The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.
The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.
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医疗团体实践管理者在采用和实施 Medicare 医生质量报告系统中的作用。
DOI：
10.1097/hmr.0000000000000061
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发表时间：
2016
影响因子：
2.5
通讯作者：
Gans,David
中科院分区：
文献类型：
--
作者：
Coulam,Robert;Kralewski,John;Dowd,Bryan;Gans,David
背景：尽管有大量关于影响医疗团体实践采用质量保证 (QA) 计划的因素的研究，但很少有人关注团体实践管理者的角色。目的：为了深入了解这些管理者在 QA 计划中所扮演的角色，我们分析了医疗实践如何采用和实施医疗保险医师质量报告系统 (PQRS)，这是美国最大的医师质量报告系统。方法：我们于 2011 年对全国便利样本进行了焦点小组访谈。 76名医疗团体执业管理者。使用 Van de Ven 及其同事的创新决策框架来组织和分析答复。调查结果：管理员对 PQRS 进行了尽职调查，影响了向医生提出问题以供采用的方式，并管理了此后的实施。管理者的建议很大程度上受到实践特征、财务激励和早期采用质量改进创新的实践承诺的影响。事实上，所有尝试过的人都同意 PQRS 实施起来很简单。然而，Medicare 的 PQRS 报告的复杂性阻碍了管理员使用数据来支持质量管理。讨论：团体实践管理员在与患者护理质量相关的活动中发挥着重要作用 - 他们不仅限于实践的业务方面。特别是，随着 PQRS 在 2014 年之后变得更加普及，医疗保险应该考虑到管理人员所扮演的角色，通过更积极地让管理人员参与制定这些计划并使管理人员更容易使用结果。实践意义：需要对非医生管理在医疗团体实践中快速发展的作用进行更多研究。实践管理员在如何采用和使用质量报告举措方面发挥着比通常理解的更大的作用，并且如果得到更有用的质量报告形式的支持，他们将处于影响这些资源更适当使用的特殊地位。
Background:Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators.Purpose:To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States.Methodology:We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues.Findings:Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators’ recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare’s PQRS reports impeded use of the data by administrators to support quality management.Discussion:Group practice administrators are playing a prominent role in activities related to the quality of patient care—they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results.Practice Implications:More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if supported by more useful forms of quality reporting.