How Eight Primary Care Practices Initiated and Maintained Quality Monitoring and Reporting

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Figure 1.
Degree of difficulty or problematic nature of collecting and reporting quality indicators in specific areas, as reported by our eight study practices.
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Figure 2.
Factors involved in development and maintenance of quality assessment, improvement, and reporting in a primary care practice.

Table 1.

Characteristics of the Primary Care Practices Studied

Characteristic	Participating Primary Care Practices
	Large Group	Small Private			Nonprofit/CHC			Teaching
	Practice A	Practice B	Practice C	Practice D	Practice E	Practice F	Practice G	Practice H
Community^*	Town	Town	Small city	Rural	Rural	Rural	Rural	Small city
Practice type	Private	Private	Private	Private	CHC	CHC	Nonprofit	Teaching
Medical specialties represented	FM, IM	IM	P	FM	FM, IM, P	FM, IM	FM, IM	FM
Provider FTEs
Physician	8.0	1.0	1.0	1.0	2.8	3.0	4.0	6.8
Nurse practitioner or physician assistant	6.0	1.5	0	1.0	2.4	3.0	4.75	2.7
Other staff FTE	36.0	7.5	3.0	7.0	24.0	22.0	36.0	30.5
Patient insurance (% of visits)
Medicare	34	47	0	40	28	29	29	21
Medicaid	9	18	58	18	26	11	28	20
Private insurance	45	32	40	37	27	44	28	56
Uninsured	12	3	2	2	19	16	13	2
Medical record type	EHR	Paper	Paper	EHR	Paper	EHR	EHR	EHR
Reporting program participation^†
PQRI	Yes	No	No	Yes	No	No	No	Yes
CCNC	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
IPIP	No	Yes	Yes	No	No	Yes	No	No
Bridges to Excellence	Yes	No	No	No	No	No	Yes	No

* Community type (by population): rural, <25,000; town, 25,000–100,000; small city, 100,000–500,000.
† Physician Quality Reporting Initiative (PQRI) is the 2007 pilot program (Medicare); Community Care of North Carolina (CCNC) is sponsored by Medicaid; Improving Performance in Practice (IPIP) is a grant-funded demonstration project; and Bridges to Excellence is by Blue Cross/Blue Shield of North Carolina.
CHC, federally qualified community health center; IM, internal medicine; FM, family medicine; P, pediatrics; FTE, full-time equivalent; EHR, electronic health record.

Table 2.

Self-Assessment of Organizational Attributes and Culture among the Primary Care Practices Studied (n = 8)

Measure	Scores of Practices Studied	Published Comparison Data	P^*
Organizational attributes	n = 8	n = 51
Communication	3.48 (0.58)	3.50 (0.59)^†	.929
Decision making	3.75 (0.48)	3.60 (0.53)^†	.455
Stress/chaos	3.05 (0.62)	3.00 (0.64)^†	.837
Change history	3.47 (0.60)	3.13 (0.45)^†	.063
Culture of group practice	n = 8	n = 88
Information	3.00 (0.42)	2.28 (0.54)^‡	<.001
Quality	3.03 (0.39)	2.61 (0.40)^‡	.005
Business	2.42 (0.34)	2.80 (0.45)^‡	.022
Innovativeness	2.25 (0.59)	2.32 (0.43)^‡	.670
Autonomy	2.91 (0.64)	2.80 (0.38)^‡	.464

Values provided as mean (SD).
* P of difference between mean of the practices we studied and the mean from published comparison data, using standard t test.
† Data from 51 family practices in New Jersey and eastern Pennsylvania belonging to the New Jersey Family Medicine Research Network. Source: Ohman-Strickland PA, Orzano AJ, Nutting PA, et al. Measuring organizational attributes of primary care practices: Development of a new instrument. Health Serv Res 2007;42(3 Part 1):1257–73 (17).
‡ Data from 88 primary care group practices in Minnesota, North Dakota, South Dakota, and Wisconsin. Source: Kaissi A, Kralewski J, Curoe A, Dowd B. How does the culture of medical group practice influence the types of programs used to assure quality of care? Health Care Manage Rev 2004;29(2):129–38 (18).