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Patient Safety and Quality

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A multifaceted quality improvement program can have a robust impact on the quality of primary care

Primary care practices that participate in a quality improvement (QI) project, which involves performance reports, optional practice site visits to educate clinicians, and annual network meetings to share best practices, can improve their performance on a broad spectrum of clinical quality indicators, concludes a new study. The researchers examined the impact of a QI demonstration project on 31 process and 5 outcome quality measures among practices in a primary care practice-based research network, the Practice Partner Research Network (PPRNet). The QI program, which involved 99 practices that used the same electronic medical record (EMR) system and 530 clinicians and staff, significantly improved 29 of the 36 quality of care measures.

A Medical University of South Carolina team, led by Steven Ornstein, M.D., extracted EMR data on 847,073 patients to identify the quality measures pertinent to cardiovascular disease and diabetes, cancer screening, adult immunization, respiratory and infectious disease, mental health and substance abuse, obesity and nutrition, safe medication prescribing in the elderly, as well as a summary measure, the Summary Quality Index (SQUID). With the QI program, the SQUID improved by 2.43 percent, with clinically significant improvements for 29 of the 36 quality measures, including all 5 outcome measures. The specific improvement strategies involved prioritizing performance, involving all staff in development of QI approaches, redesigning delivery systems, activating patients (for example, limiting medication refills when appointments were needed), and using EMR tools to a greater extent.

The findings suggest that broader adoption of EMR and specific QI activities among primary care practices can improve the quality of primary care in the United States.

The study was supported by the Agency for Healthcare Research and Quality (HS13716). More details are in "Improving the translation of research into primary care practice: Results of a national quality improvement demonstration project," by Dr. Ornstein, Paul J. Nietert, Ph.D., Ruth G. Jenkins, Ph.D., and others, in the July 2008 Joint Commission Journal on Quality and Patient Safety 34(7), pp. 379-390.

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