Enhancing Patient Care with Practice Systems - Results are Mixed

Field of Work: Disseminating evidence and evaluation approaches for improving physician practice systems.

Problem Synopsis: A 2001 report from the Institute of Medicine documented the need for reliable measures of medical systems that affect the quality of health care, to guide efforts to improve quality and ensure accountability. However, efforts by insurers and large employers to measure the quality of care—often by surveying patients and measuring outcomes—have been plagued with problems, according to staff at the National Committee for Quality Assurance (NCQA), including the unreliability of information and the cost of collecting it.

Synopsis of the Work: From 2001 to 2007, staff and consultants at NCQA created, tested and disseminated tools to measure "practice systems": formal processes and information systems used to ensure high-quality care and prevention of chronic illness. NCQA also investigated links between the use of practice systems and clinical quality measures, patient experiences of care and resource use/cost in physician practices.

Key Results

  • Project staff created the Physician Practice Connections-Readiness Survey (PPC-RS) to measure the presence and use of formal processes and information systems in medical offices to treat and prevent chronic illnesses. Staff also created the Physician Practice Connections (PPC), a Web-based program that allows medical offices to assess and provide documentation of the use of office practice systems and if they reach a predetermined threshold of performance, to gain recognition from the NCQA for using practice systems to enhance patient care.
  • Organizations began using the PPC, or NCQA recognition, to evaluate physicians' offices use of systems. By March 2009, more than 2000 physicians in 200 practices had received NCQA recognition for their efforts in implementing and using practice systems in their offices.
  • The PPC program was modified so that it could be used in the assessment of "patient-centered medical homes" (PCMH). The modified program, known as PPC-PCMH, was being used in the vast majority of PCMH demonstration and pilot projects.
  • The Centers for Medicare & Medicaid Services used a version of the PPC-PCMH in its large-scale medical home demonstration for Medicare. As of March 2009, additional practices were seeking recognition/qualification under this new program.
  • Project staff reported positive relationships between the use of practice systems and improved clinical quality and reduced costs of care, but not with better patient experiences.