Coulam Robert, Kralewski John, Dowd Bryan, Gans David
Robert Coulam, PhD, JD, is Professor of Practice in Health Policy and Management, Simmons College, Boston, Massachusetts. E-mail:
Health Care Manage Rev. 2016 Apr-Jun;41(2):145-54. doi: 10.1097/HMR.0000000000000061.
Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators.
To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States.
We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues.
Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management.
Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results.
More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if supported by more useful forms of quality reporting.
尽管有大量关于影响医疗集团实施质量保证（QA）计划因素的研究，但很少有研究关注集团管理人员的作用。
为深入了解这些管理人员在QA计划中所起的作用，我们分析了医疗实践如何采用和实施美国最大的医生质量报告系统——医疗保险医师质量报告系统（PQRS）。
2011年，我们对全国76名医疗集团管理人员进行了便利抽样焦点小组访谈。使用范德文及其同事的创新决策框架对回答进行整理和分析。
管理人员对PQRS进行了尽职调查，影响了向医生介绍该问题以供采用的方式，并在此后管理实施过程。管理人员的建议受到实践特征、财务激励措施以及实践中对尽早采用质量改进创新措施的承诺的严重影响。几乎所有尝试实施的人都认为PQRS实施起来很简单。然而，医疗保险PQRS报告的复杂性阻碍了管理人员使用这些数据来支持质量管理。
医疗集团管理人员在与患者护理质量相关的活动中发挥着重要作用——他们不仅限于实践的业务方面。特别是，随着2014年后PQRS的普及程度越来越高，医疗保险应考虑管理人员所起的作用，更积极地让管理人员参与制定这些计划，并使管理人员更容易使用结果。
需要对医疗集团中非医生管理人员迅速演变的作用进行更多研究。实践管理人员在质量报告倡议的采用和使用方式中所起的作用比通常理解的要大，如果有更有用的质量报告形式提供支持，他们在影响更合理地使用这些资源方面处于特殊地位。
