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Improving the Quality of Care in Small Internal Medicine Practices: An Evaluation

Jill Anne Marsteller, Chun-Ju Hsiao, Simon C Mathews, William S Underwood, Paula M Woodward, Michael S Barr

Small practices face unique challenges to improving quality of care. We conducted a pre-post-test of a quality improvement intervention provided by the Center for Practice Innovation (CPI) to 34 small internal medicine practices featuring two site visits, a practice assessment, self-selection of focus areas for improvement and ongoing 'directed guidance' of the practices. In bivariate analyses, the intervention was associated with statistical improvement in percent of patients with: controlled blood pressure for diabetic patients (68% vs. 77%); assessment of fall risk (78% vs. 93%); asthma patients on inhaled corticosteroid (91% vs. 100%); flu vaccine (86% vs. 97%); and pneumococcal vaccine (83% vs. 99%). Additionally, statistically significant improvements were noted in selected practice processes and patient satisfaction measures. However, clinician and staff assessments showed some negative changes. Quality improvement initiatives focused on small practices can improve clinical and patient satisfaction measures but may have risks for clinician and staff satisfaction.