Monitoring and Improving Quality and Performance

Measurement of clinical care has become increasingly important for documenting and improving the level of evidence-based care we provide. Performance measures should be built into the process of care to serve as reminders and permit the efficient capture of quality data for reporting. The National Quality Forum now endorses clinical performance measures for many of the common conditions that family physicians treat.

Comparative effectiveness research (CER) is used to determine if different treatments or procedures used in the care of the same condition have significantly different patient outcomes. If research shows that one treatment is clearly more efficacious than another, all physicians should be promoting that treatment for most patients. EHRs help researchers collect data at the point of care and provide a platform for public health surveillance.

Measurement is the key to any quality improvement effort, whether streamlining patient flow or improving health outcomes for diabetic patients. As a general rule, measures for clinical care require data that the physician would want to have available to make the best diagnostic and treatment recommendations for the patient. This information can be organized on a flow sheet or template in the EHR for the dual purpose of ease of access by the care team and ease of data collection for quality measures. Quality measures can be used for both internal quality improvement and external reporting. An increasing portion of physician compensation will be attached to performance measures over time, so the degree to which these measures can be integrated into the system of care will determine the quality of patient care and the level of practice revenue.

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