Evaluating the Effects of EHRs, P4P and Medical Home Redesign in the Hudson Valley

Study Overview
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Brief Summary
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The investigators will conduct a longitudinal cohort study with concurrent controls. The investigators will include all primary care physicians in the Hudson Valley including family practitioners, internists, and pediatricians. The purpose of this study is to determine the effects of implementing electronic health records (EHRs), pay-for-performance incentives for physicians (P4P), and Medical Home redesign on health care quality, cost and patient experience in the Hudson Valley.

Detailed Description
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The Hudson Valley is implementing several innovative programs to potentially improve quality and reduce the cost of health care delivered. First the Taconic Health Information Network and Communities Regional Health Information Organization (THINC RHIO) is facilitating diffusion of EHRs in office practices in the Hudson Valley. Second, THINC RHIO is also offering a strategic approach to pay-for-performance. Third, an additional component of the THINC P4P project will be an added financial incentive for private practice physicians who implement and reach Level II of Physician Practice Connections® - Patient Centered Medical Home (PCMH)™, NCQA's new national recognition system for physician practices. Our study will seek to determine the effect of each of these initiatives on health care quality and cost of care in the Hudson Valley. We will also measure the patient experience before and after implementation of the Medical Home.

Official Title
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Evaluating the Effects of EHRs, P4P and Medical Home Redesign in the Hudson Valley

Conditions
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Quality of Health Care, Electronic Health Records

Intervention / Treatment
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* Other: Electronic health record (EHR)
* Other: Medical Home redesign


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary care physicians working in the offices practices in the Hudson Valley, and who are members of the Taconic IPA. Exclusion Criteria: Physicians who opt out from the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 1<br>Physicians that are using paper-based medical charts and who are not receiving Medical Home redesign incentives. | |
| 2<br>Physicians that are using Electronic Health Records (EHRs) and who are not undergoing Medical Home redesign. | Other: Electronic health record (EHR)<br>* Computer-based system that allows physicians to access and manage patient records electronically.<br>|
| 3<br>Physicians that are using Electronic Health Records (EHRs) and undergoing Medical Home redesign. | Other: Electronic health record (EHR)<br>* Computer-based system that allows physicians to access and manage patient records electronically.<br>Other: Medical Home redesign<br>* Implementation of NCQA Level III Medical Home<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| health care quality (as determined by previously selected and approved quality indicators) |  | 5 years | 
| health care utilization |  | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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electronic health records, health information technology, physician incentives, quality of health care