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of services, and lower-quality patient care. These inefficiencies in turn will hamper efforts to improve access to care.


Support physician-led efforts to document quality and efficiency


The physician-led teams will be the linchpin of our future health care delivery system. Directly and indirectly, physicians will impact both health care quality and costs. Measuring their performance to identify weaknesses that warrant change creates tremendous opportunity to improve health care quality and efficiency.28A


Physician performance measurement and improvement may prove a lost opportunity for strengthening the health care system if we do not appropriately address methodological and other shortcomings of existing efforts. Too many government programs and commercial insurance companies, for example, rely on data from claims submitted for payment rather than on a close examination of the care delivered to the patient. All quality improvement programs should adopt a national set of standard, meaningful, evidence- based measures that improve both patient outcomes and patient satisfaction.


Key Actors and the Flow of Information in the Medical Neighborhood


Community Family


Patient


Patient-centered medical home provides patient- centered, comprehensive, and coordinated care that supports patient self-care; offers superb access to care; and employs a systems-based approach to quality and safety


Acute and post-acute care • inpatient hospital care


• rehabilitation • skilled nursing care • home health services


• emergency department


Ambulatory care • specialty care • subspecialty care • ancillary services (e.g., physical therapy, podiatry, speech therapy)


• retail clinics


State and local public health (e.g., smoking cessation, tobacco use prevention, infectious disease control, chronic disease prevention)


Provide significant investment in health information technology


Diagnostic services • lab • imaging


Pharmacy • medication management


Community and social services (e.g., hospice, personal care services, home-delivered meals, home modifications, assistive technology, accessible transportation, education and support for patient self-care)


Taylor EF, Lake T, Nysenbaum J, Peterson G, Meyers D. Agency for Healthcare Research and Quality. Coordinating care in the medical neighborhood: critical components and available mechanisms. June 2011.


66 TEXAS MEDICINE September 2012


As in nearly every other sphere of modern life, technology has delivered enormous improvements in medicine. Once-unimaginable diagnostic tools and treatments are now commonplace. HIT has tremendous potential to advance the quality of care, prevent medical errors, and streamline health care delivery systems. Recognizing this potential, the government and employers are pushing physicians and providers to adopt HIT quickly so they can better measure the value they receive for their health care dollar. Physicians themselves, of course, are motivated to provide the best possible care, which in modern times involves the use of various technologies, including HIT.


The primary goal of any quality program must be to promote safe and effective care across the health care delivery system. Getting the right care to the patient at the right time will reduce overall costs in the long run.


Fair and ethical quality programs are patient- centered and link evidence-based performance and improvement measures to financial incentives.


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