May 2012

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Despite knowledge of evidence--based guidelines, physicians often do not follow best practices. Barriers to physician quality improvement efforts include a culture that does not value measurement, time constraints, and little training in quality improvement efforts. Electronic health records (EHRs) have been shown to improve care in patients with diverse medical problems including asthma, diabetes, congestive heart failure, chronic kidney disease, depression, children with ADHD, childhood obesity, and in preventive care screening for breast cancer and colorectal cancer. EHRs have also been shown to reduce medication errors and infection rates. Meaningful use (MU) requirements are an attempt to incent physicians to use EHRs to improve quality by linking financial payments to quality reporting. Meaningful use requires eligible providers to track 3 core quality metrics and 3 other metrics from a menu set of 38 quality metrics, many designed for primary care, but for many medical specialties there are no pertinent quality metrics included in the meaningful use set. With similar financial incentives, will physicians without appropriate metrics participate in designing specialty specific metrics, and how will their adherence to custom metrics compare with adherence to metrics by physicians with appropriate meaningful use metrics? This project examined whether physicians would report on clinical quality measures mandated by an outside agency, and whether they would be willing to develop clinical quality metrics they felt exemplified quality in their specialty. Departments without the required number of CMS approved metrics were encouraged to develop metrics that they felt were meaningful for their specialty. While the ideal metrics are evidence--based medicine (EBM) guidelines or best practices, it is recognized that not all specialties have EBM--based guidelines readily available. However, all guidelines had to plausibly improve care processes, outcomes, or both. Tracking the metrics had to be technically feasible using our current software. Forms for use within the EHR were developed as needed to facilitate data collection by the providers to document clinical care measures. This project measured adherence to quality metrics as a surrogate marker for clinical quality. It compared adherence rates between specialties with and without appropriate meaningful use quality metrics, and examined rates of adherence between mandated and self--selected metrics. The results of this project demonstrated that providers may be willing to report on quality metrics and may participate in choosing and developing metrics to report on. Providers in departments with few MU metrics and those with many MU metrics made similar significant improvements in rates of adherence to the MU core metrics, but no significant improvements in the MU menu metrics. Both groups made similar significant improvements in specialty--selected metrics.




School of Medicine



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