Bringing Measurement to the Point of Care (New York)

Summary: 

This project assessed the impact and challenges of introducing health information technology tools to assist small primary care practices in measuring quality of care. In collaboration with an electronic health record (EHR) vendor, the Primary Care Information Project (PCIP) deployed new functionality that allowed clinicians to view 'real time' measures of the delivery of clinical preventive services. In addition, the EHR added patient specific alerts and 'one click' options to act on potentially missed opportunities for followup care or recommended preventive services. Providers using these systems were given substantial technical support and training to use these tools.

The primary objectives of this project were to:

  1. Design a simple and intuitive point of care quality measurement and decision support user interface.
  2. Validate a set of automated clinical quality measures that address priority public health issues.
  3. Characterize provider attitudes and measure provider satisfaction with performance indicators.
  4. Determine the impact of the quality dashboard on the accuracy of, and provider satisfaction with, EHR derived quality measures.
  5. Disseminate findings though national measurement consensus organizations (e.g., National Quality Forum's "Standardizing Ambulatory Care Performance Measures" project), through EHR vendors participating in this project, and through peer reviewed publications.

The study found that across the 56 practices involved, most did not have prior quality measurement experience or engage in quality improvement activities prior to the adoption of the EHR. Though most quality measures selected for this study showed post implementation improvement, a review of over 6,100 patient records showed that automated EHR-derived quality reports underreported many of the practices' performance. Providers found some documentation tasks within the EHR to be straight forward, while other data entry processes posed challenges that affect subsequent quality measurement and reporting.

Grant Number: 
R18 HS017059
Funding Mechanism: 
Ambulatory Safety and Quality Program: Enabling Quality Measurement through Health IT (R18)
AHRQ Funded Amount: 
$694,961
Principal Investigator: 
Wu, Winfred
Organization: 
New York City Health and Mental Hygiene
City: 
New York
Location: 
New York
Project Dates: 
September 30, 2007 to September 29, 2010
Project Status: 
Ended

Project Categories

Community: 
Non-rural
Care Setting: 
Ambulatory
Community Health Center
Family Medicine
Federally Qualified Health Center (FQHC)
Internal Medicine
Primary Care
Aspect of Care: 
Prevention
Quality Measurement/Quality Improvement
Target Population: 
Adults
Coronary Artery Disease
Diabetes
HIV/AIDS
Inner City
Low-SES/Low Income
Medicaid
Medically Underserved
Mental Health/Depression
Obesity
Racial/Ethnic Minorities
Racial/Ethnic Minorities: African American
Racial/Ethnic Minorities: Hispanic Latino
Safety Net
Uninsured
Last Modified: August 2015

News and Publications

Wu, W. Bringing Quality Measurement to the Point of Care - Final Report. (Prepared by New York City Department of Health and Mental Hygiene under Grant No. R18 HS017059). Rockville, MD: Agency for Healthcare Research and Quality, 2011. (PDF, 172.96 KB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Project Activities