Practice Performance Measurement
Practice performance measurement addresses the organization and promotion of safe and high quality care. The purpose of this section is to provide tools and strategies to help evaluate physician performance and the patient/family perspective regarding the quality of their care. Collecting data on performance, sharing these data with clinicians, staff and families and being transparent with patients and families will help drive medical home improvement. Please note that this page provides additional resources as to what is provided in the Practice Performance Measurement section of the Building Your Medical Home toolkit.
The Institute of Medicine has identified six dimensions of quality which include care that is effective, efficient, equitable, timely, patient-centered, and safe. Quality can be viewed from both a clinical and operational perspective:
- Clinical quality improvement focuses on the scope of improvement of clinical outcomes.
- Operational quality includes the business operational aspects of healthcare delivery in practices.
- Other dimensions such as equitable care, patient access, and patient-centered care further expand the scope of quality.
The Model for Improvement, the Plan Do Study Act [PDSA] model, is extensively utilized by the Institute for Healthcare Improvement [IHI]. The PDSA model has been successfully applied in several inpatient and outpatient healthcare settings to improve clinical quality and patient outcomes. However, in addition to clinical improvement using the PDSA model, there are other business models for quality that can significantly impact operational quality in healthcare. This includes the LEAN methodology which aims at eliminating waste in processes to enhance efficiency. In contrast to methodologies that aim to improve existing healthcare processes, Management Sciences offers a proactive approach of using operations research to improve flow, revenue, and safety in hospital and clinic office settings.
Further, quality improvement results occur as a product of teamwork. Teamwork involves a set of skilled cross-disciplinary interactions that are learned, practiced and refined to provide better care delivery management, promote safety, and enhance outcomes.
The commitment to quality improvement is implicit in the Academy's mission of promoting the health and well-being of all children. The Academy has enhanced its range of programs, resources, and tools, as well as its relationship with external agencies and organizations to decrease the quality gap and provide optimal health care quality to all children. For more information on quality improvement at the Academy, click here.
Further Reading
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Measuring Medical Homes: Tools to Evaluate the Pediatric Patient- and Family-Centered Medical Home 
Developed on behalf of the National Center for Medical Home Implementation by Rebecca A. Malouin, PhD, MPH, this monograph presents various tools available and in use to identify, recognize, and evaluate a practice as a pediatric medical home. Because no one tool is recognized as the de facto tool to assess pediatric practices, a review of the relative merits of existing tools will help inform purchasers, payers, providers, and patients in evaluating pediatric practices. The tools reviewed in this monograph include:
American Academy of Pediatrics (AAP) Resources
- Education in Quality Improvement for Pediatric Practice (EQIPP)
EQIPP courses are designed to help pediatricians identify and close the gaps in practice using practical tools, document improved quality care on a continuous basis, earn CME credit, and meet MOC Part 4: Performance in Practice requirements all at once. By using EQIPP, a pediatrician can collect data to measure current levels of care at baseline and improve care through Plan, Do, Study, Act (PDSA) cycles.
- EQIPP: Medical Home for Pediatric Primary Care
The goal of the EQIPP: Medical Home for Pediatric Primary Care course is to help pediatric health care providers create plans for improvement to address gaps identified in key activities of the medical home. This EQIPP course will focus on the following key activities related to medical home:
- Developing a highly functioning, multidisciplinary quality improvement team
- Knowing and manage your patient population
- Enhancing access to care
- Providing family-centered care
- Providing and document planned, proactive, comprehensive care
- Coordinating care across all settings
- Practice Management Online (PMO)
More tools on quality improvement can also be found on PMO, which is available as a member benefit to all AAP members, such as:
- Medical Home Care Coordination Measurement Tool
This tool provides an example for how pediatricians can collect patient level data on care coordination services provided, the time required to provide the services, the complexity of the patient's needs, and the outcome resulting from the intervention.
- Patient Survey
These are sample documents that can be used or modified to ask patient's about their satisfaction with their office visit.
- Quality Improvement Innovation Network (QuIIN)
The mission of the QuIIN, a network of practicing pediatricians and their staff, is to improve care and outcomes for children and families. QuIIN does so by using quality improvement science to test practical tools, measures, and strategies for use in everyday pediatric practice, the child's medical home, as well as by informal assessment that provides practicing pediatrician perspective into evidenced based recommendations and tools for implementation. QuIIN quality improvement projects use QI science, including measurement.
Agency for Healthcare Research and Quality (AHRQ) Resources
- Building the Evidence Base for the Medical Home: What Sample and Sample Size Do Studies Need?
This white paper provides information about how to determine the effect sizes a given study can expect to detect, identifies the number of patients and practices required to detect policy-relevant, achievable effects, and demonstrates how evaluators can select the outcomes and types of patients included in analyses to improve a study's ability to detect true effects.
- Child Version of the CAHPS Clinician and Group Visit Survey
The Visit Survey asks patients to report on their experiences with providers and office staff at their most recent visit to a doctor's office. The CAHPS Clinician and Group Child Visit Survey 2.0 can be used to assess the experiences of children and their parents during the child’s most recent visit with a provider. To learn more, visit Read about the CAHPS Visit Survey.
- Care Coordination Accountability Measures for Primary Care Practice
This report presents selected measures from the Care Coordination Measures Atlas that are well-suited for primary care practice. The selected measures are divided into two sets: Care Coordination Accountability Measures (from the patient/family perspective) and Companion Measures (from the health care professional and system perspectives; ie, self-assessment). Pediatric measures featured in this report include the following:
- Care Coordination Accountability Measures
- Primary Care Assessment Tool—Child Edition (PCAT-CE)
- Alternative: Family-Centered Care Self-Assessment Tool—Family Version
- Companion Measures for Health Care Professionals
- Family-Centered Care Self-Assessment Tool— Provider Version
- Primary Care Assessment Tool - Provider Version (PCAT-PE)
- Care Coordination Measurement Tool (CCMT)
- Companion Measures for System Representatives
- Medical Home Index (MHI-LV)
- Primary Care Assessment Tool—Facility Edition (PCAT-FE)
- Child Health Care Quality Toolbox
Concepts, tips, and tools for evaluating the quality of health care for children.
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) Podcast Series on QI
This resources is a series of CAHPS podcast on improving patients’ experiences with care is now available. The QI podcast series will feature speakers from a variety of organizations around the country who share both their professional expertise and their experiences using CAHPS surveys to assess and improve the quality of care they deliver.
- Improving Evaluations of the Medical Home
This brief offers a concise description for decision makers of why and how to commission effective evaluations of medical home demonstrations. It provides insights into what outcomes to assess, why to include control practices, and why not accounting for clustering can doom an evaluation.
- Measuring Patients' Experiences with Medical Homes Using the CAHPS PCMH Item Set (Archived Webinar)
AHRQ hosted a webinar on the development and anticipated uses of the new Patient-Centered Medical Home (PCMH) Item Set.
- National Quality Measures Clearinghouse (NQMC)
NQMC is a public resource for evidence-based quality measures and measure sets. Measure summaries are organized by topic, organization, or domain, and can be compared side-by-side. Also available are expert commentaries for editorial insights on current issues in the field of quality measurement. The Tutorial on Quality Measures provides an introduction to the field of quality measurement and how to best use NQMC. Collecting data on practice performance, sharing these data with clinicians, staff and families and being transparent with patients and families will help drive medical home improvement.
- Why Improve Patient Experience? How To Justify the Effort
The CAHPS Improvement Guide highlights the clinical and business benefits associated with improving patients' experiences with ambulatory care. This section of the Guide can help health care organizations make a compelling case for identifying and addressing performance issues revealed by CAHPS survey scores.
Institute for Healthcare Improvement (IHI)
Some of the offerings on the IHI Web site include:
- Knowledge Center—the content "library" featuring tools, change ideas, measures, improvement stories, and other resources to support improvement efforts
- Explore by Interest—provides a more in-depth look at key topic areas by gathering content from across the site
- IHI Offerings—hosts information on training and skill-building learning opportunities
- User Communities—features such as blogs, wikis, and discussion boards available soon
- Explore by Interest—allows for deeper content searches by topic, care setting, role, etc. For example, see the Improve Primary Care Access page
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The CAHPS Improvement Guide—Practical Strategies for Improving the Patient Care Experience
Agency for Healthcare Research and Quality (AHRQ)
Case Study—Colorado Children's Healthcare Access Program: Helping Pediatric Practices Become Medical Homes for Low-Income Children
The Commonwealth Fund—June 2010
A recent evaluation that shows children covered by Medicaid and with a medical home in a private pediatric practice supported by CCHAP visit the emergency department less often, have more preventive care visits, and are less expensive for the state Medicaid program than children in non-CCHAP-affiliated practices.
Developing and Running a Primary Care Practice Facilitation Program: A How-to Guide
Agency for Healthcare Research and Quality (AHRQ)
This how-to guide shows ways to support organizations interested in starting a practice facilitation program. Practice facilitation is a strategy to improve primary health care processes and outcomes through the creation of an ongoing, trusting relationship between an external facilitator and a primary care practice.
Powerful Partnerships—A Handbook for Families and Providers Working Together to Improve Care
National Initiative for Children’s Healthcare Quality (NICHQ)
This guidebook provides insight and advice to make the most of the partnerships between family members and health providers on quality improvement teams.
Pennsylvania practice achieves improved care for patients with asthma, along with top certification
Wyckoff AS. AAP News. 2009;30(11):26.
AHRQ Health Care Innovations Exchange
The US Agency for Healthcare Research and Quality's (AHRQ) Health Care Innovations Exchange provides a central repository of searchable innovations and QualityTools that enables health care decisionmakers to quickly identify ideas and tools that meet their needs classified by disease or clinical category, patient population, stage of care, setting of care, etc.
- Frontline Innovators on Changing Care, Improving Health
This video series features stories about the value of implementing innovations to improve patient-centered care, including a program that reduces school absences and unnecessary emergency department for inner city children using telemedicine.
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The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program
Smith PJ, Santoli JM, Chu SY, Ochoa DQ, Rodewald LE. Pediatrics. 2005;116;130-139
Associations Between Quality of Primary Care and Health Care Use Among Children With Special Health Care Needs
Raphael JL, Mei M, Brousseau DC, Giordano TP. Arch Pediatr Adolesc Med. 2011;165(5):399-404.
Child Health Research—Identifying Quality Problems and Improving Care
Agency for Healthcare Research and Quality (AHRQ)
This brief summarizes findings from selected AHRQ-supported research on pediatric health care quality published from 2006-2010.
Coping Among Parents of Children With Special Health Care Needs With and Without a Health Care Home
Drummond A, Looman W, Phillips A. Journal of Pediatric Health Care. 2011
Early Evaluations of the Medical Home: Building on a Promising Start
Mathematica Policy Research and Agency for Healthcare Research and Quality (AHRQ). 2012
Effect of Hospital-Based Comprehensive Care Clinic on Health Costs for Medicaid-Insured Medically Complex Children
Arch Pediatr Adolesc Med. 2011
Evidence for Family-Centered Care for Children With Special Health Care Needs: A Systematic Review
Academic Pediatrics . 2011;11:136-143
Implementing Patient-Centered Medical Home Pilot Projects, Lessons from AF4Q Communities
Robert Wood Johnson Foundation
Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care
Cooley WC, McAllister JW, Sherrieb K, Kuhlthau K. Pediatrics. 2009;124;358-364
Improvement in the Family-Centered Medical Home Enhances Outcomes for Children and Youth with Special Health Care Needs
McAllister JW, Sherrieb K, Cooley WC. J Ambulatory Care Manage. 2009;32(3)188-196
The Medical Home: Growing Evidence to Support a New Approach to Primary Care
Rosenthal TC. The Journal of the American Board of Family Medicine. 2008;21(5):427-440
The Medical Home, Preventive Care Screenings, and Counseling for Children: Evidence from the Medical Expenditure Panel Survey
Romaire MA. Acad Pediatr. 2010;10(5):338-45
Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States
Patient-Centered Primary Care Collaborative (PCPCC) (2010)
The report highlights 14 state medical home projects, including Community Care of North Carolina and the Colorado Department of Health Care Policy and Financing, which resulted in positive outcomes in pediatric care.
Patient-Centered Medical Home Characteristics and Staff Morale in Safety Net Clinics
Lewis SE, Nocon RS, Tang H; Young Park S, Vable AM, Casalino LP, Huang ES, Quinn MT, Burnet DT, Summerfelt WMT, Birnberg JM, Chin MH. Arch Intern Med. 2012;172(1):23-31.
The Pediatric Alliance for Coordinated Care: Evaluation of a Medical Home Model
Pediatrics. 2004;113(5 Suppl):1507-16
Primary Care Attributes and Mortality: A National Person-Level Study
Jerant A, Fenton JJ, Franks P. Ann Fam Med. 2012(10)1:34-41.
Strengthening Health Care for Children: Primary Care and the Medical Home. National Business Group on Health (2009)
Center for Prevention and Health Services (2009)
The Value of the Medical Home for Children without Special Health Care Needs
Long WE, Bauchner H, Sege RD, Cabral HJ, Garg A. Pediatrics. 2012;129:1.87-98.
This article discusses a study that found that the medical home setting provides benefits to children without special health care needs. Benefits of care through a medical home setting include improved health care use, decreased emergency department visits, and increased health-promoting behaviors such as family reading, sleep hygiene, and helmet use.
For a list of published articles that highlight cost savings associated with medical home implementation, please click here.
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