The Agency for Healthcare Research and Quality (AHRQ) has recently released two white papers related to quality improvement in primary care (PC).
As part of the effort to create a quality health care system in the United States, a variety of organizations, including many payers and delivery systems, are encouraging PC care organizations to use quality improvement (QI) initiatives to improve their performance. QI requires practices to:
- continually assess performance,
- plan changes in areas where improvements are warranted,
- monitor the effects of those changes, and
- refine as needed.
Use of QI by PC practices is an important component of efforts to improve population health. It will also result in improvement of the patient and provider experience and decrease the cost of care.
However, these activities are not routinely integrated into PC, and engaging in QI activities will be a new endeavor for most practices. Getting practice buy-in to undertake QI is challenging. This paper provides strategies for practice facilitators and the organizations that train and deploy them, based on the experiences of experts in the field.
Since QI activities are not routinely used in PC practices, using these strategies will be a new experience. This white paper was developed for practice facilitators and those who deploy them, and makes the following recommendations about strategies for facilitators to use in successfully engaging practices:
- assess the practice’s readiness to engage,
- develop tailored strategies appropriate for the practice, and
- maintain practice buy-in for meaningful and sustained engagement in QI efforts.
It is widely agreed that reshaping and revitalizing the PC system in the United States is critically important to achieving high quality, accessible, and efficient health care for all Americans. PC practices can improve their ability to deliver high quality care and improve patient outcomes through the effective use of health IT to facilitate QI.
While it is recognized that adaption of health IT by PC has been encouraged through recent health care policies and incentives, it is also recognized that significant barriers exist. These include:
- time and capital costs,
- lack of provider and staff training in data analysis and QI, and
- unfamiliarity with the potential benefits of using health IT for QI.
The authors of this white paper note there needs to be similar efforts “to encourage and expand use of health IT for QI.” They conclude by saying:
“With these barriers in mind, we recommend the following next steps for collaboration among PC practices, practice facilitators, IT developers, and decisionmakers to increase the use of health IT for QI in primary care:
- Share examples of exemplary uses and best practices to inspire and guide primary care practices seeking to create a culture that embraces using health IT for QI.
- Continue to develop and refine technology to produce high-functioning, interoperable health IT tools.
- Empower PC providers and staff with the necessary knowledge and skills to maximize the use of health IT for QI.
- Provide guidance and tools to help PC practices redesign processes and workflows to accommodate the effective use of health IT for QI.
- Expand the availability of financial and other transformation incentives and supports.
Although significant obstacles prevent many PC practices from using health IT for QI, practices in diverse settings have demonstrated it is possible and pays off in improved processes of care and patient outcomes. Additional support for PC practices seeking to make these transformations—in the form of payment reforms and technical assistance—will help more practices adopt a culture of commitment to using health IT for continuous QI and ultimately ensure patients are receiving the best possible primary care.”