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Organizational Factors Influencing Patient Safety/Quality in Medical Group Practices

Organizational Factors Influencing Patient Safety/Quality in Medical Group Practices. John E. Kralewski, Ph.D. University of Minnesota. Some Findings from 20+ Studies Over the Past 10 Years. Basic model includes Incentives Organizational structure Culture

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Organizational Factors Influencing Patient Safety/Quality in Medical Group Practices

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  1. Organizational Factors Influencing Patient Safety/Quality in Medical Group Practices John E. Kralewski, Ph.D. University of Minnesota

  2. Some Findings from 20+ Studies Over the Past 10 Years • Basic model includes • Incentives • Organizational structure • Culture • Will focus on four outcome studies and then two projects designed to better understand those studies

  3. Four Studies Designed to Determine What Makes a Difference • Prescription drug errors • PPPSA performance • PMPM costs and patient satisfaction • Physician payment amount and quality

  4. What Did We Find? • Drug Errors • 27.7% of prescriptions had errors • 12.9% if over/under dose left out • More prescriptions/patient – more errors • Rural – more errors • Monitor chronic illness – fewer errors • Electronic drug prompts – fewer prescriptions • Quality culture – fewer errors • Cohesive culture – fewer errors • Physician payment methods – no influence • Practice size and complexity – no influence

  5. What Did We Find? • PPPSA • Six patient safety domains • 380 practices – range 12% to 63% • Medium practice size – high performance • EHRs influence Rx records and renewals • Proportion of revenue from Medicare and Medicaid has negative effect on drug management, but positive on informing patients of rights and encouraging patients to share safety concerns

  6. What Did We Find? • Patient Satisfaction and Costs • PMPM costs do not influence satisfaction • Cohessive culture – nurse practitioners increase satisfaction; larger practices lower satisfaction • Physician payment, workload, specialty mix, physician age had no influence on satisfaction

  7. What Did We Find? • Physician Payment and Quality • The amount paid to medical practices for services has no influence on quality as measured by claims data

  8. What Did We Find? • Overall • EHRs have less influence than expected • Physician payment (method and amount) has less influence than expected • Culture is important but hard to change • Practice size is an important factor, complexity unclear • Physician characteristics influence costs but not quality

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