TY - JOUR T1 - Managing Patient Populations in Primary Care: Points of Leverage JF - The Journal of the American Board of Family Medicine JO - J Am Board Fam Med SP - 238 LP - 244 DO - 10.3122/jabfm.2012.02.100224 VL - 25 IS - 2 AU - Robert Eidus AU - Wilson D. Pace AU - Elizabeth W. Staton Y1 - 2012/03/01 UR - http://www.jabfm.org/content/25/2/238.abstract N2 - Common “quality” metrics may represent the quality of care for large populations; however, they do not adequately represent quality in individual primary care settings, especially as stand-alone indices. Using discreet threshold values to measure quality in primary care may result in physicians focusing on managing patients by the numbers at the expense of making individualized and nuanced clinical decisions. Current performance measures may be misapplied as proxies for both cost savings and quality. We posit that developing and focusing measurement on high-leverage activities will yield better clinical outcomes and potentially lower cost. As a starting point for further work in this area, we suggest the development of metrics that track identification and management of depression; management of transitions of care; care coordination; team-based care; identification and support of socially frail/isolated individuals; pharmacologic management, including optimizing medication and dealing with adherence issues; and establishment of a therapeutic environment. These processes, or others like them, will require infrastructure that may be costly and time-consuming, and measuring these processes will require thought and effort. Nevertheless, we believe developing metrics based on high-leverage activities will yield greater clinical and economic returns than relying on the metrics currently in place. ER -