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

• health care quality (as determined by previously selected and approved quality indicators) [ Time Frame: 5 years ] [ Designated as safety issue: No ]
• health care costs (as calculated by utilization) [ Time Frame: 5 years ] [ Designated as safety issue: No ]

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.

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.

All primary care physicians (i.e. general internists, pediatricians and family practice physicians) in the Hudson Valley who are members of the Taconic Independent Practice Association (IPA).

• Quality of Health Care
• Electronic Health Records

• Other: Electronic health record (EHR)
  Computer-based system that allows physicians to access and manage patient records electronically.
• Other: Medical Home redesign
  Implementation of NCQA Level II Medical Home

• 1
  Physicians that are using paper-based medical charts and who are not receiving Medical Home redesign incentives.
• 2
  Physicians that are using electronic health records and who are not undergoing Medical Home redesign.
  Intervention: Other: Electronic health record (EHR)
• 3
  Physicians that are using electronic health records and undergoing Medical Home redesign.
  Interventions:

  • Other: Electronic health record (EHR)
  • Other: Medical Home redesign

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.

• New York State Department of Health
• The Commonwealth Fund
• Taconic Health Information Network and Community (THINC)
• Taconic Independent Practice Association (TIPA)