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

Published In: Annals of Internal Medicine, v. 151, no. 7, Oct. 6, 2009, p. 456-463, W-147-W153

Posted on RAND.org on January 01, 2009

by Mark W. Friedberg, Kathryn L. Coltin, Dana Gelb Safran, Marguerite Dresser, Alan M. Zaslavsky, Eric C. Schneider

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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. CONCLUSIONS: 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.

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