INTRODUCTION
Clinical quality reporting burdens small practices with estimated costs
of $50,000 per provider per year 1. Practice burdens
include data entry, interference with patient interactions, and lack of
interoperability 2, 3. Basic EHR reporting
functionality that meets requirements for Meaningful Use certification
are often of limited utility in efforts to improve quality metrics in
high risk populations 4. Moreover, it is not clear
that smaller primary care practices have the ability to generate the
types of quality performance reports that are essential to inform
efforts to improve the quality of care they deliver 5,
6.
In 2015 the Agency for Healthcare Research and Quality (AHRQ) launched
EvidenceNOW, a national project offering practice facilitation support
to more than 1500 primary care practices with ten or fewer clinicians to
improve the cardiovascular risk factors Aspirin, Blood Pressure,
Cholesterol and Smoking (ABCS) 7. AHRQ funded seven
EvidenceNOW cooperatives, including the Healthy Hearts Northwest (H2N)
cooperative, to understand the technical assistance (TA) that small to
medium sized primary care practices need to improve performance on the
ABCS clinical quality measures (CQMs).
In 2016 the EvidenceNOW evaluation team documented challenges
participating clinicians encountered in their efforts to produce
clinical quality reports for the project 5. They found
that although the software performed well for billing data,
functionality for population quality improvement activities was limited.
Earlier observation by practice facilitators (PFs) 8
pointed to the importance of the ability of EHR software to extract,
aggregate, and format data so clinicians can see care gaps
9. In addition, a practice must have personnel with
analytic and reporting skills to use the software 5.
Weakness in either factor has the potential to impair a clinicians’
ability to see, understand, and act on quality metrics on which practice
revenue increasingly depends 10.
A short and easy-to-use instrument to quickly assess a practice’s
ability to produce reliable practice-facing reports for quality
improvement (QI) will benefit practice facilitators (PFs) who provide
external support to a primary care practices. Here we describe a tool
developed by the H2N study team for this purpose. We examine the
relationships between a practice’s PHITA score, its ability to report
CQMs, and practice characteristics. Finally, we describe themes that
emerged from an analysis of qualitative data derived from notes kept by
PFs for practices with the lowest and highest PHITA scores.