National Committee On Quality Assurance Research Articles

Estimating Associations Between Medical Home Adoption, Utilization, and Quality: A Comparison of Evaluation Approaches.

Methodological differences between evaluations of medical home adoption might complicate readers' ability to draw conclusions across studies. To study whether associations between medical home adoption and patient care are affected by methodological choices. Among 71 practices participating in the Pennsylvania Chronic Care Initiative (a medical home pilot), we estimated cross-sectional and longitudinal associations between 4 definitions of "medical home adoption" [National Committee on Quality Assurance (NCQA) recognition in year 3, Medical Home Index scores at baseline and 3, and within-practice changes in Medical Home Index scores between baseline and year 3] and utilization and quality. Six utilization and 6 quality measures. In cross-sectional analyses at year 3, NCQA recognition was associated with higher rates of nephropathy monitoring (7.23 percentage points; confidence interval, 0.45-14.02), breast cancer screening (7.48; 2.11-12.86), and colorectal cancer screening (8.43; 2.44-14.42). In longitudinal analyses, NCQA recognition was associated with increases in hospitalization rates (2.75 per 1000 patient-months; 0.52-4.98). In baseline cross-sectional analyses, higher Medical Home Index scores were associated with fewer ambulatory care-sensitive hospitalizations (-0.61 per 1000 patient per month; -1.11 to -0.11), all-cause emergency department visits (-6.80; -12.28 to -1.32), and ambulatory care-sensitive emergency department visits (-5.60; 10.32 to -0.88). There were no statistically significant associations between any other measure of medical home adoption and quality or utilization. The findings of medical home evaluations are sensitive to methodological choices. Meta-analyses, narrative reviews, and other syntheses of medical home studies should consider subdividing their findings by analytic approach.

Effects of Patient-centered Medical Home Transformation on Child Patient Experience.

Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation. This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n = 21) and non-PCMH (n = 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS). A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P = .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P < .0005) and 7.2% (P < .0005) higher CAHPS child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P = .001) and 11.0% (P < .0005) lower CAHPS child development and prevention composite scores, respectively. Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices.

Incentivizing Primary Care Providers to Innovate: Building Medical Homes in the Post-Katrina New Orleans Safety Net

To evaluate safety-net clinics' responses to a novel community-wide Patient-Centered Medical Home (PCMH) financial incentive program in post-Katrina New Orleans. Between June 2008 and June 2010, we studied 50 primary care clinics in New Orleans receiving federal funds to expand services and improve care delivery. Multiwave, longitudinal, observational study of a local safety-net primary care system. Clinic-level data from a semiannual survey of clinic leaders (89.3 percent response rate), augmented by administrative records. Overall, 62 percent of the clinics responded to financial incentives by achieving PCMH recognition from the National Committee on Quality Assurance (NCQA). Higher patient volume, higher baseline PCMH scores, and type of ownership were significant predictors of achieving NCQA recognition. The steepest increase in adoption of PCMH processes occurred among clinics achieving the highest, Level 3, NCQA recognition. Following NCQA recognition, 88.9 percent stabilized or increased their use of PCMH processes, although several specific PCMH processes had very low rates of adoption overall. Findings demonstrate that widespread PCMH implementation is possible in a safety-net environment when external financial incentives are aligned with the goal of practice innovation.

Urologists and the Patient Centered Medical Home

Hopes are high that the delivery system reforms embodied in the patient centered medical home will improve the quality of care for patients with chronic diseases. While primary care physicians, given their training, will likely be the locus of care under this model, there are certain conditions for which urologists are well suited to provide the continuous and comprehensive care called for by the patient centered medical home. To assess the feasibility of the urology based patient centered medical home, we analyzed national survey data. For our measure of medical home infrastructure, we mapped items from the 2007 and 2008 NAMCS (National Ambulatory Medical Care Survey) to the NCQA (National Committee on Quality Assurance) standards for patient centered medical home recognition. We determined the proportion of urology practices in the United States that would achieve patient centered medical home recognition. Finally, we used NAMCS data to estimate the impact of consolidating genitourinary cancer (ie prostate, bladder, kidney and testis) followup care among the current supply of urologists. Nearly three-quarters of urology practices meet NCQA standards for patient centered medical home recognition. At present, primary care physicians spend 9,295 cumulative workweeks providing direct and indirect care to survivors of genitourinary cancers. Off-loading half of this care to urology practices, in the context of the patient centered medical home, would generate an average of 0.73 additional workweeks for each practicing urologist. Urology practices may possess the capacity needed to direct medical homes for their patients with genitourinary cancers. Successful implementation of this model would likely require a willingness to manage some nonurological conditions.

Are Primary Care Practices Ready to Become Patient‐Centered Medical Homes?

To measure the readiness of rural primary care practices to qualify as patient-centered medical homes (PCMHs), one step toward participating in changes underway in health care finance and delivery. We used the 2008 Health Tracking Physician Survey to compare PCMH readiness scores among metropolitan and nonmetropolitan primary care practices. The National Committee on Quality Assurance (NCQA) assessment system served as a framework to assess the PCMH capabilities of primary care practices based on their services, processes, and policies. We found little difference between urban and rural practices. Approximately 41% of all primary care practices offer minimal or no PCMH services. We also found that large practices score higher on standards primarily related to information technology and care management. Achieving the benefits of the PCMH model in small rural practices may require additional national promotion, technical assistance, and financial incentives.

Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature

BACKGROUND AND OBJECTIVE:Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards. The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare servicesMETHODS:We did a systematic review of the literature to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and Cinhal.RESULTS:Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programs in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management.CONCLUSIONS:There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.

81 UROLOGY PRACTICES AND READINESS FOR MEDICAL HOME REFORMS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201181 UROLOGY PRACTICES AND READINESS FOR MEDICAL HOME REFORMS John M. Hollingsworth, Joseph W. Sakshaug, and David C. Miller John M. HollingsworthJohn M. Hollingsworth Ann Arbor, MI More articles by this author , Joseph W. SakshaugJoseph W. Sakshaug Ann Arbor, MI More articles by this author , and David C. MillerDavid C. Miller Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.145AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The degree to which existing physician practices possess the “structural readiness” to function as medical homes has been incompletely examined. Prior evaluations have focused mainly on primary care practices. As there are certain conditions for which specialty practices might be the optimal medical home (e.g., urology practices for men with prostate cancer), there is also a need to better understand the current infrastructure in these settings. METHODS We mapped items from the 2007 and 2008 National Ambulatory Medical Care Surveys (NAMCS) to specific elements in the National Committee on Quality Assurance (NCQA) standards for medical home recognition. We awarded points to a practice for each NCQA element that it passed. We then calculated a practice's “structural readiness” score by dividing its point total by the available number. Finally, we estimated the proportion of physician practices that would achieve medical home status according to clinical specialty (i.e., urology versus other surgical specialty versus medical specialty). RESULTS Urology practices outperformed other surgical and medical specialty practices on ten of 15 measured elements. Moreover, urology practices achieved a higher percent of “must pass” elements (45.2% versus 33.7 versus 31.5%, respectively; P<0.001). Nearly three quarters of urology practices meet current NCQA standards for medical home recognition, as compared to just half of other surgical and medical specialty practices (Table). Estimate (95% Confidence Interval) Measure of Practices' Achievement Urology Other Surgical Specialty Medical Specialty p-Value Mean ‘structural readiness‘ score 44.8(38.5–51.0) 31.3(28.0–34.6) 28.2(26.0–30.4) <0.001 % of ‘must pass‘ elements achieved 45.2(39.1–51.2) 33.7(30.0–37.5) 31.5(29.2–33.9) <0.001 % achieving a given level of recognition <0.001 Not recognized 27.4(19.1–37.4) 47.8(41.3–54.4) 54.4(48.8–60.0) Level 1 34.3(23.8–46.8) 33.5(27.5–40.1) 28.6(22.7–35.2) Level 2 21.2(12.9–33.0) 11.6(7.8–16.9) 11.1(8.3–14.6) Level 3 17.1(9.3–29.4) 7.1(4.5–10.9) 5.9(3.4–10.3) CONCLUSIONS Our findings indicate that the majority of urology practices possess the “structural readiness” for implementation of proposed medical home reforms. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e35 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Hollingsworth Ann Arbor, MI More articles by this author Joseph W. Sakshaug Ann Arbor, MI More articles by this author David C. Miller Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Assessment of evidence-based psychotherapy practices in usual care: challenges, promising approaches, and future directions.

Assessment of evidence-based psychotherapy practices in usual care: challenges, promising approaches, and future directions.

Bridging the Osteoporosis Quality Chasm

Bridging the Osteoporosis Quality Chasm

Pay for quality — what every interventional cardiologist needs to know: Part I

Pay for quality — what every interventional cardiologist needs to know: Part I

Diabetes Self-Management Education: A Saga of Angels and Demons

As American Diabetes Association (ADA) President, Health Care & Education this past year, I have enjoyed a unique opportunity to interact with diabetes educators representing a variety of different practice settings from all across the United States, as well as from many different countries in other parts of the world. As my year unfolded, I began noticing some common issues and concerns that kept coming up. As a result, I have spent quite a bit of time reflecting on the role of diabetes self-management education (DSME) today in the treatment of diabetes and particularly on three key issues that I see challenging our ability to deliver quality DSME. The prevalence of type 2 diabetes has virtually exploded over the past 20 years. The Centers for Disease Control and Prevention (CDC) estimates that the incidence of diabetes is 1.3 million new cases annually.1 Many of us have seen the CDC's colored maps.2 These maps graphically illustrate the notion that our health care delivery system may be becoming overloaded from the challenge of treating > 18 million Americans with diabetes, to say nothing of the 41 million with prediabetes.1 Today, we have access to more and better pharmaceuticals and newer technologies than ever before to aid in the effective medical management of diabetes. So how well are our patients doing? Are Americans with diabetes wining or losing their war on diabetes? One well-regarded national measure of success is the National Committee on Quality Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS). This quality management tool is used by many health care professionals and policy makers to evaluate the quality of performance in key areas such as diabetes management. The NCQA 2004 State of Health Care Quality Report cites HEDIS data showing that 15% of diabetes patients covered …

MCOs Still Not Getting Mental Health Care Right

Back to table of contents Previous article Next article Health Care EconomicsFull AccessMCOs Still Not Getting Mental Health Care RightMark MoranMark MoranSearch for more papers by this authorPublished Online:19 Nov 2004https://doi.org/10.1176/pn.39.22.00390005Managed care plans that publicly report performance data showed significant gains in quality of care last year on several critical measures, but no gains were recorded on key measures in the treatment of mental illness, according to a report by the National Committee on Quality Assurance (NCQA).The NCQA's annual report, “State of Health Care Quality,” found that performance improvements recorded last year among the 563 managed care plans that reported their results were among the largest ever. These plans cover about 69 million people and represent a subsection of the broader health care system, according to the NCQA.Average health plan performance in the area of controlling high blood pressure improved from 58 percent to 62 percent, an improvement that will mean about 2,500 fewer fatal heart attacks this year, according to the NCQA. Health plans are also doing a better job controlling the cholesterol of patients with diabetes; rates for that measure improved from about 55 percent to over 60 percent.But the NCQA report specifically singled out mental health as an area where the performance of managed care plans has been dismal. Rates for two key measures—follow-up care and medical management of depression—remain generally low and indicate that patients get the correct care only about 50 percent of the time, according to NCQA.The report is based on results from managed care plans that use the NCQA's Health Plan Employer Data and Information Set (HEDIS), a tool to measure performance on important dimensions of care and service. NCQA is a nonprofit accrediting organization for managed care organizations.Lawrence Lurie, M.D., chair of APA's Committee on Managed Care, said the NCQA report is a worthwhile effort to measure quality across the health care system, but questioned what health plans are doing to remedy deficiencies in treatment of mental illness.“What NCQA is measuring is important,” Lurie told Psychiatric News. “Follow-up treatment after hospitalization is an especially critical issue. But the question I would raise is whether health plans are doing anything to provide incentives, or make it easier, for clinicians to meet the performance measures.”At least one psychiatrist and APA leader expressed deep skepticism about the integrity of the findings. Edward Gordon, M.D., chair of APA's Advisory Committee on Medicare and member of the APA Committee on RBRVS, Codes, and Reimbursement, called NCQA an apologist organization for the managed care industry. “If [the plans] cared about patient needs, they would take a position for parity in mental illness,” he said.In the area of medical management of depression, the HEDIS measure looks at the percentage of members of a managed care plan with depression who received antidepressant medication during the acute phase (defined as the 12-week period following diagnosis) and the continuation phase (the six-month period following diagnosis). The measure also looks at the percentage of a plan's patients who received at least three visits with a clinician during the 12-week period following diagnosis.In the commercial market, 60.7 percent of patients were prescribed antidepressant medication during the acute phase, and only 44.1 percent of all patients with depression remained on antidepressant medication continuously during the six-month period following diagnosis. And just 20.3 percent received at least three visits with a clinician during the 12-week period following diagnosis, according to NCQA data.Rates were even lower for Medicare and Medicaid patient (see chart on page 5).The HEDIS instrument also measures the percentage of patients in a managed care plan who received follow-up treatment after hospitalization for mental illness.According to the NCQA report, 74.4 percent of patients in the commercial market had a follow-up visit in the 30-day period following hospitalization last year. Among Medicare patients, 60.3 percent received a follow-up visit, while 56.4 percent of Medicaid patients received a follow-up visit during the 30-day period following hospitalization.The report is posted online at<www.ncqa.org/communications/SOMC/SOHC2004.pdf>.▪ ISSUES NewArchived

Perspectives on the Value of American Society of Clinical Oncology Clinical Guidelines as Reported by Oncologists and Health Maintenance Organizations

Although the American Society of Clinical Onoclogy's (ASCO) Health Services Research (HSR) committee activities have primarily focused on clinical guideline development, little is known about the value placed on these guidelines by the desired end users. ASCO members and Health Maintenance Organizations (HMOs) were surveyed on the value and implementation of ASCO guidelines. In this article, we summarize our findings. ASCO members (n = 1500) were queried about whether they had read ASCO's first four clinical guidelines and technology assessment; whether they agreed with the recommendations; whether they used guidelines in clinical practice; and how guidelines had affected reimbursement. HMOs (n = 131) were queried on how they identify, implement, and value the first four ASCO clinical guidelines. The membership survey indicated that ASCO guidelines were read more often by physicians in private healthcare settings compared with physicians in academic practices (P <.02). Disagreement rates were low for all guidelines (range, 1% to 7%). One quarter of respondents reported that the guidelines were difficult to find and difficult to apply to the practice setting, and approximately one tenth of respondents indicated that the guidelines were difficult to evaluate, interpret, or read. The HMO survey indicated that one third of HMOs reported use of ASCO guidelines, with higher rates of usage by larger HMOs and by those with higher National Committee on Quality Assurance (NCQA) ratings. Respondent HMOs valued guidelines for various purposes and used multiple methods of guideline identification and implementation. ASCO guidelines are generally highly supported by physicians and HMOs. Additional studies are needed to identify implementation barriers and to see whether guidelines have resulted in improvements in healthcare.

National Committee on Quality Assurance health-plan accreditation: predictors, correlates of performance, and market impact.

Accreditation of health care organizations has traditionally been considered a building block of quality assurance. However, the differences between accredited and nonaccredited health plans and the impact of accreditation on plan enrollment are not well understood. To determine the characteristics of plans that have submitted to accreditation review, the performance of accredited plans on quality indicators and the impact of accreditation on enrollment. The databases containing 1996 data on health plans' National Committee on Quality Assurance (NCQA) accreditation status, organizational characteristics, Health Plan Employer Data and Information Set (HEDIS) scores, and patient-reported quality and satisfaction scores were linked to compare accredited health plans to nonaccredited plans. We also combined longitudinal data sets (1993-1998) on accreditation and health plan enrollment. Mean performance of accredited and nonaccredited plans on HEDIS measures and patient-reported measures of quality; health plan enrollment changes. Accredited plans have higher HEDIS scores but similar or lower performance on patient-reported measures of health plan quality and satisfaction. Furthermore, a substantial number of the plans in the bottom decile of quality performance were accredited suggesting that accreditation does not ensure high quality care. Receipt of accreditation has been associated with increased enrollment in the early years of the accreditation program; however, plans denied NCQA accreditation do not appear to suffer enrollment losses. NCQA accreditation is positively associated with some measures of quality but does not assure a minimal level of performance. Efforts now underway to incorporate plan performance on HEDIS into criteria for accreditation seem warranted.

Championship Management for Healthcare Organizations

Stakeholders will put increasing pressure on integrated health systems (IHS) for measured performance, demanding data on quality and patient satisfaction, while simultaneously pressing for lower cost. The changes to Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and the growing importance of the National Committee on Quality Assurance (NCQA) are simply forerunners of an intensifying trend. Quality of care in particular will face increasing scrutiny. Achieving competitive targets in these areas will also require measures addressing demand and worker satisfaction. "Balanced scorecard" approaches will allow IHS and their accountable work groups to track performance on several dimensions and establish integrated goals or targets. Those with consistently good scores will be labeled "champions." Champions will support the multidimensional measures with improved decision processes. About eight major processes will be central--governance/strategic management, clinical quality, clinical organization, financial planning, planning and marketing, information services, human resources, and plant services. It is possible to map these processes to the criteria of the Joint Commission, NCQA, and Malcolm Baldrige Quality Award. The processes themselves can be measured and common weaknesses identified and corrected. Champions share some common characteristics that seem to arise from the combination of processes and measures. Among these characteristics are service line orientation, extensive partnering with other organizations, and the possibility of outsourcing organizational components.

Effective reports for health care quality data: lessons from a CAHPS demonstration in Washington State.

Advances in quality measurement and increased interest by is more difficult than communication about other industries because of the tremendous range of needs that people have lay persons in being more involved in decisions about their health care have created a significant demand from consumers for health care [3]. In recent years, important steps have been taken to address for information on quality of health care [1–3]. Developing easy-to-use and understandable formats for presenting health these issues. Health care accreditation, regulatory, and government organizations in the USA have made a concerted effort care quality information to consumers is a necessary condition for meeting this demand and for stimulating competition on to develop and standardize measures of health care quality. The National Committee on Quality Assurance (NCQA) has, over quality. Consumers’ decisions about which health plan and provider several years, refined its Health Plan Employer Data and Information Set (HEDIS) which has set standards for measures to select often are not based on standardized quality information, but recent studies suggest that there is increasing of health care quality in managed care health plans. In addition, federal agencies, such as the Agency for Health Care Policy interest in consumer survey data [4]. If consumers can be given salient, accurate, and easily interpretable reports on and Research (AHCPR), and private foundations have funded research to help understand what consumers need to know quality of health care, this may not only help them to make better choices about their health care, but health care about health care quality, how best to measure quality, and how best to present information to consumers [3,4,6–8]. This organizations may also be more motivated to improve the quality of the care that they provide [5]. research includes the work of the Picker-Commonwealth Program for Patient Centered Care [9–11], recent efforts by the There are several challenges in effectively providing health care quality information to consumers. First, there is no Health Care Financing Administration (HCFA) to assess consumer experiences with care [12], and surveys by AHCPR, the consensus about the critical measures of quality [2]. For other consumer products there are well-established definitions of Commonwealth Fund, and the Kaiser Family Foundation to assess what information consumers are most interested in and excellence. For example, automobiles typically are rated on comfort, fuel economy, power, safety, and reliability by rewould find most useful [4]. Employers and other purchasers also have initiated many cognized sources using commonly accepted measures. No set of accepted measures is yet available for health care. important efforts. The Minnesota Health Data Institute, the Southeastern Michigan Employer and Purchaser, the Second, not enough attention has been paid to developing and assessing effective means of communicating with consumers Massachusetts Health Purchasers Group, and the Pacific Business Group on Health, among others, have all provided about health care quality. Knowledge about how to develop effective consumer report formats for complex health care comparative data on health care quality to consumers. These programs have added significantly to the growing knowledge data is just emerging. Communication about health care data