Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics

Abstract Background Quality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition’s Quality Measurement Enhancement Project sought to collect data from primary care providers’ (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs’ perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare. Methods Qualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes. Results Three themes with sub-themes emerged. Theme #1: Minnesota’s current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity. Conclusion Aligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs’ perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them

Food and environmental parasitology in Canada:A network for the facilitation of collaborative research

Parasitic diseases are of considerable public health significance in Canada, particularly in rural and remote areas. Food- and water-borne parasites contribute significantly to the overall number of parasitic infections reported in Canada. While data on the incidence of some of these diseases are available, knowledge of the true burden of infection by the causative agents in Canadians is somewhat limited. A number of centers of expertise in Canada study various aspects of parasitology, but few formal societies or networks of parasitologists currently exist in Canada, and previously none focused specifically on food or environmental transmission. The recently established Food and Environmental Parasitology Network (FEPN) brings together Canadian researchers, regulators and public health officials with an active involvement in issues related to these increasingly important fields. The major objectives of the Network include identifying research gaps, facilitating discussion and collaborative research, developing standardized methods, generating data for risk assessments, policies, and guidelines, and providing expert advice and testing in support of outbreak investigations and surveillance studies. Issues considered by the FEPN include contaminated foods and infected food animals, potable and non-potable water, Northern and Aboriginal issues, zoonotic transmission, and epidemiology