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Understanding claims-based quality profiles in primary care practice: the role of office system tools and health
1Mark A. Davis, PhD, is Professor, Department of Management, College of Business, University of North Texas, Denton. E-mail: Mark.Davis@unt.edu. Robert J. Pavur, PhD, is Professor, Department of Information Technology and Decision Sciences, College of Business, University of North Texas, Denton. E-mail: Robert.Pavur@unt.edu. The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.
Background:
Claims-based quality profiles are increasingly used by third-party payers as a means of monitoring and remunerating physician performance. As traditional approaches to assessing performance yield to electronically generated data, identifying practice tools capable of influencing the behavior of these measures becomes essential to effectively managing medical practices.
Purpose:
The aim of this study was to examine the effect of using office system tools (i.e., patient registries, physician reminders, and flow sheets) and health information technology (HIT) on claims-based quality profile scores in primary care practices.
Methodology:
We analyzed survey responses from primary care physicians (n = 191) regarding their use of office system tools and HIT. These responses were linked to quality profile scores obtained from a Blue Cross Blue Shield of Texas claims-based data set.
Findings:
Elevated quality profile scores were associated with physicians who reported higher use of HIT. In addition, the influence of one office system tool, physician reminders, was contingent upon the availability and use of HIT.
Practice Implications:
Our findings indicate that primary care practices that fail to implement or use HIT appropriately will fare poorly in systems that monitor and reward performance based on measures derived from claims data. Linking prompts or reminders directly to clinical actions that influence quality indicators endorsed by payers should be a component of quality assurance programs.
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