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.