Tackling the Triple Aim in Primary Care Residencies

Dr. Katrina Donahue published the baseline data from the I3 (Impact cubed) Collaborative that seeks to improve care of patients served by primary care residency practices in North Carolina, South Carolina and Virginia. This work was published in the February 2015 issue of Family Medicine with Ann Lefebvre from the North Carolina Area Health Education Centers, Michele Stanek from the University of South Carolina Warren P. Newton and Alfred Reid who with Dr. Donahue are with the department of family medicine at UNC-Chapel Hill.
“The I3 POP collaborative seeks to improve dramatically quality of care and patient experience while reducing cost in 27 primary care residency programs in North Carolina, South Carolina, and Virginia”. This project uses the triple aim framework developed by the Institute for Healthcare Improvement:

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

They found that the baseline data of the primary care residency practices were highly variable but comparable to national standards. Their work also underscores the difficulty of obtaining secondary data from actual clinical care records from diverse practices even when using measures mandated by meaningful use legislation.
Important findings include:

• The difficulties in obtaining population-based data for patients in these residency practices.
• The striking variance between different health care systems’ use of identical software products.
• The ability to measure and report quality metrics is fraught with difficulty during an EHR transition “EHRs are the central nervous system of modern practice, and brain transplants remain challenging!”
• Across the residency practices measures for quality of chronic care for diseases is relatively better than those for preventative care.
• Patient experience is difficult to compare across residencies.
• Key drivers of cost such as hospitalization and ED utilization rates also show striking variation.
• Registry use and faculty leadership in data management are critical success factors for assessing practice performance.

Tackling the Triple Aim in Primary Care Residencies: The I3 POP Collaborative. Fam Med. 2015 Feb ;47(2):91-7.

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