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

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.

Study Overview

• Status: Completed
• Conditions: Electronic Health Records; Quality of Health Care
• Intervention / Treatment: Other: Electronic health record (EHR); Other: Medical Home redesign

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 438

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10021
      • Weill Cornell Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

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).

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
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 (EHRs) and who are not undergoing Medical Home redesign.	Other: Electronic health record (EHR); Computer-based system that allows physicians to access and manage patient records electronically.
3; Physicians that are using Electronic Health Records (EHRs) and undergoing Medical Home redesign.	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 III Medical Home

What is the study measuring?

Primary Outcome Measures

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

Collaborators and Investigators

• Sponsor: Weill Medical College of Cornell University
• Collaborators: The Commonwealth Fund; New York State Department of Health; Taconic Health Information Network and Community (THINC); Taconic Independent Practice Association (TIPA)

Publications and helpful links

General Publications

• Kern LM, Edwards A, Kaushal R. The Patient-Centered Medical Home and Associations With Health Care Quality and Utilization: A 5-Year Cohort Study. Ann Intern Med. 2016 Mar 15;164(6):395-405. doi: 10.7326/M14-2633. Epub 2016 Feb 16.
• Kaushal R, Edwards A, Kern LM; HITEC Investigators. Association between electronic health records and health care utilization. Appl Clin Inform. 2015 Jan 28;6(1):42-55. doi: 10.4338/ACI-2014-10-RA-0089. eCollection 2015.
• Kern LM, Edwards A, Kaushal R. The patient-centered medical home, electronic health records, and quality of care. Ann Intern Med. 2014 Jun 3;160(11):741-9. doi: 10.7326/M13-1798.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2008
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: November 14, 2008
• First Submitted That Met QC Criteria: November 18, 2008
• First Posted (Estimate): November 19, 2008

Study Record Updates

• Last Update Posted (Actual): February 23, 2017
• Last Update Submitted That Met QC Criteria: February 17, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Keywords: health information technology; electronic health records; quality of health care; physician incentives
• Other Study ID Numbers: 0508190240