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Patient Safety and Quality

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Medical groups want to improve chronic disease care but many feel constrained by limited resources and lack of financial incentives

Multiclinic medical groups are motivated to improve the quality of their chronic disease care but feel hampered by limited resources and lack of financial incentives to improve quality. In a study supported by the Agency for Healthcare Research and Quality (HS09946), researchers surveyed medical and administrative leaders of 18 medical groups, 84 of their constituent clinics, and their primary care physicians in one metropolitan area.

Of the 18 medical groups, 17 had an overall physician leader for quality improvement (QI), and 11 had a leader at each of their constituent clinics. Almost 100 percent of clinical leaders reported that their medical groups saw QI as important and expected clinics to improve care for diabetes and heart disease. For example, 89 percent of clinic site leaders reported that their group had mapped steps to improve quality, and 83 percent held regular formal QI meetings. In addition, a majority of the medical groups were involved in QI initiatives for diabetes and heart disease care (83 and 67 percent, respectively).

Only one-third of medical group directors thought there were adequate resources for QI. About 17 percent thought that their incentives (bonuses or penalties based on quality of care) were aligned with quality or that physician compensation was affected by quality. However, 72 percent of medical groups measured physician performance for diabetes, and 61 percent did so for coronary heart disease.

More details are in "The quest for quality: What are medical groups doing about it?" by Leif I. Solberg, M.D., Patrick J. O'Connor, M.D., M.P.H., Jon B. Christianson, Ph.D., and others, in the April 2005 Journal on Quality and Patient Safety 31(4), pp. 211-219.

Editor's Note: A related article gives six examples of quality-based payments that have been implemented in the United States and four developing countries to improve care quality. For more details, see McNamara, P. (2005). "Quality-based payment: Six case examples." International Journal of Quality in Health Care 17(4), pp. 357-362. Reprints (AHRQ Publication No. 05-R060) are available from the AHRQ Publications Clearinghouse.

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