Article Figures & Data
Tables
A-TRIP Performance Ownership and Region Specialty, No. of Doctors* and Other Clinicians Payer Mix† Description of Patients Year Practice Opened, Year EMR Acquired Site visits by Sept 2005 Network Meetings Attended 2003–2005 SQUID at Baseline SQUID at 36 mo A-TRIP = Advanced Translaton of Research into Practice; SQUID = Summary Quality Index; EMR = electionic medical record; Medi/Medi = Medicare Medicaid crossover. * Number of individuals, may be part-time or full-time. † Other insurance includes private insurance, commercial insurance, and preferred provider organizations, eg, Blue Cross, Cigna. ‡ Proportions are based on charges; the percentage of visits that are Medicare in this practice is higher. Technophiles Physician partnership, Mid Atlantic Internal medicine, 2 Medicare,‡ 22% Other insurance, 74% Self-pay, 4% Most are working, middle to upper- middle class 1984, 2001 0 3 53.8 73.6 Multiple physician partnership, South Family medicine, 4 Nurse-practitioner, 1 Medicare, 20%–25% Medicaid, 5%–10% Other insurance and some uninsured make up remainder Representative of community: from jobless/illiterate to some doctors/professors. Mostly middle class, less than one half with college degrees 1981, 2000 3 1 49.7 64.8 Physician-owned service corporation, Midwest Internal medicine, 6 Medicare, 35%–40% Medicaid, 5%–10% Other insurance, 50%–60% Uninsured, <2% Representative of metro area: from limited-income elders to a few advanced- degree professionals; 60%–70% working class 1980, 1997 4 3 47.5 61.2 Physician partnership, incorporated, South Family medicine, 2 Medicare, 18%–20% Medi/Medi, 12%–15% Other insurance, 65%–70% Low-education levels, high unemployment (poverty rate in community is 35%). Practice draws from 3–4 small counties and also serves college and industry employees 2000, 2000 4 1 43.3 57.1 Physician partnership, West Internal medicine, 2 Physician’s assistant, 1 Nurse-practitioner, 3 Medicare, 25% Medicaid, 1% Other insurance, 74% Majority are upper-middle class 1995, 2002 0 2 47.9 55.8 Motivated Team Physician partnership, incorporated, Midwest Family medicine, 2 Nurse-practitioner, 1 Medicare, 32% Medicaid, 5% Other insurance, 55% Self-pay, 8% Rural, mostly middle-income and lower education levels, range includes uninsured farmers and top officials in companies 1985, 1998 4 3 47.7 61.3 Hospital, Midwest Family medicine, 8 Physician’s assistant, 1 Medicare, 16% Medicaid, 4% Other insurance, 77% Self-pay, 3% Urban, mixed-race/ethnicity, representative of blue-collar community 1980, 1995 4 2 49.9 58.7 Care Enterprise Physician, Gulf Coast Internal medicine, 1 Nurse-practitioner, 1 Medicare, 60% Medicaid, 5% Other insurance, 35% Geriatric practice, most are retired military. Spectrum from very poor to very wealthy 1983, 1994 4 2 51.9 61.8 Physician, South Internal medicine, 2 Nurse-practitioner, 2 Medicare, 33% Medicaid, 3% Other insurance, 62% Uninsured, 2% Largely blue-collar but includes aerospace engineers. About 25% African American, 2% Hispanic 1989, 1999 4 3 40.5 50.4 Practice Archetype Prioritize Performance Involve All Staff Redesign Delivery Systems Activate Patients Use EMR Tools PPRNet = Practice Partner Research Network; EMR = electronic medical record. Note: Strategies are described in: Feifer C, Ornstein SM. Strategies for increasing adherence to clinical guidelines and improving patient outcomes in small primary care practices. Jt Comm J Qual & Safety. 2004;30(8):432–441. Technophiles ▪ ▪ ▪ ▪ ▪ ▪ ▪ Motivated Team ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Care Enterprise ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪
Additional Files
Supplemental Appendix
Supplemental Appendix. Additional Details on Study Methods
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 3 pages, 73 KB
The Article in Brief
Different Paths to High-Quality Care: Three Archetypes of Top-Performing Practice Sites
Chris Feifer, DrPH , and colleagues
Background This study looks at 9 medical practices that have been successful in improving the quality of medical care they deliver.
What This Study Found The practices in this study, which are successful in improving quality of care, can be described by 3 models or archetypes. The Technophile archetype describes practices that quickly adopt and consistently use an electronic medical record and its tools, such as automated guides to help clinicians and staff perform and document routine tasks. Each of these practices has a doctor who is committed to finding new ways to use the electronic medical record. Practices in the Motivated Team archetype look for new ways to use existing resources to improve quality. They involve the entire practice by sharing information, holding practice meetings, involving and motivating staff, and setting aside time for improvement efforts. Practices in the Care Enterprise archetype select clinical areas that they want to improve and design systems to do so, involving staff if needed. They take a customer-service approach to provide care that meets the needs of patients and doctors and is consistent with recommended guidelines.
Implications
- No single approach creates success in improving quality of care. Practices in this study use many common strategies, with different approaches for organizing their practice change efforts.
- Practices that succeeded in improving quality in this study had someone in the practice who was a "champion" for the improvement effort.
- Medical practices do not have to start out with a focus on technology to improve quality.
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