Defining Barriers and Potential Solutions for Collecting and Reporting Quality Performance Measures in Primary Care Offices (Virginia)

Project Final Report (PDF, 1.74 MB)

Project Details - Ended

Project Categories

Summary:

Despite available reimbursement incentives to primary care practices to track performance and quality measurements, many practices lack the needed experience, resources, or time to become fully engaged in these programs. In this project, primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) were asked to conduct quality performance monitoring data collection and reporting (QPMDCR) projects. Five practices were involved in the project representing a range of practice sizes, patient populations, resources, medical record systems (both electronic and paper-based), and experience with quality improvement projects. Relevant literature from 1989 to the present was shared with the practices to supplement the research of practice experience. The main objectives of the project were to:

  • Implement QPMDCR projects at selected primary care practices.
  • Develop a process model outlining a series of steps practices need to consider as they move toward implementation of performance monitoring.
  • Develop an interactive Web tool for practices' self-assessment of strengths and weaknesses relative to conducting performance monitoring.
  • Synthesize relevant literature of quality performance monitoring and reporting in ambulatory care settings, especially primary care offices.

The five practices completed implementations and had some degree of success in their selection and planning of projects, data collection, and generation of comparative reports. Each practice approached the task differently with some relying heavily on physician involvement, and others relying on nursing and other practice staff. How data were collected also varied, with some using manual data collection, some using automated methods, and some using a combination of the two methods. Practices encountered multiple and significant barriers such that while four of the five will continue some form of performance monitoring, one is likely to be discontinuing any further efforts in this area. A major barrier to this work was the lack of expertise within the practice in systematic collection and analysis of performance data. Practices need assistance in order to identify, implement, and learn the systems which provide these functions. Financial support was needed in order to compensate those involved in the projects, including the time needed for physician champions to lead efforts, and collect and analyze the data.

Defining Barriers/Solutions for Collecting Quality Performance - 2009

Summary Highlights



Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Target Population: General

Summary: Primary care practices are aware of the reimbursement incentives for monitoring patient outcomes to improve care management. However, inexperience with comparative data analysis, unfamiliarity with or limited access to information technology resources, and inadequate reimbursement for related activities limits progress in this area. Clinicians have competing demands for their time that limit their ability to become fully engaged in quality performance monitoring data collection and reporting (QPMDCR).

Primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) were invited to conduct QPMDCR projects of their choosing to identify and document barriers to performance monitoring. Participating practices covered a range of practice size, patient population, resources, medical record systems (electronic or paper-based), and experience with quality improvement activities. Project participants reviewed relevant literature from 1989 to the present to supplement the research of practice experience. The objective was to comprehensively describe the issues involved in supporting primary care practices to collect and report quality measure data and document effective strategies that practices have used.

Specific Aims

  • Implement QPMDCR projects at selected primary care practices. (Achieved)
  • Develop a process model outlining a series of steps practices need to consider as they move toward implementation of performance monitoring. (Achieved)
  • Develop an interactive Web tool for practices’ self-assessment of strengths and weaknesses relative to conducting performance monitoring. (Achieved)
  • Synthesize relevant literature of quality performance monitoring and reporting in ambulatory care settings, especially primary care offices. (Achieved)

2009 Activities: Five of six practices implemented and completed a QPMDCR project in 2008. Three focus groups were held with each of the implementing practice teams over the study period. The final report was prepared in 2009.

Impact and Findings: All five practices that completed implementations achieved some degree of success in selecting and planning a project, gathering data, and generating comparative reports. Some practices relied heavily (or exclusively) on physician involvement, while others involved nurses and other practice staff. Two practices utilized automated queries of data; the remaining practices utilized manual data collection methods or some combination of the two approaches.

All of the study practices experienced multiple and common barriers. Many obstacles were beyond practices’ control and significant enough to hinder progress. As a result, most practices were able to gather and analyze data and spend time brainstorming ways to make improvements to care delivery, but ultimately were unable to establish mechanisms for ongoing quality improvement in their practices as an outcome of this project. It is important to note that study practices did not have the necessary expertise in systematic collection and analysis of performance data and needed assistance to identify, set up, and learn the systems that provide this function. They also needed financial support to compensate for the time involved in performance monitoring, including time for physician champions to lead initiatives, time for data collection tasks, and time for interpretation of data. One practice that implemented their project experienced significant difficulty and was likely to discontinue performance monitoring efforts. The remaining practices planned to continue with some form of performance monitoring.

Selected Outputs

Longo DR, Rothemich SF, Krist AH, et al. Report of Experiences from Primary Care Practices in the Virginia Ambulatory Care Outcomes Network (ACORN): The Virginia Ambulatory Care Outcomes Research Network (ACORN); 2009 Mar. Prepared for Agency for Healthcare Research and Quality.

Interactive Web tool for practices’ self-assessment of strengths and weaknesses relative to conducting performance monitoring. Available at: http://www.pubapps.vcu.edu/brads/qpm/.

Quality Performance Monitoring, Data Collection, and Reporting - Final Report

Citation:
Longo DR, Rothemich SF, Krist AH, et al. Quality Performance Monitoring, Data Collection, and Reporting - Final Report. (Prepared by the Virginia Commonwealth University under Contract No. 290-07-10011-2.) AHRQ Publication No. 15- 0024-EF. Rockville, MD: Agency for Healthcare Research and Quality. April 2015. (PDF, 1.74 MB)
Principal Investigator: 
Document Type: 
Research Method: 
This project does not have any related resource.
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.