Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Marney White

Abstract

Abstract

Background

Healthcare organizations are making the transition from volume to value-based care, thus relying on standardized performance measures for quality improvement. Some challenges of this strategy include the following: ambiguity and inconsistency of metric definitions across reporting systems, a dearth of measures that are representative of clinical care and patient experience, and unfair or inappropriate comparisons of organizations serving patients exposed to different sociodemographic risk factors.

Rationale

Developing and evaluating a clinical quality scorecard that is internal to a federally qualified health center will provide insight into its value-based performance. It will also allow for efficient improvement in clinical care and patient experience as well as data transparency among health care providers. The goal of the current project was to develop one such clinical quality scorecard for implementation at Cornell Scott-Hill Health Center (CS-HHC).

Method

Quality indices were compiled from a list of standardized performance measures included in the health care initiatives of CS-HHC. The scorecard was implemented in September 2018, and measures taken before and after implementation were compared. Primary outcomes included patient outcomes (physical measures such as diabetic hemoglobin A1c and blood pressure levels) as well as clinic endpoints (overall quality of care and likelihood of recommending clinic). Specific time points for selected metrics were plotted into line graphs to allow visual analysis over time and monthly progress reports were distributed to department leaders of CS-HHC. Analysis for the current study was limited to measures that are administered to the health center on a monthly basis. Metrics were evaluated 3-months prior to scorecard implementation, and were compared to outcomes measured 3-months after scorecard distribution. A cross-sectional survey was administered at baseline and 5-months following scorecard implementation to assess changes in comprehension of metrics among medical directors.

Results

Visual inspection of the line graphs suggested improvement from baseline to post-scorecard implementation in the following measures of patient outcomes: HIV viral load suppression, CD4 monitoring, lipid screening, hepatitis B vaccination and diabetic low density lipoprotein levels. However, these changes did not reach statistical significance when evaluated with unpaired students’ t-tests. Questionnaire item responses show an improvement in medical directors’ comprehension of clinical quality measures from baseline to follow-up; the mean scores for each item were descriptively higher after 5 months of scorecard distribution than at baseline.

Conclusions

The development and evaluation of a clinical quality scorecard suggests that improvement in clinical care, patient experience and data transparency is feasible within a federally qualified health center. Future research should utilize a longitudinal intervention design to explore possible trends in health center performance metrics and analyze medical directors’ comprehension of clinical quality measures.

Comments

This is an Open Access Thesis.

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