The Greater Richmond Patient Centered Medical Home Collaborative members (PCMH Collaborative) are community based, safety net organizations that rely on community investment to sustain their work. To ensure that value is delivered in return for this investment, each organization is committed to a program of continuous improvement and performance measurement.
To document ongoing quality improvement, the Patient Centered Medical Home Collaborative members review their performance compared to other clinics in the PCMH Collaborative and compare their quality measure performance to external standards. Current quality measures include tobacco cessation, cervical cancer screening, blood pressure control, and diabetes control. This practice is commonly called “benchmarking.”
For the most part, the updated NCQA benchmarks are not significantly different than those in the 2013 report from NCQA. The only measure that differs significantly is the Cervical Cancer Screening Rate, on which Medicaid health plans nationally performed lower (a lower screening rate) than the previous year.
Click the link to see how PCMH Collaborative members are demonstrating an Impact on Quality.
The use of patient-reported measures is the subject of a recent Institute for Healthcare Improvement (IHI) article titled How Do Patient-Reported Measures Contribute to Value in Health Care? The article is based on an interview by IHI Vice President Kathy Luther with IHI Communications Specialist Jo Ann Endo. Ms. Endo discusses the potential for patient-reported measures (PRMs) to catch direct input from patients to improve care delivery and assist organizations to develop value-based systems.
Highlights from the article include:
- PRMs provide the patient’s perspective on their health status. PRMs are different from other types of standardized data collection tools because they ask patients specific questions related to their condition and their life at the time of the interview.
- PRMs require baseline data through questions that obtain information on how the patient is functioning before treatment or interventions. Following treatment or interventions the patient is then questioned at regular intervals on the same PRMs.
- Collecting PRMs from patients with similar conditions, over time, allows providers to learn what works and what doesn’t in patient care. This information enables providers and patients to make informed treatment decisions.
- The challenge to using PRMs is that the data needs to be collected over time. This requires health care organizations to have a long term relationship patients and embed tools and procedures into normal procedures.
Use of PRMs is relatively new in the U.S. but it has been used extensively and successfully in Europe. PRMs don’t easily fit into the U.S. fee-for-service system but this type of data will be crucial as population health and value-based health care become the norm.
Click here to learn more and read the article at IHI.
Study: Quality of Care Higher in Medical Homes Compared with Other Practices
Physician practices that become patient-centered medical homes can expect to achieve modest improvements in health care quality compared with traditional practices, according to a new Commonwealth Fund–supported study in Annals of Internal Medicine. The researchers, led by Lisa M. Kern, M.D., of Weill Cornell Medical College, compared medical home practices with two types of traditional practices, one using paper records and one using electronic health records (EHRs). All medical homes also have an EHR system.
In addition, the study found that the new roles and relationships of providers and staff working in medical homes may be at least as important as EHR usage in driving quality improvement. Defining team members’ roles and responsibilities, establishing a culture of population management, and becoming accountable for performance are also critical to successful medical home transformation—though the latter two are greatly enabled by EHRs, the researchers say.
Read more about this important new study: 1753_kern_pcmhs_ehrs_quality_care_annintmed_06_2014_itl
The February 12 issue of the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange (http://www.innovations.ahrq.gov) focuses on community-wide initiatives to enhance access for vulnerable populations.
The featured Innovations describe three community-wide initiatives that seek to increase access to health care for vulnerable populations. The programs include
- A community collaborative that opened a free clinic for uninsured children and implemented targeted interventions for patients with sickle cell anemia and substance abuse issues (click here);
- A community-funded, nonprofit organization that matches eligible uninsured and underinsured patients with providers who agree to serve them at a discounted rate (click here); and
- A school-based, collaborative, community-wide program that provides mental health and other support services to students and their families living in neighborhoods plagued by poverty and crime (click here).
The featured QualityTools include
Evidence-based research tells us that a quality health system must focus on positive health outcomes and process measures. However, few studies to date have examined the relationship between quality process measures and long-term reductions in disease complications. This recent article published in the American Journal of Managed Care finds that patients with diabetes who received proper and complete testing experienced fewer complications in the long term. In fact, study authors stated that those who showed the fewest complications in the long term were those who were considered sickest at the start of the study. The study used a composite measure approach, where quality of care was measured as patients with diabetes who received all three process measures: glycated hemoglobin (HbA1c), lipids, and microalbuminuria.
In this study, the researchers examine how to build staff buy-in for PCMH transformation. The study authors conclude that “Practices seeking to become a PCMH face numerous challenges. In our study, however, participants affirmed that the benefits can be substantial and showed that given necessary internal and external supports, long-term buy-in to PCMH can be achieved.”
The researchers conducted in-depth interviews with individuals in medical practices participating in a PCMH initiative. The findings from the interviews, published in the January-February issue of the Annals of Family Medicine, identify 13 strategies for achieving whole-staff engagement during the transformation to PCMH. These strategies fit into three themes: effective internal communication, effective resource use, and creation of a team environment.
Click here to read the full article, including all 13 strategies for increasing staff buy-in.
The American Journal of Managed Care just published the results of a study titled “Dispensing Channel and Medication Adherence: Evidence Across 3 Therapy Classes.” The purpose of this study was to examine the association of mail order versus retail pharmacy dispensing channels with medication adherence for patients on diabetes, hypertension, or high blood cholesterol medications. After adjusting for prior adherence behavior (PAB), differential days of supply, and differences in demographics and disease burden, the study found that patients who use mail order have a greater likelihood of being adherent than patients who use a retail pharmacy.
Click here to access the article. Am J Manag Care. 2013;19(10):798-804
Three new online resources funded by AHRQ and developed by the Institute for Safe Medication Practices can help community pharmacies and outpatient settings improve medication safety and protect patients from the adverse effects of medication errors:
- High-Alert Medications Consumer Leaflets – Patient education checklists developed during a study of the impact of community pharmacies that counseled consumers who picked up prescriptions for certain high-alert medications including warfarin, fentanyl patches, and more.
- Assessing Barcode Verification System Readiness in Community Pharmacies – A free tool that helps community pharmacies assess their readiness and prepare for future implementation of a barcode product verification system.
- High-Alert Medication Modeling and Error-Reduction Scorecards (HAMMERS™) – A free tool designed to help community pharmacies identify their unique set of system and behavioral risks associated with dispensing certain high-alert medications and use a series of scorecards to estimate how often prescribing and dispensing errors reach patients and how the frequency will change if certain interventions are implemented.
Click here to access the tools.
Below is the link to the Ted talk mentioned in the October PCMH meeting: Rebecca Onie asks audacious questions: What if waiting rooms were a place to improve daily health care? What if doctors could prescribe food, housing and heat in the winter?
We had a discussion today around the impact of patient access and adherence to medications. This study reports on barriers to and facilitators of medication adherence for asthma and diabetes patients who were both adherent and nonadherent to their medication regimen.