Journal of Healthcare Management - March/April 2014 - (Page 97)

c osts and B enefits of (Leatherman et al., 2003; Reiter, Kilpatrick, Greene, Lohr, & Leatherman, 2007). To overcome their reluctance, primary care practices need information about the costs and benefits of transformation to assess the potential burden of, the value in, and the organization's capacity for engaging in this type of change. Likewise, payers and policy makers need this information to design reimbursement strategies and set priorities that support and sustain quality improvement efforts. As part of a larger study to assess the process of transformation in primary care practices participating in NC IPIP (Donahue et al., 2013), we sought to identify the practice-level costs and benefits associated with transformation. t ransfor Ming p riMary c are p ractices in each of four domains: patient registries, planned care templates, protocols, and patient self-management support tools. Practices were classified as improved if they achieved a rating of 4 on at least two domains at any point within the first year. Clinical measures included diabetes (percentage of sampled diabetes patients with hemoglobin A1C < 9%, blood pressure < 130/80 mmHg, LDL cholesterol levels < 100 mg/dL, yearly eye examinations, and annual nephropathy screening) and asthma (percentage of sampled asthma patients with asthma control assessment, controller medicine use, influenza vaccination, and a bundled measure including all three). Using the first 12 months of clinical data, we ran a separate repeated measures logistic regression with random intercept and slope for each clinical measure in each practice. Also for each practice, we averaged the standardized slopes (time trends) for the different clinical measures. Practices with a mean greater than 1 were classified as improved. Second, we engaged practice coaches to help us identify practices that had staff members with sufficient involvement to provide the historical and/ or current context of practices' experience with NC IPIP. As noted in Table 1, we approached and interviewed four practices that improved in both metrics, three practices that improved in practice change scores but not clinical process/outcome scores, three practices that improved in clinical process/outcome scores but not practice change scores, and two practices that showed no improvement in either metric. METHODS We used a comparative case study design (Yin, 2008) to describe the personnel and nonpersonnel costs and benefits involved in transformational change. Study Setting and Sample Eligible practices were those participating in NC IPIP that had data on the following: (1) practice coaches' ratings of change implementation (practice change score) and (2) process and outcome measures (clinical outcomes). Of the 100 participating practices, we identified 76 that had at least one year's worth of data. From these, we purposely selected 12 practices using a two-step process. First, we categorized practices as either improved or not improved on each of the measures (Table 1). Practice change scores were assigned by practice coaches using a scale of 0 (no implementation) to 5 (full implementation) 97

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014