Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

PURPOSE Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations. METHODS In this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Practice use of QI strategies was measured by the validated Change Process Capability Questionnaire (CPCQ) Strategies Scale (scores range from −28 to 28, with higher scores indicating more use of QI strategies). Multivariable linear regression was used to examine the association between practice characteristics and the CPCQ strategies score. RESULTS The mean CPCQ strategies score was 9.1 (SD = 12.2). Practices that participated in accountable care organizations and those that had someone in the practice to configure clinical quality reports from electronic health records (EHRs), had produced quality reports, or had discussed clinical quality data during meetings had higher CPCQ strategies scores. Health system–owned practices and those experiencing major disruptive changes, such as implementing a new EHR system or clinician turnover, had lower CPCQ strategies scores. CONCLUSION There is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US states. Findings suggest that practices may need external support to strengthen their ability to do QI and to be prepared for new payment and delivery models

Factors Associated With Use of Quality Improvement Strategies Among Small-to Medium Size Primary Care Practices in the United States.

Context: Improving health care quality in small-to-medium-size primary care practices, where the majority of Americans receive care, is a national priority, but little is known about these practices\u27 ability to use quality improvement (QI) strategies to deliver high quality care. Objective: To examine variations in the use of QI strategies across small-to-medium primary care practices and to assess practice-level factors associated with variations. Design: Cross-sectional study. Multivariable linear regression was used to examine the independent relationship between practice characteristics and the use of QI strategies as measured by the strategies scale of the Change Process Capability Questionnaire (CPCQ), a validated instrument designed to measure practice use of QI strategies. Setting: Data from 1,091 small-to-medium-size practices (≤10 clinicians) in 12 US states engaged in a national initiative to improve quality of care for heart health. Participants: Survey of practice leaders to assess practices characteristics and use of improvement strategies. Results: Of the practices surveyed, 84% had 10 or fewer clinicians, 21% had experienced multiple disruptive changes in the prior year, and most had meaningful use-certified electronic health records. Mean CPCQ strategies score was 8.6 (range -28 to +28, SD=12.2). Mean CPCQ scores were higher for practices that were part of accountable care organizations (+2.06, p=0.006) or had participated in demonstration projects (+1.59, p=0.04). Also, practices that discussed clinical quality data during meetings, that had someone in practice to configure EHR quality reports, and that had produced quality reports at least once in the prior six months had higher CPCQ strategies scores. Practices experiencing major disruptive changes had lower mean CPCQ scores (-3.0, p=0.001). Conclusion: Use of QI strategies varied greatly among small-to-medium-size primary care practices. Findings suggest that strengthening organizational makeup, increasing practice EHR capabilities and reducing organizational disruption could enhance the quality of care delivered by small-to-medium-size practic