to Practice Transformation Evidence from the Comprehensive Primary - - PowerPoint PPT Presentation

Bringing the Patient Voice to Practice Transformation

Evidence from the Comprehensive Primary Care (CPC) Initiative

Janel Jin, MSPH Center for Medicare & Medicaid Innovation

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CPC Aimed to Strengthen Primary Care

Theory of Change CPC tests whether the provision of comprehensive primary care at the practice site, supported by multi-payer payment reform, continuous use of data, and meaningful use of health information technology, can achieve better care, smarter spending, and healthier people. Participants

• 4 year model: 2012-2016
• 7 regions: 4 states and portions of

3 states

• 496 participating practices
• 2,200 practitioners supporting 2.7

million active patients, including 335,000 Medicare and 78,000 Medicaid beneficiaries

• 38 public and private payers
• Robust learning system

CPC Centered on Patients and Families

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Patient Engagement Tactics in CPC

PFACs Patient Surveys Conduct a practice- based survey to collect data on patient experience Convene patient and family advisory council (PFACs) Practices were required to implement one of two options:

Is practice use of PFACs related to patient engagement in quality improvement?

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PFACs in CPC

Patients, caregivers, clinicians, office staff, and practice leadership

Aim for at least 8 patients and caregivers who are diverse and representative of the practice population

Regularly meet to discuss improvements in care, processes, and experiences

Ongoing, continuous feedback with a broad perspective

Information is used to drive change, and results are communicated back to the PFAC

Not just a “check-the-box” activity, communication loop is critical

Method and Data Source

• Retrospective cohort study of CPC practices comparing

choice of PFAC, survey, or both in 2015 to practice-rated patient engagement in 2016

• Practice self-assessment via an online portal

– Fielded quarterly – 100% response rate

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Nearly half of practices chose to convene PFACs

Total practices: 445

34 9 40 34 60 36 22 235 19 29 6 19 7 9 27 116 4 31 8 11 8 16 16 94 50 100 150 200 250

AR CO NJ NY OH OK OR All-Regions

Number of Practices

Practice Choice of Patient Engagement Tactic in 2015 Practice-based Survey Patient and Family Advisory Council Both

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Are PFACs associated with higher patient engagement?

• Three binary outcomes:
• 1. Patients generated quality improvement

project ideas in the last year

• 2. Patients were seen as equal partners in

quality improvement

Dichotomized responses from a 5-point Likert scale (strongly disagree to agree)

• 3. Practices shared quality improvement

data with patients

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PFACs increased likelihood that patients generated quality improvement ideas

• Practices with PFACs had

a 42% increase in likelihood compared to practices with surveys only

• Results similar for both

PFAC groups

• Statistically significant

difference after adjusting for region, size, rural/urban status, ownership

14.5% 54.3% 52.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Survey PFAC only Both

% of Practices where Patients Generated Quality Improvement Ideas

(n = 235) (n = 116) (n = 94) 10

• Practices with PFACs were

four times as likely view patients as equal partners

• Results similar for both

PFAC groups (PFAC only vs PFAC + survey)

• Statistically significant

difference after adjusting for region, size, rural/urban status, ownership

62.98% 91.38% 91.5%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Survey PFAC only Both

% of Practices that Agreed Patients are Equal Partners in QI

(n = 235) (n = 116) (n = 94)

PFAC practices more likely to view patients as equal partners in quality improvement

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Patient engagement tactic did not impact whether quality improvement data was shared

10.6% 9.5% 19.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Survey PFAC only Both

% of Practices Who Shared Quality Improvement Data with Patients

(n = 235) (n = 116) (n = 94)

• Low rates of sharing

data with patients in all three groups

• No statistical differences

between groups

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Limitations

• Practices self-selected their tactic
• Not nationally representative
• Did not measure specific PFAC

activities

• No control group with zero patient

engagement

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Conclusions

PFACs may enhance patient-centered quality improvement

Having a PFAC was associated with having patients drive quality improvement projects and viewing patients as equal partners. Notably no significant differences between doing both survey and PFAC versus PFAC only.

Patient input and partnership did not translate into data transparency

No difference in patients seeing data or results, which is a major piece of quality improvement.

More to learn

Further investigation is needed to understand elements of successful implementation of patient engagement, and whether or not patient engagement in quality improvement translates into better outcomes.

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Policy Implications

Patient and caregiver input is a critical part of robust quality improvement, especially as alternative payment models grow Primary care practices are uniquely positioned to leverage patient and caregiver input PFACs are an important tool for practices to engage patient voices. CPC+, a new CMS model, requires all practices to convene a PFAC

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Questions?

More on CPC:

https://innovation.cms.gov/initiatives/compre hensive-primary-care-initiative/

Contact:

janel.jin@cms.hhs.gov

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