0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Associations Between Structural Capabilities of Primary Care Practices and Performance on Selected Quality Measures

Mark W. Friedberg, MD, MPP; Kathryn L. Coltin, MPH; Dana Gelb Safran, ScD; Marguerite Dresser, MS; Alan M. Zaslavsky, PhD; and Eric C. Schneider, MD, MSc
[+] Article and Author Information

From Brigham and Women's Hospital, Harvard Medical School, and Blue Cross/Blue Shield of Massachusetts, Boston; Harvard Pilgrim Health Care, Wellesley; and Massachusetts Health Quality Partners, Watertown, Massachusetts.


Acknowledgment: The authors thank Katherine Howitt, MA, for invaluable assistance in fielding the survey; Elaine Kirshenbaum of the Massachusetts Medical Society, for advice regarding development of the physician survey; and Arnold Epstein, MD, MA, for helpful comments on an earlier draft of this paper.

Grant Support: By The Commonwealth Fund. Dr. Friedberg was supported by a National Research Service Award from the Health Resources and Services Administration (5 T32 HP11001 20).

Potential Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol: Physician practice survey instrument available from Dr. Friedberg (e-mail, mfriedbe@rand.org). Statistical code: Available from Dr. Friedberg (e-mail, mfriedbe@rand.org). Data set: Not available.

Requests for Single Reprints: Eric C. Schneider, MD, MSc, RAND Boston, 20 Park Plaza, 7th Floor, Suite 720, Boston, MA 02116; e-mail, eschneid@rand.org.

Current Author Addresses: Dr. Friedberg: RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138.

Ms. Coltin: Harvard Pilgrim Health Care, 93 Worcester Street, Wellesley, MA 02481.

Dr. Safran: Blue Cross Blue Shield of Massachusetts, 401 Park Drive, Boston, MA 02215.

Ms. Dresser: Massachusetts Health Quality Partners, 100 Talcott Avenue, Watertown, MA 02472.

Dr. Zaslavsky: Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115.

Dr. Schneider: RAND Boston, 20 Park Plaza, 7th Floor, Suite 720, Boston, MA 02116.

Author Contributions: Conception and design: M.W. Friedberg, K.L. Coltin, D.G. Safran, E.C. Schneider.

Analysis and interpretation of the data: M.W. Friedberg, K.L. Coltin, D.G. Safran, M. Dresser, A.M. Zaslavsky, E.C. Schneider.

Drafting of the article: M.W. Friedberg, D.G. Safran, M. Dresser, A.M. Zaslavsky, E.C. Schneider.

Critical revision of the article for important intellectual content: K.L. Coltin, D.G. Safran, A.M. Zaslavsky, E.C. Schneider.

Final approval of the article: D.G. Safran, A.M. Zaslavsky, E.C. Schneider.

Statistical expertise: A.M. Zaslavsky.

Obtaining of funding: E.C. Schneider.

Administrative, technical, or logistic support: K.L. Coltin, E.C. Schneider.

Collection and assembly of data: M.W. Friedberg, M. Dresser, E.C. Schneider.


Ann Intern Med. 2009;151(7):456-463. doi:10.7326/0003-4819-151-7-200910060-00006
Text Size: A A A

Background: Recent proposals to reform primary care have encouraged physician practices to adopt such structural capabilities as performance feedback and electronic health records. Whether practices with these capabilities have higher performance on measures of primary care quality is unknown.

Objective: To measure associations between structural capabilities of primary care practices and performance on commonly used quality measures.

Design: Cross-sectional analysis.

Setting: Massachusetts.

Participants: 412 primary care practices.

Measurements: During 2007, 1 physician from each participating primary care practice (median size, 4 physicians) was surveyed about structural capabilities of the practice (responses representing 308 practices were obtained). Data on practice structural capabilities were linked to multipayer performance data on 13 Healthcare Effectiveness Data and Information Set (HEDIS) process measures in 4 clinical areas: screening, diabetes, depression, and overuse.

Results: Frequently used multifunctional electronic health records were associated with higher performance on 5 HEDIS measures (3 in screening and 2 in diabetes), with statistically significant differences in performance ranging from 3.1 to 7.6 percentage points. Frequent meetings to discuss quality were associated with higher performance on 3 measures of diabetes care (differences ranging from 2.3 to 3.1 percentage points). Physician awareness of patient experience ratings was associated with higher performance on screening for breast cancer and cervical cancer (1.9 and 2.2 percentage points, respectively). No other structural capabilities were associated with performance on more than 1 measure. No capabilities were associated with performance on depression care or overuse.

Limitation: Structural capabilities of primary care practices were assessed by physician survey.

Conclusion: Among the investigated structural capabilities of primary care practices, electronic health records were associated with higher performance across multiple HEDIS measures. Overall, the modest magnitude and limited number of associations between structural capabilities and clinical performance suggest the importance of continuing to measure the processes and outcomes of care for patients.

Primary Funding Source: The Commonwealth Fund.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)