Research ArticleHealth Policy

Core Principles to Improve Primary Care Quality Management

Justin B. Mutter, Winston Liaw, Miranda A. Moore, Rebecca S. Etz, Amanda Howe and Andrew Bazemore
The Journal of the American Board of Family Medicine November 2018, 31 (6) 931-940; DOI: https://doi.org/10.3122/jabfm.2018.06.170172

References

  1. 1.↵
    Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2001.
  2. 2.↵
    Agency for Healthcare Research and Quality. National quality measures clearinghouse home page. Available from: https://www.qualitymeasures.ahrq.gov. Accessed March 22, 2018.
  3. 3.↵
    1. Porter ME,
    2. Larsson S,
    3. Lee TH
    . Standardizing patient outcomes measurement. N Engl J Med 2016;374:504–7.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Casalino LP,
    2. Gans D,
    3. Weber R,
    4. et al
    . US physician practices spend more than $15.4 billion annually to report quality measures. Health Aff (Millwood) 2016;35:401–6.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Eijkenaar F,
    2. Emmert M,
    3. Scheppach M,
    4. Schöffski O
    . Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy 2013;110:115–30.
    OpenUrlCrossRefPubMedWeb of Science
  6. 6.↵
    1. Magill MK,
    2. Ehrenburger D,
    3. Scammon DL,
    4. et al
    . The cost of sustaining a patient-centered medical home: experience from 2 states. Ann Fam Med 2016;13:429–35.
    OpenUrl
  7. 7.↵
    1. Ryan J,
    2. Doty MM,
    3. Hamel L,
    4. Norton M,
    5. Abrams MK,
    6. Brodie M
    . Primary care providers' views of recent trends in health care delivery and payment. The Commonwealth Fund. Available from: http://www.commonwealthfund.org/publications/issue-briefs/2015/aug/primary-care-providers-views-delivery-payment. Published August 5, 2015. Accessed March 22, 2018.
  8. 8.↵
    1. Starfield B,
    2. Shi L,
    3. Macinko J
    . Contribution of primary care to health systems and health. Milbank Q 2005;83:457–502.
    OpenUrlCrossRefPubMedWeb of Science
  9. 9.↵
    1. Starfield B
    . Primary care: concept, evaluation, and policy. New York: Oxford University Press; 1992.
  10. 10.↵
    1. Bodenheimer T,
    2. Sinsky C
    . From Triple to Quadruple Aim: care of the patient requires care of the provider. Ann Fam Med 2014;12:573–6.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    Agency for Healthcare Research and Quality. 2015 National healthcare quality and disparities report and 5th anniversary update on the national quality strategy. Available from: http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqdr15/2015nhqdr.pdf. Published April 2016. Accessed March 22, 2018.
  12. 12.↵
    1. Starfield B,
    2. Mangin D
    . An international perspective on the basis of pay for performance. Qual Prim Care 2008;18:399–404.
    OpenUrl
  13. 13.↵
    1. Roland M,
    2. Campbell S
    . Successes and failures of pay for performance in the United Kingdom. N Engl J Med 2014;370:1944–9.
    OpenUrlCrossRefPubMedWeb of Science
  14. 14.↵
    1. Forbes LJL,
    2. Marchand C,
    3. Doran T,
    4. Peckham S
    . The role of the quality and outcomes framework in the care of long-term conditions: a systematic review. Br J Gen Pract 2017;67:e775–e784.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Steel N,
    2. Willems S
    . Research learning from the UK Quality and Outcomes Framework: a review of existing research. Qual Prim Care 2010;18:117–25.
    OpenUrlPubMed
  16. 16.↵
    1. Doran T,
    2. Roland M
    . Lessons from major initiatives to improve primary care in the United Kingdom. Health Aff (Millwood) 2010;29:1023–9.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Gilliam SJ,
    2. Siriwardena AN,
    3. Steel N
    . Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework—a systematic review. Ann Fam Med 2012;10:461–8.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Gillam S,
    2. Steel N
    . The quality and outcomes framework—where next? BMJ 2013;346:f659.
    OpenUrlFREE Full Text
  19. 19.↵
    1. Llanwarne NR,
    2. Abel GA,
    3. Elliott MN,
    4. et al
    . Relationship between clinical quality and patient experience: analysis of data from the English quality and outcomes framework and the national gp patient survey. Ann Fam Med 2013;11:467–72.
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. Langdown C,
    2. Peckham S
    . The use of financial incentives to help improve health outcomes: is the quality and outcomes framework fit for its purpose? A systematic review. J Public Health (Oxf) 2013;36:251–8.
    OpenUrl
  21. 21.↵
    1. Dixon A,
    2. Khachatryan A,
    3. Wallace A,
    4. Peckham S,
    5. Boyce T,
    6. Gillam S
    . The quality and outcomes framework: does it reduce health inequalities? London: National Institute for Health Research Service Delivery and Organisation Programme; 2010. Available from: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08–1716-207_V01.pdf. Accessed March 22, 2018.
  22. 22.↵
    1. Gillam S,
    2. Siriwardena N
    1. Checkland K,
    2. Harrison S
    . The impact of the QOF of practice organization and service delivery. In: Gillam S, Siriwardena N, editors. The quality and outcomes framework: QOF—transforming general practice. Abingdon: Radcliff Publishing, Ltd.; 2011.
  23. 23.↵
    1. Hicks N,
    2. Bell D
    . English developments in value-based care: the beginnings of a revolution? Health Affairs Blog. Available from: http://healthaffairs.org/blog/2016/03/16/english-developments-in-value-based-care-the-beginnings-of-a-revolution/. Published March 16 2016. Accessed March 22, 2018.
  24. 24.↵
    1. Corrigan P,
    2. Hicks N
    . What organisation is necessary for commissioners to develop outcomes based contracts? The COBIC case study. October 2012. Published October 2012. Accessed March 22, 2018.
  25. 25.↵
    1. Noble DJ
    . Accountable care organizations and clinical commissioning groups face an uncertain challenge for improving public health. J Public Health Res 2012;1:113–6.
    OpenUrl
  26. 26.↵
    Centers for Medicare & Medicaid Services. Better care. Smarter spending. Heathier people: paying providers for value, not volume. Available from: https://www.cms.gov/newsroom/fact-sheets/better-care-smarter-spending-healthier-people-paying-providers-value-not-volume. Published January 2015.
  27. 27.↵
    Centers for Medicare & Medicaid Services. Quality payment program executive summary. Available from: https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf. Published 2016.
  28. 28.↵
    Senate Finance Committee. Medicare Access and CHIP Reauthorization Act of 2015: ensuring successful implementation of physician payment reforms. Available from: https://www.finance.senate.gov/imo/media/doc/26671.pdf. Published July 2016. Accessed March 22, 2018.
  29. 29.↵
    1. McWilliams JM
    . MACRA: big fix or big problem? Ann Intern Med 2017;167:122–4.
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Eggleton K,
    2. Liaw W,
    3. Bazemore A
    . Impact of gaps in merit-based incentive payment system measures on marginalized populations. Ann Fam Med 2017;15:255–7.
    OpenUrlAbstract/FREE Full Text
  31. 31.↵
    1. Baker DW,
    2. Qaseem A
    . Evidence-based performance measures: preventing unintended consequences of quality measurement. Ann Intern Med 2011;155:638–40.
    OpenUrlCrossRefPubMed
  32. 32.↵
    Assistant Secretary for Planning and Evaluation. Social risk factors and performance under Medicare's value-based purchasing programs. Available from: https://aspe.hhs.gov/system/files/pdf/253971/ASPESESRTCfull.pdf. Published 2016. Accessed March 22, 2018.
  33. 33.↵
    1. Casalino LP,
    2. Elster A,
    3. Eisenberg A,
    4. Lewis E,
    5. Montgomery J,
    6. Ramos D
    . Will pay-for-performance and quality reporting affect health care disparities? Health Aff (Millwood) 2007;26:w405–14.
    OpenUrlAbstract/FREE Full Text
  34. 34.↵
    1. Meyer GS,
    2. Nelson EC,
    3. Pryor DB,
    4. et al
    . More quality measures versus measuring what matters: a call for balance and parsimony. BMJ Qual Saf 2012;21:964–8.
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Asch SM,
    2. Kerr EA
    . Measuring what matters in health: lessons from the Veterans Health Administration state of the art conference. J Gen Intern Med. 2016;31:S1–2.
    OpenUrl
  36. 36.↵
    1. Reinertsen JL,
    2. Gosfield AG,
    3. Rupp W,
    4. Whittington JW
    . Engaging physicians in a shared quality agenda. IHI innovation series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007.
  37. 37.↵
    1. Reuben DB,
    2. Sinsky CA
    . From transactional tasks to personalized care: a new vision of physicians' roles. Ann Fam Med 2018;16:168–70.
    OpenUrlAbstract/FREE Full Text
  38. 38.↵
    1. Young RA,
    2. Roberts RG,
    3. Holden RJ
    . The challenges of measuring, improving, and reporting quality in primary care. Ann Fam Med 2017;15:175–82.
    OpenUrlAbstract/FREE Full Text
  39. 39.↵
    1. Goitein L
    . Virtual quality: the failing of public reporting and pay-for-performance programs. JAMA Int Med 2014;174:1912–13.
    OpenUrl
  40. 40.↵
    1. Stange KC,
    2. Ferrer RL
    . The paradox of primary care. Ann Fam Med 2009;7:293–99.
    OpenUrlFREE Full Text
  41. 41.↵
    1. Kuhn TS
    . The structure of scientific revolutions, 3rd ed. Chicago: University of Chicago Press; 1996.
  42. 42.↵
    1. Starfield B
    . Is patient-centered care the same as person-focused care? Perm J 2011;15:63–9.
    OpenUrlPubMed
  43. 43.↵
    1. Boyd CM,
    2. Darer J,
    3. Boult C,
    4. Fried LP,
    5. Boult L,
    6. Wu AW
    . Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005;294:716–24.
    OpenUrlCrossRefPubMedWeb of Science
  44. 44.↵
    1. Berwick DM,
    2. Nolan TW,
    3. Whittington J
    . The triple aim: care, health, and cost. Health Affairs 2008;27:759–69.
    OpenUrlAbstract/FREE Full Text
  45. 45.↵
    1. Herzer KR,
    2. Pronovost PJ
    . Physician motivation: listening to what pay-for-performance programs and quality improvement collaboratives are telling us. Jt Comm J Qual Patient Saf 2015;41:522–8.
    OpenUrlPubMed
  46. 46.↵
    1. Starfield B
    . Measurement of outcome: a proposed scheme. Milbank Q 2005;83:1–11.
    OpenUrlCrossRef
  47. 47.↵
    1. Berenson RA,
    2. Rice T
    . Beyond measurement and reward: methods of motivating quality improvement and accountability. Heath Serv Res 2015;50:2155–86.
    OpenUrl
  48. 48.↵
    1. Wynia MK
    . The risks of rewards in health care: how pay-for-performance could threaten, or bolster, medical professionalism. J Gen Intern Med 2009;24:884–7.
    OpenUrlCrossRefPubMedWeb of Science
  49. 49.↵
    1. Pronovost PJ,
    2. Bo-Linn GW
    . Preventing patient harms through systems of care. JAMA 2012;308:769–70.
    OpenUrlCrossRefPubMedWeb of Science
  50. 50.↵
    1. Conway PH,
    2. Cassel CK
    . Engaging physicians and leveraging professionalism: a key to success for quality measurement and improvement. JAMA 2012;308:979–80.
    OpenUrlCrossRefPubMedWeb of Science
  51. 51.↵
    1. Donabedian A
    . The quality of care: how can it be assessed? JAMA 1988;260:1743–8.
    OpenUrlCrossRefPubMedWeb of Science
  52. 52.↵
    1. Xu Y,
    2. Wells PS
    . Getting (along) with the guidelines: reconciling patient autonomy and quality improvement through shared decision making. Acad Med 2016;91:925–9.
    OpenUrl
  53. 53.↵
    1. Rothman DJ
    . Strangers at the bedside: a history of how law and bioethics transformed medical decision making, 2nd ed. New York: Aldine de Gruyter, 2011.
  54. 54.↵
    1. Brook RH
    . The end of the quality improvement movement: long live improving value. JAMA 2010;304:1831–32.
    OpenUrlCrossRefPubMedWeb of Science
  55. 55.↵
    1. Smith SM,
    2. Wallace E,
    3. Salisbury C,
    4. Sasseville M,
    5. Bayliss E,
    6. Fortin M
    . A core outcome set for multimorbidity research (COSmm). Ann Fam Med 2018;16:132–8.
    OpenUrlAbstract/FREE Full Text
  56. 56.↵
    1. Devoe JE,
    2. Bazemore AW,
    3. Cottrell EK,
    4. et al
    . Perspectives in primary care: a conceptual framework and path for integrating social determinants of health into primary care. Ann Fam Med 2016;14:104–8.
    OpenUrlFREE Full Text
  57. 57.↵
    1. Asch DA,
    2. Werner RM
    . Paying for performance in population health: lessons from health care settings. Prev Chronic Dis 2010;7:A98.
    OpenUrlPubMed
  58. 58.
    1. Basch E,
    2. Torda P,
    3. Adams K
    . Standards for patient-reported outcome-based performance measures. JAMA 2013;310:139–40.
    OpenUrlCrossRefPubMedWeb of Science
  59. 59.
    1. DiAngi YT,
    2. Lee TC,
    3. Sinsky CA,
    4. Bohman BD,
    5. Sharp CD
    . Novel metrics for improving physician fulfillment. Ann Intern Med 2017;167:740–1.
    OpenUrl
  60. 60.
    1. Madara JL,
    2. Bukhart J
    . Professionalism, self-regulation, and motivation: how did health care get this so wrong? JAMA 2015;313:1793–4.
    OpenUrl
  61. 61.↵
    1. Rosenberg CE
    . The tyranny of diagnosis. Milbank Q 2002;80:237–60.
    OpenUrlCrossRefPubMedWeb of Science
  62. 62.↵
    Centers for Medicare and Medicaid Services. Consensus core set: ACO and PCMH/primary care measures. Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/ACO-and-PCMH-Primary-Care-Measures.pdf. Published February 2016. Accessed March 22, 2018.
  63. 63.↵
    1. Szanton SL,
    2. Thorpe RJ,
    3. Boyd C,
    4. et al
    . Community aging in place. Advancing better lives for elders: a bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. J Am Geriatr Soc 2011;59:2314–20.
    OpenUrlCrossRefPubMed
  64. 64.↵
    1. Szanton SL,
    2. Leff B,
    3. Wolff JL,
    4. Roberts L,
    5. Gitlin LN
    . Home-based care program reduces disability and promotes aging in place. Health Aff (Millwood) 2016;35:1558–63.
    OpenUrlAbstract/FREE Full Text
  65. 65.↵
    1. Szanton SL,
    2. Alfonso YN,
    3. Leff B,
    4. et al
    . Medicaid cost savings of a preventive home visit program for disabled older adults. J Am Geriatr Soc 2018;66:614–20.
    OpenUrl
  66. 66.↵
    1. Rotenberg J,
    2. Kinosian B,
    3. Boling P,
    4. Taler G
    . Home-based primary care: beyond extension of the independence at home demonstration. J Am Geriatr Soc. 2018;66:812–817.
    OpenUrl
  67. 67.↵
    1. DeJonge KE,
    2. Taler G,
    3. Boling PA
    . Independence at home: community-based care or older adults with severe chronic illness. Clin Geriatr Med 2009;25:155–69.
    OpenUrlCrossRefPubMed
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Keywords