"In the domain of primary care, this is a risk too great." Successful ProgramsĬommitment to these principles, the authors suggest, will be the start of "a primary care bridge across the quality chasm," and it will provide broad rewards. "Our near-exclusive focus on extrinsic programs, quality management's version of 'strangers at the bedside,' risks devaluing provider-patient and provider-community relationships in the quest for quality improvement," the authors write. To succeed, an effective primary care quality management program must recognize that clinicians' key motivation is the desire to improve patient outcomes. Primary care, the report says, "relies on high-functioning relationships characterized by trust and professionalism." Current quality management programs, on the other hand, rely on rewards, penalties and requirements. "Future quality programs for primary care must understand that measurements are imperfect proxies for outcomes as such, policymakers and regulatory agencies must be wary of mistaking points for trajectories." Principle 4 Such measurements are of limited use in primary care because patient outcomes are vectors more than they are discrete points. Individual data measurements do not adequately account for trajectories, complexity or high-risk environments, the authors write. The authors note that recording measures is particularly difficult in primary care, where physicians and other health care professionals "are often juggling an array of medical and psychosocial concerns at once." This neglect is one of the sources of our current quality crisis." Principle 3 "In neglect of this principle, quality programs in primary care have overemphasized the dissemination and collection of metrics while largely ignoring their impact on costs and provider-patient experiences. "Whether evolutionary or revolutionary in scope, health policies must be judged by their impact on the quadruple aim in its entirety," they add. The original triple aim of better health care, better patient experience, lower health care costs and higher clinician satisfaction, the authors write.The original triple aim of better health care, better patient experience and lower costs "cannot be reached piecemeal," the authors write - and primary care's fourth aim of clinician satisfaction only makes the vectors more interdependent. "Adherence to this first principle will be particularly essential in the context of the epidemiologic prevalence of multimorbidity and the demographic growth of the geriatric population precariously little is known about how to accurately and effectively measure quality in these groups." Principle 2 They write that the current model for quality management in primary care does not improve outcomes, costs or patient experience because it is too focused on measuring disease, biomedical data and processes. What the authors call their cornerstone principle advises that "the singular objective of quality management in primary care is to improve the health of patients and populations." These, the authors write, "serve as the foundation for a bridge to high-functioning primary care that will lead American health care closer to the quadruple aim." Principle 1
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