External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients with Chronic Diseases

A growing body of research suggests that care management processes (CMPs) can improve the quality of health care for patients suffering from certain chronic diseases, such as asthma, congestive heart failure, diabetes and depression. The Institute of Medicine (IOM) has therefore advocated government financial assistance to physician organizations to improve their clinical information technology (IT), which is considered fundamental to the use of CMPs. The authors of this study examined the extent to which physician organizations currently employ CMPs in treating the four chronic diseases mentioned, and the effect that external incentives and IT capabilities would have on physician organizations' use of CMPs. During 2000-01, the researchers conducted a National Survey of Physician Organizations and the Management of Chronic Illness (NSPO). Survey results include responses from 1,040 physician organizations with 20 or more physicians. The study found that of 16 possible CMPs available for use in treating these four illnesses, the average physician organization used 5.1. External incentives, such as public recognition for scoring well on quality care measures or receiving better contracts, were significantly associated with additional CMP use, as was additional IT capability. The association between IT capability and CMP use supports the IOM's advocacy of improving technology. However, the study does have limitations. For instance, it is possible that some respondents overstated CMP use, or that response bias may exist. Also, while there is evidence to support the fundamental assumption motivating the study - that CMPs improve health care quality - more research needs to be conducted to further explore CMP use and clinical outcomes.