Performance on Electronic Clinical Quality Measures in the Comprehensive Primary Care Initiative.

Electronic clinical quality measures (eCQMs) that capture data from electronic health records promise accurate and timely measurement, but their use has been limited in payment. The Comprehensive Primary Care initiative sponsored by the Centers for Medicare & Medicaid Services used eCQMs as part of a shared savings incentive. To assess performance, the authors developed benchmarks for 11 measures and compared performance of initiative and benchmark practices.

The Effects of a Primary Care Transformation Initiative on Primary Care Physician Burnout and Workplace Experience.

Background: Physician burnout is associated with deleterious effects for physicians and their patients and might be exacerbated by practice transformation.

Objective: Assess the effect of the Comprehensive Primary Care (CPC) initiative on primary care physician experience.

Design: Prospective cohort study conducted with about 500 CPC and 900 matched comparison practices.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions.

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative.

Unlabelled: Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations.

Risk Stratification Methods and Provision of Care Management Services in Comprehensive Primary Care Initiative Practices.

Purpose: Risk-stratified care management is essential to improving population health in primary care settings, but evidence is limited on the type of risk stratification method and its association with care management services.

Methods: We describe risk stratification patterns and association with care management services for primary care practices in the Comprehensive Primary Care (CPC) initiative. We undertook a qualitative approach to categorize risk stratification methods being used by CPC practices and tested whether these stratification methods were associated with delivery of care management services.

Behavioral Health and the Comprehensive Primary Care (CPC) Initiative: findings from the 2014 CPC behavioral health survey.

Background: Incorporating behavioral health care into patient centered medical homes is critical for improving patient health and care quality while reducing costs. Despite documented effectiveness of behavioral health integration (BHI) in primary care settings, implementation is limited outside of large health systems. We conducted a survey of BHI in primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a four-year multi-payer initiative of the Centers for Medicare and Medicaid Services (CMS).

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

Background: The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support.

Methods: We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices.

Electronic health records improve clinical note quality.

Background And Objective: The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes.

QNOTE: an instrument for measuring the quality of EHR clinical notes.

Background And Objective: The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole.

Does this patient have medical decision-making capacity?

Context: Evaluation of the capacity of a patient to make medical decisions should occur in the context of specific medical decisions when incapacity is considered.

Objective: To determine the prevalence of incapacity and assessment accuracy in adult medicine patients without severe mental illnesses.

Data Sources: MEDLINE and EMBASE (from their inception through April 2011) and bibliographies of retrieved articles.

How well do the Framingham risk factors correlate with diagnoses of ischemic heart disease and cerebrovascular disease in a military beneficiary cohort?

We sought to determine how well the Framingham prediction rules correlate with ischemic heart disease and cerebrovascular disease in a military beneficiary cohort by examining demographic and International Classification of Diseases, Ninth Revision codes from electronic medical records between 2001 and 2008. This sample (n = 163,627) included people averaged at 52 years of age (range 18-108); slightly more than half were male (55%), 21% were African-American, and 59% were Caucasian. Fifteen percent of beneficiaries had ischemic heart disease and 3.

Tricyclic antidepressants and headaches: systematic review and meta-analysis.

Objective: To evaluate the efficacy and relative adverse effects of tricyclic antidepressants in the treatment of migraine, tension-type, and mixed headaches.

Design: Meta-analysis.

Data Sources: Medline, Embase, the Cochrane Trials Registry, and PsycLIT.

Ethical practice under fire: deployed physicians in the global war on terrorism.

The Global War on Terrorism brings significant ethical challenges for military physicians. From Abu Ghraib to Guantanamo Bay, the actions of health care providers have come under considerable scrutiny. Military providers have dual roles as military officers and medical professionals, which have the potential to come into conflict.