Primary Care Practices’ Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health

Knierim, Kyle; Hall, Tristen; Dickinson, L. Miriam; Nease, Donald E.; Cerda, Dionisia R. de la; Fernald, Douglas H.; Bleecker, Molly J.; Rhyne, Robert L.; Dickinson, W. Perry

doi:10.1001/jamanetworkopen.2019.8569

Cited by 14 publications

(10 citation statements)

References 44 publications

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“…As of 2021, most (78.0%) office‐based physicians have adopted a certified EHR, suggesting that most offices have eCQM reporting capabilities 43 . However, emerging evidence suggests technical and implementation challenges may limit the utility of the eCQMs features 44,45 . For instance, studies in primary care have found that having eCQMs capabilities has not fully translated to efficient and timely reporting 44,45 .…”

Section: Discussionmentioning

confidence: 99%

Merit‐based incentive payment system participation and after‐hours documentation among US office‐based physicians: Findings from the 2021 National Electronic Health Records Survey

Nguyen

Turner

Parekh

et al. 2022

Evaluation Clinical Practice

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Background: After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden.Methods: We used 2021 data from the National Electronic Health Records Survey.We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after-hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients.Results: We included 1801 office-based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on afterhours documentation (odds ratio = 1.44, 95% confidence interval 1.06-1.95).

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Section: Discussionmentioning

confidence: 99%

Merit‐based incentive payment system participation and after‐hours documentation among US office‐based physicians: Findings from the 2021 National Electronic Health Records Survey

Nguyen

Turner

Parekh

et al. 2022

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…The study was further complicated by major changes in the cholesterol treatment guidelines just as the project was starting. Difficulties and delays with obtaining clean CQM data as reported elsewhere 57,58 made quality improvement efforts focused on specific measures problematic as well. Despite those barriers and limitations, practices improved all 4 of the ABCS measures significantly when compared with an external comparison group.…”

Section: Discussionmentioning

confidence: 99%

Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW)

et al. 2020

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Purpose: To improve cardiovascular care through supporting primary care practices' adoption of evidence-based guidelines. Study Design: A cluster randomized trial compared two approaches: (1) standard practice support (practice facilitation, practice assessment with feedback, health information technology assistance, and collaborative learning sessions) and (2) standard support plus patient engagement support. Methods: Primary outcomes were cardiovascular clinical quality measures (CQMs) collected at baseline, 9 months, and 15 months. Implementation of the first 6 "Building Blocks of High-Performing Primary Care" was assessed by practice facilitators at baseline and 3, 6, and 9 months. CQMs from practices not involved in the study served as an external comparison. Results: A total of 211 practices completed baseline surveys. There were no differences by study arm (odds ratio [95% confidence interval]) for aspirin use (1.03 [0.99, 1.06]), blood pressure (0.98 [0.95, 1.01]), cholesterol (0.96 [0.92, 1.00]), and smoking (1.01 [0.96, 1.07]); however, there were significant improvements over time in aspirin use (1.04 [1.01, 1.07]), cholesterol (1.05 [1.03, 1.08]), and smoking (1.03 [1.01, 1.06]), but not blood pressure (1.01 [0.998, 1.03]). Improvement in enrolled practices was greater than external comparison practices across all 4 measures (all P < .05). Implementation improved in both arms for Team-Based Care, Patient-Team Partnership, and Population Management, and improvement was greater in enhanced intervention practices (all P < .05). Leadership and Data-Driven Improvement (P < .05) improved significantly, with no difference by arm. A greater improvement in Building Block implementation was associated with a greater improvement in blood pressure measures (P < .05). Conclusions: Practice transformation support can assist practices with improving quality of care. Patient engagement in practice transformation can further enhance practices' implementation of aspects of new models of care.

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“…Reporting CQMs is difficult. 13 Practices not reporting CQMs over time were excluded because AUC requires multiple data points per practice; however, excluded practices may have been providing high-quality care to their patients. If further statistical analyses are required after practices are identified as exemplars, a sufficient number of practices will be needed in the exemplar group to conduct these analyses.…”

Section: Limitationsmentioning

confidence: 99%

“…[8][9][10][11] One of the funded cooperatives was EvidenceNOW Southwest, which aimed to improve the delivery of evidence-based guidelines in clinical practice in Colorado and New Mexico, using four cardiovascular care CQMs as one set of measures for evaluating outcomes. 12,13 Others have evaluated exemplary practices based on CQMs or colon cancer screening data using a single point in time. 6,14 The success of such pragmatic practice-based trials is often defined as the magnitude of improvement from baseline.…”

Section: Introductionmentioning

confidence: 99%

Exemplary Practices in Cardiovascular Care: Results on Clinical Quality Measures from the EvidenceNOW Southwest Cooperative

et al. 2020

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BACKGROUND: Identifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies. OBJECTIVE: To identify practice characteristics associated with high performance on four cardiovascular disease CQMs. DESIGN: Longitudinal 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. Followup implementation tracking surveys were completed for 80.6% of practices. PARTICIPANTS: Adult patients, staff, and clinicians in family medicine, general internal medicine, and mixedspecialty practices. INTERVENTION: Practices received 9 months of practice facilitation and health information technology support, plus biannual collaborative learning sessions. MAIN MEASURES: This 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. RESULTS: Among 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). CONCLUSIONS: Multiple 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.

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Primary Care Practices’ Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health

Cited by 14 publications

References 44 publications

Merit‐based incentive payment system participation and after‐hours documentation among US office‐based physicians: Findings from the 2021 National Electronic Health Records Survey

Merit‐based incentive payment system participation and after‐hours documentation among US office‐based physicians: Findings from the 2021 National Electronic Health Records Survey

Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW)

Exemplary Practices in Cardiovascular Care: Results on Clinical Quality Measures from the EvidenceNOW Southwest Cooperative

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