Getting Performance Metrics Right: A Qualitative Study of Staff Experiences Implementing and Measuring Practice Transformation
Quality improvement is a central goal of the patient-centered medical home (PCMH) model, and requires the use of relevant performance measures that can effectively guide comprehensive care improvements. Existing literature suggests performance measurement can lead to improvements in care quality, but may also promote practices that are detrimental to patient care. Staff perceptions of performance metric implementation have not been well-researched in medical home settings.
To describe primary care staff (clinicians and other staff) experiences with the use of performance metrics during the implementation of the Veterans Health Administration’s (VHA) Patient Aligned Care Team (PACT) model of care.
Observational qualitative study; data collection using role-stratified focus groups and semi-structured interviews.
Two hundred and forty-one of 337 (72 %) identified primary care clinic staff in PACT team and clinic administrative/other roles, from 15 VHA clinics in Oregon and Washington.
Data coded and analyzed using conventional content analysis techniques.
Primary care staff perceived that performance metrics: 1) led to delivery changes that were not always aligned with PACT principles, 2) did not accurately reflect patient-priorities, 3) represented an opportunity cost, 4) were imposed with little communication or transparency, and 5) were not well-adapted to team-based care.
Primary care staff perceived responding to performance metrics as time-consuming and not consistently aligned with PACT principles of care. The gaps between the theory and reality of performance metric implementation highlighted by PACT team members are important to consider as the medical home model is more widely implemented.
- Peikes D, Zutshi A, Genevro J, Smith K, Parchman M, Meyers D. Early Evidence on the Patient-Centered Medical Home. Final Report (Prepared by Mathematica Policy Research, under Contract Nos. HHSA290200900019I/HHSA29032002T and HHSA290200900019I/HHSA29032005T). AHRQ Publication No. 12-0020-EF. Rockville, MD: Agency for Healthcare Research and Quality. February 2012.
- Chassin MR, Loeb JM, Schmaltz SP, Wachter RM. Accountability measures—using measurement to promote quality improvement. N Engl J Med. 2010;363:688–93. CrossRef
- Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for performance in hospital quality improvement. New Engl J Med. 2007;356(5):486–496. CrossRef
- Kizer KW, Kirsh SR. The double edged sword of performance measurement. J Gen Intern Med. 2012;27(4):395–397. CrossRef
- Hayward RA. Performance measurement in search of a path. New Engl J Med. 2007;356(9):951–953. CrossRef
- Casalino LP. The unintended consequences of measuring quality on the quality of medical care. New Engl J Med. 1999;341(15):1147–1150. CrossRef
- Malina D. Performance anxiety—what can health care learn from K–12 education? J Gen Intern Med. 2013;369(13):1268–1272.
- Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006;145(4):265–272. CrossRef
- Klein S. The Veterans Health administration: implementing patient-centered medical homes in the nation’s largest integrated delivery system. Commonwealth Fund. 2011;1537:1–24.
- Powell AA, White KM, Partin MR, et al. Unintended consequences of implementing a national performance measurement system into local practice. J Gen Intern Med. 2012;27(4):405–412. CrossRef
- Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88. CrossRef
- Conway PH, Mostashari F, Clancy C. The future of quality measurement for improvement and accountability. JAMA. 2013;309(21):2215–2216. CrossRef
- Gray BM, Weng W, Holmboe ES. An assessment of patient-based and practice infrastructure–based measures of the patient‐centered medical home: do we need to ask the patient? Health Serv Res. 2012;47:4–21. CrossRef
- Glasziou PP, Bucan H, Del Mar C, et al. When financial incentives do more good than harm: a checklist. BMJ. 2012;345:1–5. CrossRef
- Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Affairs. 2010;29:835–43. CrossRef
- Peikes D, Genevro J, Scholle SH, Torda P. The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care. AHRQ Publication No. 11-0029. Rockville, MD: Agency for Healthcare Research and Quality. February 2011.
- Getting Performance Metrics Right: A Qualitative Study of Staff Experiences Implementing and Measuring Practice Transformation
Journal of General Internal Medicine
Volume 29, Issue 2 Supplement, pp 607-613
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- patient-centered medical home
- primary care
- performance metrics
- team-based care
- focus groups
- qualitative research
- Industry Sectors
- Author Affiliations
- 1. Portland VA Medical Center Health Services Research & Development/VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Mailcode R&D63, PO Box 1034, Portland, OR, 97207, USA
- 2. Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- 3. School of Social Work, Portland State University, Portland, OR, USA
- 4. Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
- 5. Patient Centered Outcomes Research Institute, Washington, DC, USA