학술논문
Achieving Large-Scale Quality Improvement in Primary Care Annual Wellness Visits and Hierarchical Condition Coding.
Document Type
Academic Journal
Author
Zeiger TM; University Hospitals, Cleveland, OH, USA.; Thatcher EJ; University Hospitals, Cleveland, OH, USA.; Kirpekar S; University Hospitals, Cleveland, OH, USA.; Coran JJ; University Hospitals, Cleveland, OH, USA.; School of Medicine, Case Western Reserve University, Cleveland, OH, USA.; Topalsky G; University Hospitals, Cleveland, OH, USA.; Zarach MJD; University Hospitals, Cleveland, OH, USA.; Cox DA; University Hospitals, Cleveland, OH, USA.; Schario ME; University Hospitals, Cleveland, OH, USA.; Fuller KA; University Hospitals, Cleveland, OH, USA.; Upton PM; University Hospitals, Cleveland, OH, USA.; Green TM; University Hospitals, Cleveland, OH, USA.; Pronovost PJ; University Hospitals, Cleveland, OH, USA. Peter.Pronovost@UHhospitals.org.; School of Medicine, Case Western Reserve University, Cleveland, OH, USA. Peter.Pronovost@UHhospitals.org.; Frances Payne Bolton School of Nursing and Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA. Peter.Pronovost@UHhospitals.org.
Source
Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Completion of Medicare Annual Wellness Visits (AWV) and documentation of Hierarchical Condition Categories (HCC) are important metrics in accountable care organizations (ACO) with quality and financial implications. To improve performance in large healthcare organizations, quality improvement (QI) efforts need to be scaled up in a way that is feasible within available system-wide resources.
Objective: We describe a 3-year effort using a multifaceted QI framework called the fractal management system for AWV and HCC performance.
Design: Pre-post evaluation of a multi-level, health system-wide QI management system intervention between 2018 and 2020. The system provided project management, coaching, communications, feedback of performance, and health informatics.
Participants: The intervention was delivered to all 97 primary care practices within an Ohio-based accountable care organization, comprising 72,603 attributed Medicare and Medicare Advantage patients as of 2018. Eighty-nine of these practices were included in the analysis.
Approach: AWV completion was defined as percent of eligible patients with a documented AWV during the calendar year. HCC completion was defined as documented reassessment of all prior-year HCC conditions.
Key Results: AWV completion at the practice level increased from 23.7% (SD .14) in 2018 to 34.9% (SD .18) in 2019, and 59.8% (SD .17) in 2020. This was a statistically significant effect of time on AWV completion rates overall (F[2, 87] = 164.43, p < .000). More than half (56.2%) of practices met or exceeded the 60% goal in 2020. Practice-level HCC completion tracking started in 2019 (M = 75.9%, SD 7.4%) and increased in 2020 (M = 79.7%, SD 7.1%); t(172) = 2.0, p < .001.
Conclusions: AWV and HCC performance goals were met in 2020, despite service disruptions due to COVID-19. The QI approach we used is applicable to other problems and other large healthcare systems.
(© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.)
Objective: We describe a 3-year effort using a multifaceted QI framework called the fractal management system for AWV and HCC performance.
Design: Pre-post evaluation of a multi-level, health system-wide QI management system intervention between 2018 and 2020. The system provided project management, coaching, communications, feedback of performance, and health informatics.
Participants: The intervention was delivered to all 97 primary care practices within an Ohio-based accountable care organization, comprising 72,603 attributed Medicare and Medicare Advantage patients as of 2018. Eighty-nine of these practices were included in the analysis.
Approach: AWV completion was defined as percent of eligible patients with a documented AWV during the calendar year. HCC completion was defined as documented reassessment of all prior-year HCC conditions.
Key Results: AWV completion at the practice level increased from 23.7% (SD .14) in 2018 to 34.9% (SD .18) in 2019, and 59.8% (SD .17) in 2020. This was a statistically significant effect of time on AWV completion rates overall (F[2, 87] = 164.43, p < .000). More than half (56.2%) of practices met or exceeded the 60% goal in 2020. Practice-level HCC completion tracking started in 2019 (M = 75.9%, SD 7.4%) and increased in 2020 (M = 79.7%, SD 7.1%); t(172) = 2.0, p < .001.
Conclusions: AWV and HCC performance goals were met in 2020, despite service disruptions due to COVID-19. The QI approach we used is applicable to other problems and other large healthcare systems.
(© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.)