External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients with Chronic Diseases

Article (PDF Available)inJAMA The Journal of the American Medical Association 289(4):434-41 · January 2003with37 Reads
Source: PubMed
Abstract
Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P =.007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability. The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.
    • "Providers, health care systems and payers are looking for novel, more effective ways to raise the quality of care [6] . Metrics , dashboards, educational outreach, payment incentives, and other efforts to increase awareness and provide accountability have been tried but with only modest effects on reducing variation and raising quality [7][8][9]. More recently, guidelines and pathways promise advancing evidence-based practice to standardize care and reduce variation [10] but by themselves have shown mixed results [11]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Poor clinical outcomes are caused by multiple factors such as disease progression, patient behavior, and structural elements of care. One other important factor that affects outcome is the quality of care delivered by a provider at the bedside. Guidelines and pathways have been developed with the promise of advancing evidence-based practice. Yet, these alone have shown mixed results or fallen short in increasing adherence to quality of care. Thus, effective, novel tools are required for sustainable practice change and raising the quality of care. Methods: The study focused on benchmarking and measuring variation and improving care quality for common types of breast cancer at four sites across the United States, using a set of 12 Clinical Performance and Value(®) (CPV(®)) vignettes per site. The vignettes simulated online cases that replicate a typical visit by a patient as the tool to engage breast cancer providers and to identify and assess variation in adherence to evidence-based practice guidelines and pathways. Results: Following multiple rounds of CPV measurement, benchmarking and feedback, we found that scores had increased significantly between the baseline round and the final round (P < 0.001) overall and for all domains. By round 4 of the study, the overall score increased by 14% (P < 0.001), and the diagnosis with treatment plan domain had an increase of 12% (P < 0.001) versus baseline. Conclusion: We found that serially engaging breast cancer providers with a validated clinical practice engagement and measurement tool, the CPVs, markedly increased quality scores and adherence to clinical guidelines in the simulated patients. CPVs were able to measure differences in clinical skill improvement and detect how fast improvements were made.
    Full-text · Article · Sep 2016
    • "Larger organizations are often less dependent on the environment as a result of economies of scale. Similarly, larger organizations generally have greater slack resources (Cohen, March, & Olsen, 1972; Cyert & March, 1963) to draw on to take strategic action, to invest in new initiatives (Casalino et al., 2003; Rittenhouse et al., 2011; Robinson et al., 2009; Thompson, 1967), and to buffer against downside risk. Larger ACOs also care for a greater number of patients, making it worthwhile to invest in the changes needed to promote greater PAE. "
    [Show abstract] [Hide abstract] ABSTRACT: Accountable care organizations (ACOs) have incentives to meet quality and cost targets to share in any resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed methods, including a national survey, phone interviews, and site-visits, we examine the extent to which ACOs actively engage patients and their families, explore challenges involved, and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may be related to positive perceptions among ACO leaders of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training, use of interdisciplinary care teams, and frequent monitoring and reporting on progress. © The Author(s) 2015.
    Full-text · Article · Jun 2015
    • "Despite the $2.6 trillion of expenditure , the quality and efficiency of the U.S. healthcare system ranked last when compared to Britain, Canada, Germany, the Netherlands, Australia, and New Zealand (Davis et al. 2010). As a result, a concerted national effort to reform healthcare using information technologies with a focus on reducing costs and increasing quality of service is well under way (Menon et al. 2000, Casalino et al. 2003, Aron et al. 2011, Buntin et al. 2011). The recently enacted Health Information Technology for Economic and Clinical Health Act (HITECH) requires all medical records to be in standardized digital forms by 2014 (Blumenthal and Tavenner 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Health Information Exchanges (HIE) are becoming integral parts of the national healthcare reform efforts, chiefly because of their potential impact on cost reduction and quality enhancement in healthcare services. However, the potential of an HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services. In this research, we model HIE systems as multisided platforms that incorporate self-service technologies whose value to the users depends on both user-specific and network-specific factors. We develop a model of adoption, use, and involvement of clinical practices in the coproduction of the HIE services. This model is grounded in social network theory, service operations theory, and institutional isomorphism theory. A longitudinal study of actual adoption and use behaviors of 2,054 physicians within 430 community medical practices in Western New York over a three-year period has been carried out to evaluate the proposed model. This study has been supported by HEALTHeLINK, the Regional Health Information Organization of Western New York, which has an extensive database comprising over half a million transactions on patient records by the HIE users. We extracted panel data on adoption, use, and service coproduction behaviors from this database and carried out a detailed analysis using metrics derived from the foundational theories. Positioning practices within two distinct but interrelated networks of patients and practitioners, we show that adoption, use, and service coproduction behaviors are influenced by the topographies of the two networks, isomorphic effects of large practices on the smaller ones, and practice labor inputs in HIE use. Our findings provide a comprehensive view of the drivers of HIE adoption and use at the level of medical practices. These results have implications for marketing and revenue management of HIE platforms, as well as public health and national/regional healthcare policy making.
    Full-text · Article · Mar 2015
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