Learning from primary care meaningful use exemplars.

Area of Science:

• Health Informatics
• Quality Improvement
• Primary Care Research

Background:

• Clinical Quality Measures (CQMs) are a key requirement for Meaningful Use (MU) incentive payments under the HITECH Act.
• Evidence is needed on how electronic health records (EHRs) can be leveraged by practices to improve CQM performance.
• Studying high-performing practices can provide valuable insights into successful EHR implementation for quality improvement.

Purpose of the Study:

• To assess the association between EHR use, staff education, and quality improvement strategies with CQM performance in primary care practices.
• To identify specific EHR functionalities and practice characteristics associated with high CQM performance.

Main Methods:

• A multimethod study was conducted in a national primary care practice-based research network (PPRNet).
• Included EHR-based CQM performance assessment, a provider survey on EHR use and QI strategies, and focus groups.
• Statistical analyses (general linear mixed models) examined associations between survey responses and CQM performance.

Main Results:

• Seventy-one practices participated; 319 providers completed the survey.
• Wide variability in CQM performance was observed, with mean performance ranging from 89.8% (tobacco use screening) to 12.9% (chlamydia screening).
• EHR reminders were most consistently associated with individual CQM performance, while practice QI and administrative variables related to a summary quality measure.

Conclusions:

• Purposeful utilization of EHR functionalities, combined with staff education and a supportive quality improvement environment, is associated with higher CQM performance.
• EHR reminders and practice-level QI efforts are important factors in achieving better quality measure outcomes.