Getting performance metrics right: a qualitative study of staff experiences implementing and measuring practice...

Area of Science:

• Healthcare quality improvement
• Primary care transformation
• Health services research

Background:

• The patient-centered medical home (PCMH) model prioritizes quality improvement through performance measures.
• Existing research indicates performance measurement can improve care but may also introduce detrimental practices.
• Staff perceptions of performance metric implementation in PCMH settings remain under-researched.

Purpose of the Study:

• To explore primary care staff experiences with performance metrics during the implementation of the Veterans Health Administration's (VHA) Patient Aligned Care Team (PACT) model.
• To understand how performance metrics influence care delivery and staff perceptions within a large healthcare system.

Main Methods:

• An observational qualitative study design.
• Data collected via role-stratified focus groups and semi-structured interviews with 241 primary care staff across 15 VHA clinics.
• Conventional content analysis techniques applied for data coding and analysis.

Main Results:

• Staff reported performance metrics led to care changes misaligned with PACT principles.
• Metrics were perceived as not accurately reflecting patient priorities and representing an opportunity cost.
• Implementation involved limited communication and transparency, with metrics poorly adapted to team-based care.

Conclusions:

• Primary care staff viewed performance metric adherence as time-consuming and inconsistent with PACT care principles.
• Discrepancies between the intended use of metrics and their real-world application in PACT settings were identified.
• These insights are vital for optimizing the broader implementation of the medical home model.