The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71547

Onesky Aupont, MD, MPH, PhD¹, Steven Stelovich, MD², and Thomas J McLaughlin, DSc¹. (1) Department of Ambulatory Care and Prevention, Harvard Medical School, 133 Brookline Avenue 6th Floor, Boston, MA 02215, 617 509 9868, Oaupont@hms.harvard.edu, (2) Psychiatry, Arbour Hospital, 49 Robinwood Avenue, Jamaica Plain, MA 02130

Quality of care for chronic illness in primary care settings is moderate to poor despite the availability of effective therapies and treatment guidelines. To meet the challenge of improved quality for chronic illness, system barriers need to be overcome in order to enhance adoption of quality improvement programs (QIPs) in settings designed primarily for acute illness. We used interrupted time-series analysis to analyze the impact of a QIP implemented in a group practice (n=15000 patients) of a managed care organization. The program included immediate access to psychiatrists, participation of providers in the design and content of the QIP, and provision of on-site ancillary personnel. A site with similar background characteristics including number and types of providers and patient load was used as a comparison group. Findings indicate that the QIP had a positive impact on the diagnosis and prescribing patterns of 61% of providers in the experiment group as opposed to 30% in the comparison group (p<0.001). Results also suggest that after controlling for back-up specialty care, availability of on-site ancillary mental health personnel, and financial incentives, improvement in performance was more likely when providers were involved in the planning process of the QIP (p< 0.001). Adoption was associated with providers’ perception that the initiative was championed by a medical leader (p< 0.001) as opposed to offering them a financial incentive to change (p<0.001). These findings suggest that important structural changes in a medical delivery system designed for treatment of acute illness can improve care for chronic diseases.

Learning Objectives:

At the end of the session, participants will be able to:
• Identify some system barriers that hamper primary care providers from adopting quality improvement programs for chronic illness.
• To recognize the importance of provider participation in the development of QIP programs.
• To analyze natural experiments using interrupted time series analysis.

Keywords: Quality Improvement, Depression

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.