PCPs identify 8 ways to improve MU clinical quality measures

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In response to requests from the Agency for Healthcare Research and Quality to help inform clinical quality metrics in the meaningful use program, researchers interviewed primary care providers in focus groups and discussed CQMs and opportunities for improvement.

The findings from the focus groups were published in The American Journal of Managed Care and highlight eight key themes in regard to CQMs.

Here are those eight themes which discuss how to improve CQMs in the meaningful use program.

1. CQMs should be evidence-based, relevant for primary care physicians and updated regularly. For example, some physicians in the focus group expressed concern that some CQMs weren't aligned with the most updated guidelines, specifically new guidelines regarding high cholesterol from the American College of Cardiology/American Heart Association.

2. Public health-focused CQMs should apply to all providers. Certain CQMs are fair game across specialties, especially ones related to public health, like smoking cessation and obesity, according to the study. One participant in a focus group said, "Why can't you have a core like smoking cessation that applies to everybody? Why can't your dermatologist say, 'Stop smoking?'"

3. CQMs should focus on outcomes more than process. Though positive outcomes are harder to achieve than positive process numbers, many physicians said outcomes are more indicative of quality care, especially in chronic disease management.

4. Reporting CQMs should not add to workflow. The quality measures should center on achieving improved outcomes without requiring additional work, participants said. Instead, reporting should be automatically integrated into the workflow. One participant said, "Why do we have to click a box to say that we did medication reconciliation? When we opened the medication list or we made a couple of changes in medications, shouldn't that be automatically recorded?"

5. Implementing performance thresholds may boost quality. By focusing on a limited, select group of measures, physicians said quality improvements may be more attainable than having to monitor numerous measures without any thresholds.

6. Patient-generated data could be automatically captured in the EHR and incorporated into CQMs. Patient-generated data could augment clinician-captured data and can be used for clinical care purposes. Participants said any such data should still be reviewed by a clinician to ensure it is in a format that doesn't create errors. They also said evidence that such data improves outcomes is needed before developing related CQMs.

7. Developing CQMs locally can promote innovation. If developed locally, CQMs could boost innovation and create more measures that are relevant and useful for primary care physicians at the point of care. "Meaningful use ought to be using the EHR in a way that allows the providers to really figure out what they are doing with their patients and get the feedback on it," one participant said. "It really isn't sending something off to Congress so that two years from now you don't get a penalty."

8. Population health management tools are key. Health IT tools are critical for population management, participants said. They also indicated a business case for incorporating population health management tools, such as reaching out to patients who are past due for certain services, which would be beneficial to providers in the pay-for-performance environment.

"CQMs most likely to effectively improve quality in primary care should be limited to those that are evidence-based, focused on high-priority conditions, do not require additional documentation, and facilitate population management," researchers concluded.

More articles on meaningful use:

3 thoughts from Dr. Karen DeSalvo on the country's IT strategic plan
Small, rural hospitals still lagging significantly on EHR adoption
Life of a healthcare CIO: Allina Health's Susan Heichert


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