Current Measures
Gordon and Betty Moore Foundation Grant Funding
Continuity of Care is described as an on-going patient-physician relationship over time and builds on the idea that knowledge, trust, and respect have developed between the patient and physician, allowing for better interaction and communication. The Institute of Medicine labeled Continuity of Care a defining characteristic of primary care, one that Starfield and others demonstrated as essential to primary care’s positive impact on health equity, cost reduction, improved patient outcomes, patient/physician satisfaction, improved quality of care and improved primary care utilization. The American Board of Family Medicine (ABFM) has been awarded funding by the Gordon and Betty Moore Foundation to demonstrate that Continuity of Care is related to better diagnosis, and to specifically demonstrate how a clinician-level Continuity of Care performance measure is a valid and robust measure that can be associated with reduced diagnostic errors and improved quality of care. We hope to demonstrate this relationship not only in the diagnosis of cardiovascular disease and its risk factors (e.g., Diabetes and Hypertension), but also for Cancer and Infectious Disease, two other core areas of interest for the Foundation. Second, we aim to advance the Continuity of Care performance measure through a variety of CMS Federal Payment Programs.
The overall Aims of the grant include:
Aim: Estimate the impact of continuity on intermediate predictors of cardiovascular outcomes influenced by timely and accurate diagnosis. These predictors are high value treatment for early and on target diagnosis of comorbidities, including metformin, statins, and ACE-inhibitor use.
Aim: Refine ABFM’s Continuity of Care quality performance measure for implementation in public and private payment and accountability programs.
The Continuity of Care Measure
The Continuity of Care performance measure was developed in collaboration with the Robert Graham Center. Continuity of Care is defined as an on-going patient-physician relationship over time and remains one of the pillars of a high functioning health care system and one of the core virtues of primary care. High care continuity is shown to improve patient outcomes and physician well-being and is associated with decreased health care costs including total costs, ED costs, inpatient costs, primary care costs, and costs for specific conditions or treatments. It is also associated with decreased health care utilization such as ED visits and hospitalizations. As a byproduct of building a continuous, trusting relationship over time, issues of equity and social risk can be addressed.
The Continuity of Care performance measure has been vetted through a rigorous national endorsement process and received national endorsement in 2021.
In June 2023, the Core Quality Measures Collaborative (CQMC) announced that the Continuity measure will join the core measure set,
a parsimonious group of scientifically sound measures that efficiently promote a patient-centered assessment of quality. Being a part of the core measure set means that health plans across the country should adopt these measures to improve patient care.
The measure is available in the PRIME Registry, a qualified clinical data registry (QCDR), open to all primary care clinicians and is endorsed by CMS for use in the Merit-Based Incentive Payment System (MIPS) Quality Payment Program (QPP). The PRIME Registry supports MIPS and other CMS quality payment programs. For more information on the PRIME Registry contact prime@theabfm.org or visit primeregistry.org to enroll.
For measure specifications, please click here.
The Person-Centered Primary Care Measure (PCPCM) Patient Reported Outcome Performance Measure (PRO-PM)
The PCPCM PRO-PM is a patient reported outcome measure of exemplary primary care that has been developed in collaboration with the Larry A. Green Center based on extensive development work with patients, clinicians and health care payers. The PCPCM PRO-PM has been vetted through a rigorous national endorsement process and received national endorsement in 2021. The measure is also the winner in the Patient-Reported Outcomes category of the NQF Next-Generation Innovator Abstract Award.
The PCPCM PRO-PM uses a survey to ask patients to assess 11 distinct yet highly interrelated items regarding their assessment of the care they receive. The 11 items are associated with better individual health, population health, increased equity and quality and decreased costs.
The PCPCM PRO-PM has been approved for broad use in the CMS Merit-based Incentive Payment System (MIPS) Quality Payment Program (QPP). Additionally, it has been approved:
- As part of the Family Medicine measure set
- As part of the Internal Medicine measure set
- As part of the Optimizing Chronic Disease Management MVP for CY 2023
For measure specifications, please click here.
The Comprehensiveness of Care Measure
The Comprehensiveness of Care performance measure was developed in collaboration with the Robert Graham Center. Along with Continuity of Care, Comprehensiveness of Care is also one of the pillars of a high functioning health care system and one of the core virtues of primary care. Reaffirmed as a defining characteristic of primary care in the recent NASEM report, Comprehensiveness of Care leads to better health outcomes and more health equity for the population. Described by Starfield and others as “the extent to which primary care practitioners provided a broader range of services rather than making referrals to specialists for those services,” Comprehensiveness of Care differentiates primary care from other forms of health care (e.g., specialty care, hospital care).
The Comprehensiveness of Care performance measure is currently being tested in the PRIME Registry and is slated for submission for national endorsement in 2023 and for the CMS Merit-Based Incentive Payment System (MIPS) Quality Payment Program (QPP) in 2024.
Physician Trust Patient Reported Outcome Performance Measure (PRO-PM)
An ongoing, trusting relationship between clinicians and patients is especially vital for primary care clinicians since effective relationships over time have demonstrable value. The Physician Trust PRO-PM uses the Wake Forest Trust Scale (WFTS) short form, a 5-item Likert-style scale based on thorough psychometric development and testing, designed to assess trust in primary care physicians. The WFTS considers four domains of trust: fidelity, competence, honesty, and global trust. The scale has been widely used, both in the U.S. and internationally, with translations and validation in several other languages and it has been shown to have good cross-cultural consistency/validity. It has also been used in a variety of age groups and in various disadvantaged/vulnerable populations.
The Physician Trust PRO-PM is currently being tested in the PRIME Registry and is slated for submission for national endorsement in 2024 and for the CMS Merit-Based Incentive Payment System (MIPS) Quality Payment Program (QPP) in 2025.
Value Care Measure
The Value Care performance measure is currently in the conceptualization phase. Primary care is where most outpatient healthcare is delivered and where more than one-third of all visits take place. We are studying how primary care clinician decisions and behaviors affect total costs of care.
For questions related to any of ABFM’s current projects, please email MeasuresThatMatter@theabfm.org
