Article Figures & Data
Tables
- Table 1. 2014 Centers for Medicare and Medicaid Services Clinical Quality Measures Relevant to Primary Care and Included in Performance Assessment
Measure Title Measure Description Used among Practices (Mean %) Standard Deviation Clinical process/effectiveness Antidepressant medication management Percentage of patients ≥18 years old who were diagnosed with major depression and treated with antidepressant medication and who remained on antidepressant medication treatment 59.9 8.7 Asthma: use of appropriate medications Percentage of patients 5–64 years old who were identified as having persistent asthma and were appropriately prescribed controller medication 48.0 9.8 BP control Percentage of patients 18–85 years old with a diagnosis of hypertension and whose BP was <140/90 mm Hg 69.9 10.7 Cancer screening Breast Percentage of women 50–75 years old who had a mammogram to screen for breast cancer 60.2 15.6 Cervical Percentage of women 21–64 years old who received one or more Papanicolaou tests to screen for cervical cancer 48.5 16.3 Colorectal Percentage of adults 50–75 years old who had appropriate screening for colorectal cancer 54.2 16.7 Diabetes Poor control of hemoglobin A1C Percentage of patients 18–75 years old with diabetes without a recent hemoglobin A1C or hemoglobin A1C >9.0% 40.7 12.9 LDL-C management Percentage of patients 18–75 years old with diabetes whose LDL-C was <100 mg/dL 62.1 10.2 Urine protein screening Percentage of patients 18–75 years old with diabetes who had a nephropathy screening test or evidence of nephropathy 78.4 11.0 Heart failure ACE inhibitor or ARB therapy Percentage of patients aged ≥18 years with a diagnosis of heart failure who were prescribed an ACE inhibitor or ARB therapy 55.4 11.9 β-Blocker therapy Percentage of patients aged ≥18 years with a diagnosis of heart failure who were prescribed β-blocker therapy 57.9 14.0 Ischemic vascular disease Use of aspirin or another antithrombotic Percentage of patients 20–79 years old or older with a diagnosis of ischemic vascular disease who had documentation of use of aspirin or another antithrombotic 50.1 19.5 LDL control Percentage of patients 20–79 years old or older with a diagnosis of ischemic vascular disease whose LDL-C was <100 mg/dL 65.4 8.5 Efficient use of health care resources Appropriate Treatment for Children with Upper Respiratory Infection (URI) Percentage of children 3 months to 18 years old who were diagnosed with upper respiratory infection and were not dispensed an antibiotic prescription on the day of or 3 days after the episode 62.5 26.0 Patient safety Use of high-risk medications in the elderly Percentage of patients ≥66 years old who were not ordered high-risk medications 80.1 6.6 Warfarin time in therapeutic range Average percentage of time in which patients aged ≥18 years with atrial fibrillation on warfarin therapy have an INR within the therapeutic range in the past 45 days 38.8 17.7 Population/public health Chlamydia screening for women Percentage of women 16–24 years old who were identified as sexually active and who had at least one test for chlamydia 12.9 15.0 Depression screening Percentage of patients aged ≥18 years who were screened for clinical depression 36.3 27.1 Influenza immunization Percentage of patients aged ≥6 months seen for a visit in the past year who received an influenza immunization or who reported previous receipt of an influenza immunization 29.5 12.3 Pneumococcal immunization for older adults Percentage of patients ≥65 years old who have ever received a pneumococcal vaccine 63.0 20.9 Tobacco use screening and cessation intervention Percentage of patients aged ≥18 years who were screened for tobacco use within 24 months and who received cessation counseling intervention if identified as a tobacco user 89.8 8.7 ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol.
- Table 2. Mean Practice Clinician Survey Scores for General Questions and Associations with Summary Quality Index Clinical Quality Measure Performance
Questionnaire Item Item Score Across Practices, Mean (SD) Adjusted Correlation with SQUID-CQM* Use of EHR functionality EHR-based update form for patients to review their status on CQMs 49.8 (28.2) 0.20 Registries for population management 60.1 (24.6) 0.32† Web portal for patients to reinforce their clinical quality goals 44.8 (32.1) −0.11 After-visit summary to educate patients about their progress on CQM goals 69.4 (21.7) 0.19 Maintain up-to-date problem lists 82.9 (13.6) 0.14 Clinical QI strategies Medication reconciliation at each patient visit 88.3 (12.8) 0.13 Medication refill protocol 77.6 (20.1) −0.04 Point-of-care laboratory tests 74.5 (20.7) −0.05 Request patients have laboratory tests before visits 66.6 (18.9) 0.14 Follow up with patients who do not complete recommended services 64.9 (16.8) 0.21 Beliefs about EHR and QI activities EHR is helpful in achieving high-quality clinical care 72.7 (14.1) 0.29† EHR is customized in practice to facilitate high-quality clinical care 71.4 (14.9) 0.34† EHR is difficult for you to use to achieve high-quality clinical care 58.6 (15.5) −0.25† Practice has financial burdens using EHR to achieve high-quality clinical care 47.1 (18.2) 0.07 Participation in PPRNet motivating to achieve high-quality clinical care 63.6 (22.1) 0.26† Assistance from REC helpful to achieve high-quality clinical care 36.5 (18.5) 0.12 Practice administrative QI strategies Members review CQM performance reports 71.2 (19.2) 0.17 Members know the practice's improvement priorities 74.7 (16.3) 0.30† Members work consistently to achieve improvement 77.3 (14.6) 0.16 Members evaluate progress together 70.5 (17.7) 0.28† Leaders seek team members' assistance and input regarding decisions 63.5 (21.2) 0.29† Staff incentivized toward higher performance 52.4 (22.7) 0.14 Providers incentivized with rewards for achieving high performance 39.0 (24.3) 0.07 Regular staff meetings with entire team to discuss rationale for decisions 72.1 (21.1) 0.34† Leadership shows commitment to improving meaningful use of EHR 77.2 (18.4) 0.33† Test a variety of approaches using EHR to achieve high-quality clinical care 58.5 (16.0) 0.07 ↵* The correlations presented are partial correlations between practices' mean survey item responses and their Summary Quality Index (SQUID) clinical quality measures (CQM) scores. The correlations are adjusted for the mean number of chronic conditions among the practices' patients.
↵† P < .05.
EHR, electronic health record; PPRNet, Practice Partners Research Network; QI, quality improvement; REC, regional extension center; SD, standard deviation.
- Table 3. Practice Clinician Survey Scores for Specific Questions and Associations with Clinical Quality Measure Performance
Measure Agreement Staff Education EHR Reminders Standing Orders EHR Patient Education Clinical process/effectiveness Antidepressant medication management 90.9 (18.3) 63.1 (23.8) 50.8 (26.8) N/A 46.1 (23.5) Asthma: use of appropriate medications 97.0 (8.9) 59.0 (22.6) 53.1 (26.2) N/A 50.0 (23.8) Blood pressure control 96.5 (13.8) 79.0 (20.3) 74.6 (22.6) N/A 59.5 (23.4) Cancer screening Breast 97.2 (10.1) 89.2*† (15.6) 88.0*† (14.8) 69.7* (36.9) 61.0 (24.3) Cervical 98.0 (7.8) 83.4* (19.2) 83.6*† (19.4) 39.7* (38.6) 56.4† (25.7) Colorectal 99.8*† (1.1) 85.9* (17.1) 88.2*† (14.5) 51.0* (40.6) 60.2 (24.5) Diabetes Poor control of hemoglobin A1C 90.4 (16.2) 78.2 (22.8) 74.2 (25.9) 63.7 (40.5) 64.2*† (22.3) LDL-C management 91.6 (16.6) 63.4 (24.2) 68.0 (23.6) 55.5 (41.1) 64.2 (22.3) Urine protein screening 92.8 (20.2) 74.9*† (22.0) 80.2*† (23.2) 64.6* (39.8) 64.2* (22.3) Heart failure ACE inhibitor or ARB therapy 96.0 (14.5) 54.7 (22.1) 59.0*† (27.0) N/A 48.0 (24.8) β-Blocker therapy 96.5 (13.9) 54.7 (22.1) 56.2*† (27.2) N/A 48.0† (24.8) Ischemic vascular disease Use of aspirin or another antithrombotic 98.2 (7.5) 64.4*† (23.9) 75.8*† (23.8) N/A 54.4 (23.3) LDL control 94.0 (11.7) 62.4 (24.6) 64.0 (23.2) 48.3 (41.2) 54.5 (23.3) Efficient resource use Appropriate treatment for children with upper respiratory infection 89.8 (21.6) 63.2* (27.1) 36.5* (27.9) N/A 38.6* (26.5) Patient safety Use of high-risk medications in the elderly 91.7*† (18.9) 56.8 (22.0) 69.2 (20.8) N/A 43.5 (24.9) Warfarin time in therapeutic range 97.3 (13.7) 76.8* (23.0) 43.2 (29.2) N/A 49.3 (27.5) Population/public health Chlamydia screening for women 89.3* (25.1) 65.7* (24.6) 64.0*† (29.8) 30.7* (35.7) 45.4 (26.8) Depression screening 88.5 (23.2) 69.1*† (26.6) 67.7*† (29.5) 41.2* (42.2) 50.2* (29.7) Influenza immunization 97.9 (7.1) 90.6* (14.5) 88.2*† (14.7) 82.0 (29.2) 62.7 (25.1) Pneumococcal immunization for older adults 100.0 (0.0) 88.0* (17.2) 87.0*† (16.0) 72.0* (35.0) 62.3 (24.5) Tobacco use screening and cessation intervention 98.3 (8.5) 86.2 (16.7) 83.5 (17.7) N/A 62.6 (25.4) ↵* Significantly (P < .05) correlated with corresponding quality measure in bivariate (unadjusted) analysis.
↵† Significantly (P < .05) correlated with corresponding quality measure in multivariate (adjusted) analysis.
ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; EHR, electronic health record; LDL-C, low-density lipoprotein cholesterol; N/A, not applicable; SD, standard deviation.
