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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2018

Open Access 01-12-2018 | Research

Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics

Authors: Kathleen A. Culhane-Pera, Luis Martin Ortega, Mai See Thao, Shannon L. Pergament, Andrew M. Pattock, Lynne S. Ogawa, Michael Scandrett, David J. Satin

Published in: International Journal for Equity in Health | Issue 1/2018

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Abstract

Background

Quality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition’s Quality Measurement Enhancement Project sought to collect data from primary care providers’ (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs’ perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare.

Methods

Qualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes.

Results

Three themes with sub-themes emerged. Theme #1: Minnesota’s current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity.

Conclusion

Aligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs’ perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them.
Appendix
Available only for authorised users
Footnotes
1
QMEP’s projects have included improving methods of collecting data on SDOH factors, identifying the relationships between these factors and quality scores, adjusting or explaining quality scores in light of these relationships, and developing new or modified quality measures related to provider performance in identifying and addressing patients’ SDOH risk factors to improve health and treatment outcomes.
 
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Metadata
Title
Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics
Authors
Kathleen A. Culhane-Pera
Luis Martin Ortega
Mai See Thao
Shannon L. Pergament
Andrew M. Pattock
Lynne S. Ogawa
Michael Scandrett
David J. Satin
Publication date
01-12-2018
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2018
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-018-0872-3

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