Tackling the triple aim in primary care residencies: the I3 POP Collaborative

The I3 POP Collaborative's goal is to improve care of populations served by primary care residencies in North Carolina, South Carolina, and Virginia by dramatically improving patients' experience, quality of care, and cost-effectiveness. We examine residency baseline triple aim measures, compare with national benchmarks, and identify practice characteristics associated with data reporting.

We used a cross-sectional design, with 27 primary care residency programs caring for over 300,000 patients. Outcome measures were obtained via data pulls from electronic health records and practice management system submitted by residencies; they include quality measure sets for chronic illness and prevention, patient experience (usual provder continuity and time to third available), and utilization (emergency visits, hospitalizations, referrals, high-end radiology).

Thirteen practices (48%) reported all required baseline measures. We found associations between data reporting ability with registry use (59% versus 0%) and having a faculty member involved in data management (69% versus 29%). Reported measures varied widely; examples include colorectal cancer screening (median: 61%, range: 28%--80%), provider continuity (median: 52%, range: 1%--68%), subspecialty referral rate (median: 24%, range: 10%--51%). Seventy percent of patient-centered medical homes (PCMH) recognized practices had usual provider continuity (UPC) > or = collaborative median versus 0% of non-PCMH recognized practices. Median data were similar to national comparisons for chronic disease measures, lower for prevention and better for utilization.

Baseline triple aim data are highly variable among residencies, but residency care is comparable to available national standards. Registry use and faculty leadership in data management are critical success factors for assessing practice performance.