system for measurement and reporting is to have a phase-in period that will allow providers to learn procedures and protocols once the necessary infrastructure is in place, as well as obtain provider support and feedback with regard to performance measurement activities. Economies of scale available to larger organizations may allow them to respond more quickly than smaller organizations with fewer resources to devote to these tasks.

To examine the experience of practices that are currently implementing performance measurement, the committee sought input from a small sample of practices across various regions and communities. Major themes emerged from these case studies to reveal potential issues associated with implementing a national system for performance measurement and reporting. Specifically, the IOM committee sought to address two main questions: (1) What will it take to obtain provider support? and (2) How feasible is it to implement the proposed NQCB? In addition, the committee wished to address the issues associated with implementation of performance measurement, especially those faced by small practices, with particular attention to barriers and successes achieved in overcoming those barriers.

Three main themes emerged from the case studies: (1) the need to obtain physician support, (2) the need to obtain needed resources (human, technical, and financial), and (3) the importance of sustaining change. These themes are discussed below, followed by a review of barriers and successes achieved by the practices studied (see Table C-1).

Obtain Physician Support

The first step in implementing performance measurement within clinical practices is to obtain physicians’ agreement to participate. Omitting this important step could delay or undermine the success of the NQCB. The NQCB can obtain physician support in a number of ways, as indicated by the providers contacted in the committee’s case studies:

  • Support provider participation in federal, state, and local collaborative arrangements for data collection and interpretation of results.

  • Encourage those providers who are not already implementing quality improvement to seek help from their colleagues who are doing so or from their professional organizations.

  • Promote use of practice guidelines by measure developers to achieve consensus on measures, and include multiple stakeholders in the consensus process.

  • Encourage provider innovation in measurement activities that are clinically meaningful and specific to the practice setting, in addition to meeting national requirements.

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