The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox?

Purpose: To assess whether primary care practices with and without support from a larger organization differ in their ability to produce timely reports on cardiovascular disease quality measures. Background: Although many primary care practices are now part of larger organizations, it is not clear whether such a shift will improve the ability of those who work in these primary care settings to easily access and use their own data for improvement. Methods: Smaller primary care practices were enrolled in a trial of external practice support to build quality improvement (QI) capacity. A request for clinical quality measure (eCQM) data were sent to each practice and study outcomes were defined based on the date on which practices first submitted valid data for at least 1 of the 3 measures. A practice survey completed by a clinic manager captured practice characteristics, including the presence of QI support from a larger organization. Results: Of the 209 enrolled practices, 205 had complete data for analysis. Practices without central QI support had higher rates of eCQM submission at 30 days (38% vs 20%) and 60 days, (63% vs 48%) than practices with central QI support. Practices with central QI support took longer to submit data (median, 57 days) compared with practices without centralized support (median, 40 days) although this difference was not significant. Conclusion: The ability of smaller practices without centralized QI support to report their eCQMs more quickly may have implications for their subsequent ability to improve these measures.