Collaboration in Pennsylvania: Rapidly spreading improved chronic care for patients to practices

Bricker, Patricia; Baron, Richard J.; Scheirer, Jorge J.; DeWalt, Darren A.; Derrickson, John; Yunghans, Suzanne; Gabbay, Robert A.

doi:10.1002/chp.20067

Cited by 22 publications

(35 citation statements)

References 2 publications

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“…Several case studies have demonstrated that education, specifically Performance Improvement (PI) CME, improves clinical practice. [28][29][30][31][32][33][34][35] However, to our knowledge, data do not exist regarding the use of the PI CME format in the specialty of dermatology. PI CME helps physicians evaluate their practice and implement evidencebased strategies to overcome identified gaps, then remeasure their performance after these strategies have been implemented in their practice.…”

mentioning

confidence: 61%

Impact of a Performance Improvement CME activity on the care and treatment of patients with psoriasis

Gist¹,

Bhushan²,

Hamarstrom³

et al. 2015

Journal of the American Academy of Dermatology

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mentioning

confidence: 61%

Impact of a Performance Improvement CME activity on the care and treatment of patients with psoriasis

Gist¹,

Bhushan²,

Hamarstrom³

et al. 2015

Journal of the American Academy of Dermatology

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“…[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Accordingly, we leveraged a large sample of small to medium-size primary care practices in the United States to (1) assess the extent to which they use QI strategies as measured by the Change Process Capability Questionnaire (CPCQ) Strategies Scale, and (2) evaluate practice characteristics and contextual factors that may explain variations in use of QI strategies.…”

Section: Introductionmentioning

confidence: 99%

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

et al. 2018

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PURPOSE Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations. METHODSIn this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Practice use of QI strategies was measured by the validated Change Process Capability Questionnaire (CPCQ) Strategies Scale (scores range from -28 to 28, with higher scores indicating more use of QI strategies). Multivariable linear regression was used to examine the association between practice characteristics and the CPCQ strategies score. RESULTSThe mean CPCQ strategies score was 9.1 (SD = 12.2). Practices that participated in accountable care organizations and those that had someone in the practice to configure clinical quality reports from electronic health records (EHRs), had produced quality reports, or had discussed clinical quality data during meetings had higher CPCQ strategies scores. Health system-owned practices and those experiencing major disruptive changes, such as implementing a new EHR system or clinician turnover, had lower CPCQ strategies scores.CONCLUSION There is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US states. Findings suggest that practices may need external support to strengthen their ability to do QI and to be prepared for new payment and delivery models. INTRODUCTIONH ealth care delivery is evolving in the United States, with increasing emphasis on insurance payments based on improving quality instead of merely delivering health care services. 1 This emphasis has brought a greater focus on population health management, quality measurement, and health care outcomes. Primary care practices use quality improvement (QI) strategies, such as monitoring and assessing outcomes, having skilled QI teams, and using system redesigns to improve patient and population health outcomes, system performance, and clinician experience, and to reduce health care costs.2-6 Implementing QI strategies can help practices deliver appropriate health services efficiently and improve health outcomes, [7][8][9][10] yet much of what we know about the use of QI strategies in medical care comes from surveys conducted mostly in hospitals and health systems. [11][12][13][14][15][16][17] Little is known about the use of QI strategies in small to medium-size primary care practices, where more than one-half of Americans receive care for their chronic conditions. 18 Earlier studies have lacked generalizability because of small sample sizes and limited contextual diversity. Better understanding of the prevalence and reasons for variation in use of QI strategies among smaller practices is needed...

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“…Previous literature has yielded unclear results regarding the effectiveness of QI initiatives at improving diabetes care, showing positive change in clinical process measures and intensification of medication but no change in clinical outcomes. 36,[42][43][44] Recent chart audit studies showed inconsistent improvement in A1c, BP, and LDL, depending on the length of the period after the initiative. 16,[45][46][47] This study had a relatively short period after the program (1 year), yet significant improvements were found.…”

Section: Discussionmentioning

confidence: 99%

“…31 In terms of QI methodologies, the program embraced the Institute for Healthcare Improvement's Breakthrough Series approach 32 of bringing multiple teams together 2 or 3 times (ie, learning sessions) over 6 to 15 months to learn from experts, and each other, as they plan and test practice changes. 32,36 Furthermore, this approach encourages team members who attend learning sessions, usually 2 or 3 people, to work with additional team members in their organization to test and implement changes between the learning sessions (ie, action periods). Lastly, the program embedded the Model for Improvement as a strategy to test and evaluate changes on a few patients before implementing them at a practice or organizational level.…”

Section: Introductionmentioning

confidence: 99%

Results of a Mixed-Methods Evaluation of Partnerships for Health: A Quality Improvement Initiative for Diabetes Care

Harris

Paquette-Warren

Roberts

et al. 2013

The Journal of the American Board of Family Medicine

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Purpose: Quality improvement (QI) initiatives have been implemented to facilitate transition to a chronic disease management approach in primary health care. However, the effect of QI initiatives on diabetes clinical processes and outcomes remains unclear. This article reports the effect of Partnerships for Health, a QI program implemented in Southwestern Ontario, Canada, on diabetes clinical process and outcome measures and describes program participants' views of elements that influenced their ability to reach desired improvements.Methods: Part of an external, concurrent, comprehensive, mixed-methods evaluation of Partnerships for Health, a before/after audit of 30 charts of patient of program physicians (n ‫؍‬ 35) and semistructured interviews with program participants (physicians and allied health providers) were conducted.Results: The proportion of patients (n ‫؍‬ 998) with a documented test/examination for the following clinical processes significantly improved (P < .005): glycosylated hemoglobin (A1c), cholesterol, albumin-to-creatinine ratio, serum creatinine, glomerular filtration rate, electrocardiogram, foot/eye/neuropathy examination, body mass index, waist circumference, and depression screening. Data showed intensification of treatment and significant improvement in the number of patients at target for lowdensity lipoprotein (LDL) and blood pressure (BP) (P < .001). Mean LDL and BP values decreased significantly (P < .01), and an analysis of patients above glycemic targets (A1c >7% at baseline) showed a significant decrease in mean A1c values (P < .01). Interview participants (n ‫؍‬ 55) described using a team approach, improved collaborative and proactive care through better tracking of patient data, and increased patient involvement as elements that positively influenced clinical processes and outcomes.

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Collaboration in Pennsylvania: Rapidly spreading improved chronic care for patients to practices

Cited by 22 publications

References 2 publications

Impact of a Performance Improvement CME activity on the care and treatment of patients with psoriasis

Impact of a Performance Improvement CME activity on the care and treatment of patients with psoriasis

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

Results of a Mixed-Methods Evaluation of Partnerships for Health: A Quality Improvement Initiative for Diabetes Care

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