Factors related to clinical quality improvement for small practices using an EHR

Abstract

Objective: To analyze the impact of three primary care practice transformation program models on performance: Meaningful Use (MU), Patient-Centered Medical Home (PCMH), and a pay-for-performance program (eHearts).

Data sources/study setting: Data for seven quality measures (QM) were retrospectively collected from 192 small primary care practices between October 2009 and October 2012; practice demographics and program participation status were extracted from in-house data.

Study design: Bivariate analyses were conducted to measure the impact of individual programs, and a Generalized Estimating Equation model was built to test the impact of each program alongside the others.

Data collection/extraction methods: Monthly data were extracted via a structured query data network and were compared to program participation status, adjusting for variables including practice size and patient volume. Seven QMs were analyzed related to smoking prevention, blood pressure control, BMI, diabetes, and antithrombotic therapy.

Principal findings: In bivariate analysis, MU practices tended to perform better on process measures, PCMH practices on more complex process measures, and eHearts practices on measures for which they were incentivized; in multivariate analysis, PCMH recognition was associated with better performance on more QMs than any other program.

Conclusions: Results suggest each of the programs can positively impact performance. In our data, PCMH appears to have the most positive impact.

Keywords: PCMH; Quality measurement; meaningful use; pay-for-performance; primary care.

Figure 1

Program Descriptions

Figure 2

Quality Measure Trend by ProgramNotes. BMI = body mass index; Smoking R = smoking status recorded; Smoking Int = Smoking Cessation Intervention; Aspirin Tx = Antithrombotic Therapy; A1c = Hemoglobin A1c; BP = blood pressure.