Donahue Katrina E, Reid Alfred, Baxley Elizabeth G, Carter Charles, Carek Peter J, Robinson Mark, Newton Warren P
University of North Carolina Department of Family Medicine, and Cecil G. Sheps Center for Health Research, Chapel Hill, NC.
University of North Carolina Department of Family Medicine.
Fam Med. 2018 Mar;50(3):179-187. doi: 10.22454/FamMed.2018.885946.
The I3 POP Collaborative sought to improve health of patients attending North Carolina, South Carolina, and Virginia primary care teaching practices using the triple aim framework of better quality, appropriate utilization, and enhanced patient experience. We examined change in triple aim measures over 3 years, and identified correlates of improvement.
Twenty-nine teaching practices representing 23 residency programs participated. The Institute for Health Care Improvement Breakthrough Series Collaborative model was tailored to focus on at least one triple aim goal and programs submitted data annually on all collaborative measures. Outcome measures included quality (chronic illness, prevention); utilization (hospitalization, emergency department visits, referrals) and patient experience (access, continuity). Participant interviews explored supports and barriers to improvement.
Six of 29 practices (21%) were unable to extract measures from their electronic health records (EHR). All of the remaining 23 practices reported improvement in at least one measure, with 11 seeing at least 10% improvement; seven (24%) improved measures in all three triple aim areas, with two experiencing at least 10% improvement. Practices with a greater number of patient visits were more likely to show improved measures (odds ratio [OR] 10.8, 95% confidence interval [CI]: .68-172.2, P=0.03). Practice interviews revealed that engaged leadership and systems supports were more common in higher performing practices.
Simultaneous attainment of improvement in all three triple aim goals by teaching practices is difficult. I3 POP practices that were able to pull and report data improved on at least one measure. Future work needs to focus on cultivating leadership and systems supporting large scale improvement.
I3 POP协作项目旨在利用提高质量、合理利用资源和增强患者体验的三重目标框架，改善北卡罗来纳州、南卡罗来纳州和弗吉尼亚州初级保健教学机构中患者的健康状况。我们研究了三年来三重目标指标的变化情况，并确定了改善的相关因素。
来自23个住院医师培训项目的29个教学机构参与其中。对医疗保健改进研究所突破性系列协作模式进行了调整，以专注于至少一个三重目标，各机构每年提交所有协作指标的数据。结果指标包括质量（慢性病、预防）；资源利用（住院、急诊就诊、转诊）和患者体验（就医渠道、连续性）。通过参与者访谈探讨了改进的支持因素和障碍。
29个机构中有6个（21%）无法从其电子健康记录（EHR）中提取指标。其余23个机构均报告至少有一项指标有所改善，其中11个机构的改善幅度至少达到10%；7个（24%）机构在所有三个三重目标领域的指标均有所改善，其中两个机构的改善幅度至少达到10%。患者就诊次数较多的机构更有可能显示出指标改善（优势比[OR]为10.8，95%置信区间[CI]：0.68 - 172.2，P = 0.03）。机构访谈显示，积极的领导和系统支持在表现较好的机构中更为常见。
教学机构同时实现所有三个三重目标的改善很困难。能够提取并报告数据的I3 POP机构至少在一项指标上有所改善。未来的工作需要专注于培养支持大规模改进的领导力和系统。
