MITRE Corporation, McLean, VA, USA.
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Am Med Inform Assoc. 2018 Feb 1;25(2):127-134. doi: 10.1093/jamia/ocx049.
To identify physician and practice characteristics associated with high clinical and technical performance on the electronic clinical quality measure (eCQM) that calculates the proportion of patients with hypertension who have controlled blood pressure.
The study included 268 602 physicians participating in the Medicare Electronic Health Record Incentive Program between 2011 and 2014. Independent variables included delivery reform participation and physician, practice level, and area characteristics. Successful technical performance was a reported eCQM with non-zero values in both the numerator and denominator. Successful clinical performance was a reported eCQM value of ≥70% hypertension control.
Physicians with longer experience using certified health information technology, participants in delivery reform programs, and specialists that traditionally manage hypertension were 5%-15% more likely to achieve 70% control. Physicians in smaller and rural practices and a subset of physicians unlikely to primarily manage hypertension were more likely to submit measures with a zero value in either the numerator or denominator.
More physicians are using eCQMs to track and report their quality improvement efforts. This research presents the first examination of national eCQM data to identify physician and practice-level characteristics associated with performance.
With careful selection of measures relevant to the clinician's specialty, complete data entry, and support for continuous quality improvement, health care professionals can excel technically and clinically. As care delivery transitions from fee-for-service to quality- and value-based models, high performers may realize financial gains and better patient outcomes. These analyses suggest patterns that may inform steps to improve performance.
确定与电子临床质量衡量标准（eCQM）的临床和技术表现相关的医生和实践特征，该标准用于计算高血压患者中血压得到控制的比例。
本研究纳入了 2011 年至 2014 年间参与医疗保险电子健康记录激励计划的 268602 名医生。自变量包括参与交付改革和医生、实践水平和地区特征。成功的技术表现是报告的 eCQM，分子和分母均有非零值。成功的临床表现是报告的 eCQM 值≥70%的高血压控制率。
使用经认证的健康信息技术经验更丰富、参与交付改革计划的医生以及传统上管理高血压的专家，达到 70%控制率的可能性增加 5%-15%。较小规模和农村实践中的医生以及不太可能主要管理高血压的医生中，更有可能在分子或分母中提交零值的措施。
越来越多的医生正在使用 eCQM 来跟踪和报告他们的质量改进工作。本研究首次对全国 eCQM 数据进行了检查，以确定与绩效相关的医生和实践水平特征。
通过精心选择与临床医生专业相关的措施、完整的数据录入以及对持续质量改进的支持，医疗保健专业人员可以在技术和临床方面表现出色。随着医疗保健服务从按服务收费模式向质量和价值为基础的模式转变，高绩效者可能会获得经济收益和更好的患者结果。这些分析表明了可能有助于提高绩效的模式。
