Systems Research

A number of studies have shown that improving office systems and procedures can yield better quality and outcomes of care. For example, automated reminders to physicians can reduce prescribing errors and increase preventive services. Systematic performance measurement and feedback to physicians also enhanced quality of care in a variety of conditions. Studies published in JAMA by Bodenheimer using the Chronic Care Model link improved outcomes in diabetes, depression and other conditions.

RWJF supported NCQA with three grants to better understand the role of practice systems for providing high-quality care in the primary care practice setting for patients with chronic conditions and to inform the development of a standardized tool to assess practice systems. The first phase was the development of an assessment tool that identified systems or processes in doctors’ offices related to quality of care. Survey items were based on a review of health services literature and ratings from a panel of experts. Items for consideration were weighed with regard to whether systems were readily available or already in use and associated with improved outcomes (patient registry, physician reminders), compared with ideal systems that may not have yet been implemented but—in theory—would facilitate the delivery of high-quality care (integrated electronic medical records for tracking and follow-up on select patient populations).

The second phase focused on distinguishing personnel that could reliably report and identify systems in use at the practice. In the third phase, NCQA is studying whether there is a correlation between practice systems and measures of quality currently in use (e.g., rates of lipid screening or blood sugar for persons with diabetes). NCQA collaborated with several local initiatives in the California, Massachusetts and Minnesota to collect data using the practice systems survey. These sites also collected clinical performance or patient experiences data reported for community measurement or pay-for-performance.