Reports From the Field

Making Quality Real for Physicians

Journal of Clinical Outcomes Management. 2017 May;24(5)

Author(s):

Keyana N. Pennant

Lara E. Szent-Gyorgyi

Erin McElrath

Jeffrey O. Greenberg, MD

Jonathan Coblyn, MD

Sonali P. Desai, MD, MPH

References

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From the Department of Medicine Quality Program, Brigham and Women’s Hospital (Drs. Pennant, McElrath, Coblyn, and Desai) and the Institute for Relevant Clinical Data Analytics, Boston Children’s Hospital, (Drs. Szent-Gyorgyi and Greenberg), Boston, MA.

Abstract

Objectives: To describe the department of medicine quality program (DOMQP) at Brigham and Women’s Hospital (BWH).
Methods: The program began in 2007 to engage physicians in local, specialty-specific quality efforts. The program has broadened its scope to include government mandates and hospital-wide priorities, such as maintenance of certification (MOC), “meaningful use (MU),” and medication reconciliation. More recently, we have evolved into a project-based program focusing on both chronic disease management and optimizing care pathways for high-risk inpatient conditions. Our key strategies are developing metrics, raising awareness, distilling information to front-line staff, highlighting relevant action items, and bringing feedback from front-line staff to hospital leadership.
Results: We have developed 21 metrics across 13 clinical divisions, with performance improvement seen in > 50% of metrics. In 2014, we leveraged our quality metrics to earn MOC credit, with 100 physicians across 10 divisions earning MOC points through the Practice Assessment option. Additionally, department physicians achieved 90% compliance with our institutional medication reconciliation policy. The percentage of physicians achieving stage 1 MU was 98% in 2013, 99% in 2014, and 100% achieved stage 2 MU in 2015.
Conclusion: Over the past 10 years, the DOMQP has played a unique role in promoting quality and serves as a model for QI within the hospital. We are well positioned to provide support to physicians and their practices as the health care environment continues to evolve.

Key words: quality improvement; quality measurement.

Within the past several years, the health care landscape in the United States has shifted considerably. New financial risk and quality-related incentive structures have been put in place, such as financial incentives to adopt electronic health records (EHRs) and to demonstrate “meaningful use (MU)” of these EHRs [1]. There is greater focus on value based payments, and accountable care organizations (ACOs) are proliferating [2–4]. Certification and training requirements have changed and require completion of performance improvement projects [5,6]. Upcoming changes to quality measurement and improvement through the Quality Payment Program will bring further changes to how clinicians are both monitored and incentivized or penalized [7]. The confluence of these efforts provides an impetus to incorporate quality measurement and improvement into the day to day practice of medicine.

In 2007, the department of medicine (DOM) at Brigham and Women’s Hospital (BWH), a teaching affiliate of Harvard Medical School and a founding member of Partners Healthcare, began a quality program (DOMQP) to engage physicians in local, specialty-specific quality efforts [8]. The program began by focusing on internally developed performance metrics to drive physician engagement. Later, the program expanded its focus to include more externally focused mandates from federal government and other accreditation bodies [9,10]. In this article, we discuss our efforts, including our early stage work and more recent focus in the areas of meaningful use, medication reconciliation, and maintenance of certification as well as our ongoing projects focused on chronic disease management and high-risk inpatient conditions.