Docs see value in EHR-based quality improvement program

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 - laptop in hospital, female doctor

A trial program designed to incentivize the achievement of quality improvement goals in cardiovascular care received positive feedback from participating physicians, according to a report in the November issue of the American Journal of Managed Care.

Health eHearts was a two-year cluster-randomized trial piloted by the New York City Department of Health and Mental Hygiene (NYC DOMH) to offer financial incentives to practices using EHRs providing cardiovascular care that successfully incorporated certain quality measures. The department recruited 140 small practices into the program between 2009 and 2011.

All practices were EHR-enabled for at least three months, had at least 200 patients with cardiovascular diagnoses pertinent to the quality measures and sent information on those measures to the DOMH.

Practices that met goals related to aspirin therapy, control of hypertension, cholesterol control and smoking cessation received between $20 and $150 per patient who achieved a particular goal. The program paid more for patients who were more clinically difficult to manage. Investigators randomized the practices either to receive incentives or not (control group). Both groups received quarterly reports on their quality performance, coaching and training.

To determine how clinicians felt about Health eHearts, the researchers, led by Rohima Begum, MPH, of the NYC DOMH, sent surveys to the lead provider at each practice. The surveys assessed how the doctors felt about the various aspects of the program, including the quality measures, the use of EHRs and the payments.

Nearly three-quarters of the surveyed physicians responded, most of them favorably. The vast majority received and reviewed the quality reports (89 percent), thought the prioritization of quality measures was appropriate (89 percent) and understood the content in the reports (95 percent).

More clinicians in the incentive group, however, reported they would produce quality reports (87 percent vs. 72 percent in the control group), track progress toward meeting performance goals (91 percent vs. 78 percent in the control group) and hold regular check-ins after Health eHearts (71 percent vs. 57 percent in the control group).

The authors explained that as the Patient Protection and Affordable Care Act rolls out, the focus will be on new ways to deliver care and provide reimbursement. Physicians need to be convinced that meeting quality improvement goals is a worthwhile effort.

“Our study supports the hypothesis that clinician buy-in and engagement is possible if the program ensures that quality measures reports used in the program are clinically meaningful and that quality reports are relevant and accurate,” they argued.