Use of quality improvement strategies among small to medium-size us primary care practices

Bijal A. Balasubramanian, Miguel Marino, Deborah Cohen, Rikki L. Ward, Alex Preston, Rachel J. Springer, Stephan R. Lindner, Samuel Edwards, Kenneth (John) McConnell, Benjamin F. Crabtree, William L. Miller, Kurt C. Stange, Leif I. Solberg

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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. METHODS In 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. RESULTS The 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.

Original languageEnglish (US)
Pages (from-to)S35-S43
JournalAnnals of Family Medicine
Volume16
DOIs
StatePublished - Apr 1 2018

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Quality Improvement
Primary Health Care
Electronic Health Records
Accountable Care Organizations
Quality of Health Care
Linear Models
Cross-Sectional Studies
Surveys and Questionnaires
Health

Keywords

  • Health care delivery
  • Primary care
  • Quality improvement

ASJC Scopus subject areas

  • Family Practice

Cite this

Use of quality improvement strategies among small to medium-size us primary care practices. / Balasubramanian, Bijal A.; Marino, Miguel; Cohen, Deborah; Ward, Rikki L.; Preston, Alex; Springer, Rachel J.; Lindner, Stephan R.; Edwards, Samuel; McConnell, Kenneth (John); Crabtree, Benjamin F.; Miller, William L.; Stange, Kurt C.; Solberg, Leif I.

In: Annals of Family Medicine, Vol. 16, 01.04.2018, p. S35-S43.

Research output: Contribution to journalArticle

Balasubramanian, BA, Marino, M, Cohen, D, Ward, RL, Preston, A, Springer, RJ, Lindner, SR, Edwards, S, McConnell, KJ, Crabtree, BF, Miller, WL, Stange, KC & Solberg, LI 2018, 'Use of quality improvement strategies among small to medium-size us primary care practices', Annals of Family Medicine, vol. 16, pp. S35-S43. https://doi.org/10.1370/afm.2172
Balasubramanian, Bijal A. ; Marino, Miguel ; Cohen, Deborah ; Ward, Rikki L. ; Preston, Alex ; Springer, Rachel J. ; Lindner, Stephan R. ; Edwards, Samuel ; McConnell, Kenneth (John) ; Crabtree, Benjamin F. ; Miller, William L. ; Stange, Kurt C. ; Solberg, Leif I. / Use of quality improvement strategies among small to medium-size us primary care practices. In: Annals of Family Medicine. 2018 ; Vol. 16. pp. S35-S43.
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AU - Marino, Miguel

AU - Cohen, Deborah

AU - Ward, Rikki L.

AU - Preston, Alex

AU - Springer, Rachel J.

AU - Lindner, Stephan R.

AU - Edwards, Samuel

AU - McConnell, Kenneth (John)

AU - Crabtree, Benjamin F.

AU - Miller, William L.

AU - Stange, Kurt C.

AU - Solberg, Leif I.

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N2 - 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. METHODS In 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. RESULTS The 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.

AB - 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. METHODS In 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. RESULTS The 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.

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