Overuse, underuse, and misuse: Improving effective primary care at a Federally Qualified Health Center.

BACKGROUND

U.S. healthcare costs have increased exponentially to almost $4 trillion. Despite increased costs, patient outcomes remain suboptimal. It is imperative that primary care providers are intentional with testing and medical technology to improve effective care.

LOCAL PROBLEM

Preintervention chart audits showed average overspending of $79.41 per provider per day. Despite overspending, outcomes are not optimal. Only 48% of persons with hypertension and 38% of persons with diabetes at Orange Blossom Family Health (OBFH) are controlled. The aim of this 8-week quality improvement (QI) project was to decrease lab spending by 20% for adult primary care patients at OBFH.

METHODS

A rapid cycle QI initiative of four Plan-Do-Study-Act cycles, 2 weeks each, was completed to implement four interventions concurrently. The data was assessed every 2 weeks with iterative tests of change as indicated.

INTERVENTIONS

The primary care quality metrics chart audit and preclinical care coordination tools were developed, and the My Life, My Healthcare tool and medical assistant (MA)-provider huddles were initiated with the focus on effective patient care.

RESULTS

A savings of $3406.43 on overordering of labs by one provider in 8 weeks was identified. The average provider compliance to national guidelines was found to be 54.1%. There was a 19.3% increase in referrals. MA-provider huddles were balanced for this initiative.

CONCLUSIONS

The initiative addressed effective care through awareness of resource allocation, patient engagement, and team communication. Continued application of these core interventions will ensure consistent and quality healthcare.