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Building a primary care quality measurement system: Lessons from New York City
Objective: To establish a set of quality measures that could be garnered from the EHRs of PCIP primary care practices and reported back to practices to support quality improvement.
Methods: Measures were selected according to health department priorities and feasibility of collecting data via EHRs. Definitions were based on NQF where possible; 2 measures were based on USPSTF recommendations and 1 measure on the New York State HIV testing law. Numerators and denominators were translated into SQL queries, optimized for performance, and tested on internal servers. Queries ran on 651 practices via PCIP’s distributed query network. Aggregate data was returned for each month from 2009 through the present at the provider and practice level; no individual patient data was collected.
Results: An average of 578 practices returned results for each measure. Fifteen measures were incorporated into a provider feedback dashboard covering diabetes management, hypertension control, cholesterol control, smoking, and other screenings (depression, HIV, sexual history, BMI, and hepatitis C). This process took approximately one year.
Discussion: As the healthcare community develops increasingly standardized quality measures, these can be used to provide timely public health feedback to clinicians. PCIP has found that small practices are especially receptive to assistance such as quality measure dashboards, as they have limited resources for in-house quality improvement analyses. Although the process of developing these measures is resource-intensive, the resulting dashboards will be distributed to over 1500 New York City clinicians serving over one million patients.
Learning Areas:
Clinical medicine applied in public healthCommunication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research
Learning Objectives:
List examples of useful quality measures that can be drawn from an EHR
Identify challenges to creating an EHR-based quality measurement system
Evaluate a case study of using HIIT to help providers examine quality of care
Keyword(s): Quality Improvement, Information Technology
Qualified on the content I am responsible for because: I have worked at the Primary Care Information project of the New York City Department of Health for over 2 years, managing a HIIT data system of over 600 local practices and helping write and evaluate healthcare quality measures on this system.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.