.3). High improvers (n = 45) showed greater improvement implementing team-based care (32.8 vs 11.7, p = 0.0004) and population management (37.4 vs 20.5, p = 0.0057).ConclusionsMultiple strategies-registries, prompts and protocols, patient self-management support, and patient-team partnership activities-were associated with delivering high-quality cardiovascular care over time, measured by CQMs.Trial registrationClinicalTrials.gov registration: NCT02515578.

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The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox?

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The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox?

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