Defining Barriers and Potential Solutions for Collecting and Reporting Quality Performance Measures in Primary Care Offices

Despite available reimbursement incentives to primary care practices to track performance and quality measurements, many practices lack the needed experience, resources, or time to become fully engaged in these programs. In this project, primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) were asked to conduct quality performance monitoring data collection and reporting (QPMDCR) projects. Five practices were involved in the project representing a range of practice sizes, patient populations, resources, medical record systems (both electronic and paper-based), and experience with quality improvement projects. Relevant literature from 1989 to the present was shared with the practices to supplement the research of practice experience. The main objectives of the project were to:

• Implement QPMDCR projects at selected primary care practices.
• Develop a process model outlining a series of steps practices need to consider as they move toward implementation of performance monitoring.
• Develop an interactive Web tool for practices' self-assessment of strengths and weaknesses relative to conducting performance monitoring.
• Synthesize relevant literature of quality performance monitoring and reporting in ambulatory care settings, especially primary care offices.

The five practices completed implementations and had some degree of success in their selection and planning of projects, data collection, and generation of comparative reports. Each practice approached the task differently with some relying heavily on physician involvement, and others relying on nursing and other practice staff. How data were collected also varied, with some using manual data collection, some using automated methods, and some using a combination of the two methods. Practices encountered multiple and significant barriers such that while four of the five will continue some form of performance monitoring, one is likely to be discontinuing any further efforts in this area. A major barrier to this work was the lack of expertise within the practice in systematic collection and analysis of performance data. Practices need assistance in order to identify, implement, and learn the systems which provide these functions. Financial support was needed in order to compensate those involved in the projects, including the time needed for physician champions to lead efforts, and collect and analyze the data.