Care coordination, quality measurement, patient engagement and population health management strategies are routinely used by physicians with electronic health records who participate in accountable care organizations or patient-centered medical homes, according to a new study published in the American Journal of Managed Care.
Aiming to find out whether doctors using health IT and working within new reimbursement models were actually employing improved care processes, researchers Jennifer King, Vaishali Patel, Eric Jamoom and Catherine DesRoches examined cross-sectional data on office-based physicians from the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey.
"Early indicators suggest strong physician participation in initiatives to support health IT adoption and to reform healthcare payment and delivery," they said. "However, evidence on whether provider participation in these initiatives has translated to better care delivery is just beginning to emerge.
"Although studies prior to HITECH and the ACA found health IT and external reporting or payment incentives to be associated with a higher likelihood of performing these care processes," they added, "they are performed at low rates even when these factors are in place."
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King et al. examined how ACO and PCMH docs used their EHRs for 14 specific processes in four categories: population management, quality measurement, patient communication and care coordination.
They found that those factors were independently associated with better processes: "Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing the care processes."
Indeed, those docs "were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone."
While fewer than half (44 percent) reported routinely doing quality measurement, substantial majorities of docs said they routinely engage in care coordination (89 percent), patient communication (69 percent), and population management (67 percent).
"Given the cross-sectional nature of this study, these results do not establish a causal relationship between payment reform, EHR use, and these care processes," researchers said. "Nonetheless, this finding is consistent with other research that shows that healthcare providers are most likely to perform these care processes when practicing in a payment environment that incentivizes and supports such care."
Moreover, many U.S. physicians are still "not performing these processes routinely," researchers said. "Our analysis highlights several specific areas – including population management processes that require the aggregation and analysis of individual patient data and communication with patients and other care team members – where additional technology and policy supports may be important to facilitate wider adoption of these activities."
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