Patient-Centered, Evidence Based
Much less paperwork, useful feedback, usually free.
Primary care is hard.
Measuring it shouldn’t be.
Docs spend half their time on EMRs and desk work, ~half with patients, but only half of that time interacting with patients. Primary care docs now spend more than $50,000/year (in wasted time) on ‘quality’ measurement. Only a quarter of docs think this actually improves care. Meanwhile, documentation requirements hit smaller practices harder even though patients like them better, and smaller practices do a better job keeping people healthy and out of the hospital!
Practicing physicians understand we’re measuring the wrong things. It’s expensive, and it doesn’t help patient care. We need a better alternative. Measurement should be person-centered, and should reflect good primary care!
Only a third of primary care doctors believe the current incarnation of the Medical Home benefits patients.
In 2007, the AAP, AAFP, ACP and AOA joined to publish the Joint Principles of the Patient-Centered Medical Home (PCMH), based on the fundamental principles of primary care. Since then, at least 30 other organizations have created ‘definitions’ of what the PCMH should be. Most of them are NOT based on principles of primary care, and have added hugely to primary care docs’ administrative overload. Many of these organizations have created ‘recognition’ or certification programs, based on checklists of functions (electronic prescribing, CPOE, patient portals, etc.) that do not capture the essence of primary care, which is:
Continuity– of Person-Focused care over time
first Contact with the health care system, together with
Comprehensiveness– most needs met in one office and
Coordination of care in other settings and by other providers
Many authors have pointed out the deficiencies of PCMH measurement by those organizations, and primary care doctors are united in their wishes to have the special value of primary care measured, when measurement happens. The combination of documentation for billing and ‘quality measures’ produced a documentation abomination: primary care doctors spend twice as much time on documentation as they do with patients!
“During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.”
Something needs to change.
Barbara Starfield expressed this very clearly. (We should:)
“Insist that the essence of good primary care is care of patients in the context of the community and the population. This involves doing the following:
Being responsive to patients’ problems, needs and symptoms as they experience them, not as they are reformulated by professionals,
Assessing the quality of care based on improvement of patients’ problems, both as experienced and as manifested by fewer symptoms (including those from adverse effects), improved functioning, resilience to threats to subsequent health and delayed progression of ill health.”
Fortunately, we can do this with a fairly simple measurement- Health Confidence.