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Core Principles to Improve Primary Care Quality Management.

Justin B Mutter¹, Winston Liaw², Miranda A Moore²

¹From Department of Medicine, Center for Biomedical Ethics and Humanities, University of Virginia School of Medicine, Charlottesville, VA (JBM); Robert Graham Center, Washington DC (JBM, WL, AB); Department of Family and Community Medicine, University of Texas Health Science Center at Houston, Houston, TX (WL); Department of Family and Preventative Medicine, Emory University School of Medicine, Atlanta, GA (MAM); Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond (RSE); Department of Population Health and Primary Care, Norwich Medical School University of East Anglia, Norwich, UK (AH) jbm4n@hscmail.mcc.virginia.edu.

Journal of the American Board of Family Medicine : JABFM

|November 11, 2018

Summary

American healthcare quality management faces challenges. A new approach, guided by four core principles, is needed to improve primary care and achieve the Quadruple Aim.

Keywords:

Children's Health Insurance Program Medicare Population Health Primary Health Care Quality of Health Care

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Area of Science:

Health Services Research
Quality Improvement Science
Primary Care Medicine

Background:

Current quality management in US healthcare is inefficient and burdensome, particularly in primary care.
The effectiveness of performance measurement in achieving the Quadruple Aim is increasingly questioned.
Existing quality improvement efforts in primary care have often failed due to a lack of alignment with core primary care principles.

Purpose of the Study:

To assess the current state of quality management in US primary care.
To examine the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) in comparative perspective.
To propose a principles-based framework for effective primary care quality management.

Main Methods:

Comparative analysis of US quality management with the UK's Quality and Outcomes Framework.
Assessment of current performance measurement burdens in primary care.
Identification of foundational principles for high-functioning primary care.

Main Results:

Current quality management systems are costly, redundant, and do not effectively support the Quadruple Aim.
Primary care delivery is crucial for healthcare quality, but past improvement efforts have been largely unsuccessful.
A disciplined approach grounded in four principles is essential for successful quality management.

Conclusions:

Quality management in primary care requires adherence to four foundational principles: optimizing health, harnessing the Quadruple Aim, using measurements as tools, and prioritizing therapeutic relationships.
Implementing these principles can create a pathway to high-functioning primary care.
This approach aims to advance American healthcare closer to achieving the Quadruple Aim.