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Knierim KE, Hall TL, Dickinson LM, et al. Primary Care Practices’ Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health. JAMA Netw Open. 2019;2(8):e198569. doi:10.1001/jamanetworkopen.2019.8569
How quickly can primary care practices report electronic clinical quality measures based on evidence-based guidelines for cardiac care?
In this quality improvement study of 211 primary care practices, the median time to report any baseline electronic clinical quality measure was 8.2 months. Time to report varied by measure type and practice characteristics.
This study suggests that clinical quality measure reporting still takes a great deal of time and effort, and as the health care system increasingly moves to value-based structures that require electronic clinical quality measures, some practices may be left behind without better incentives and support.
The capability and capacity of primary care practices to report electronic clinical quality measures (eCQMs) are questionable.
To determine how quickly primary care practices can report eCQMs and the practice characteristics associated with faster reporting.
Design, Setting, and Participants
This quality improvement study examined an initiative (EvidenceNOW Southwest) to enhance primary care practices’ ability to adopt evidence-based cardiovascular care approaches: aspirin prescribing, blood pressure control, cholesterol management, and smoking cessation (ABCS). A total of 211 primary care practices in Colorado and New Mexico participating in EvidenceNOW Southwest between February 2015 and December 2017 were included.
Practices were instructed on eCQM specifications that could be produced by an electronic health record, a registry, or a third-party platform. Practices received 9 months of support from a practice facilitator, a clinical health information technology advisor, and the research team. Practices were instructed to report their baseline ABCS eCQMs as soon as possible.
Main Outcomes and Measures
The main outcome was time to report the ABCS eCQMs. Cox proportional hazards models were used to examine practice characteristics associated with time to reporting.
Practices were predominantly clinician owned (48%) and in urban or suburban areas (71%). Practices required a median (interquartile range) of 8.2 (4.6-11.9) months to report any ABCS eCQM. Time to report differed by eCQM: practices reported blood pressure management the fastest (median [interquartile range], 7.8 [3.5-10.4] months) and cholesterol management the slowest (median [interquartile range], 10.5 [6.6 to >12] months) (log-rank P < .001). In multivariable models, the blood pressure eCQM was reported more quickly by practices that participated in accountable care organizations (hazard ratio [HR], 1.88; 95% CI, 1.40-2.53; P < .001) or participated in a quality demonstration program (HR, 1.58; 95% CI, 1.14-2.18; P = .006). The cholesterol eCQM was reported more quickly by practices that used clinical guidelines for cardiovascular disease management (HR, 1.35; 95% CI, 1.18-1.53; P < .001). Compared with Federally Qualified Health Centers, hospital-owned practices had greater ability to report blood pressure eCQMs (HR, 2.66; 95% CI, 95% CI, 1.73-4.09; P < .001), and clinician-owned practices had less ability to report cholesterol eCQMs (HR, 0.52; 95% CI, 0.35-0.76; P < .001).
Conclusions and Relevance
In this study, time to report eCQMs varied by measure and practice type, with very few practices reporting quickly. Practices took longer to report a new cholesterol measure than other measures. Programs that require eCQM reporting should consider the time and effort practices must exert to produce reports. Practices may benefit from additional support to succeed in new programs that require eCQM reporting.
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