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Improving Evidence Based Performance in Physician Practice
Executive Summary & Descriptive Statistics
Mark A. Davis, Ph.D. & Robert J. Pavur, Ph.D.
College of Business
University of North Texas
Denton, TX 76203
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Dear Practice Administrator:
Healthcare researchers have conjectured that some office system characteristics are
capable of elevating the delivery of preventive services and the quality-of-care
provided by physician practices. With that proposition in mind, we conducted a
survey of 1,000 physician practices in the State of Texas to learn how those practices
organize their office resources and procedures. This report describes the results
from the 250 respondents that completed the survey. To show our appreciation to
practices like yours that participated, we are pleased to share the results of that
survey with you.
From a research perspective, we hoped to uncover the connections between the
application of office systems and tools and “evidenced-based” quality of care. We
relate the more prominent connections below. In addition, the descriptive statistics
published herein offer approximate benchmarks and norms for physicians and other
providers seeking to create office systems capable of providing the highest levels of
evidence-based quality.
Based on this pilot investigation, we recently submitted a grant to the Agency for
Healthcare Research and Quality requesting funds to conduct a large-scale
investigation of physician practices in the State of Texas. Meanwhile, we hope these
preliminary data will benefit the very challenging work of primary care practices
across the State of Texas. Please accept our sincere thanks for participating in this
very important research.
Sincerely,
Mark A. Davis, Ph.D.
College of Business
University of North Texas
Robert J. Pavur, Ph.D.
College of Business
University of North Texas
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Key Variables
Our survey was composed of 70 items addressing the degree to which the physician
practice employed information technology, disease registries, physician reminders,
flow sheets, health risk profiles, patient interventions, and other methods for
supporting preventive care and clinical practice guidelines. Each survey item
presented a five-point response set ranging from (1) “no use” to (5) “very high use”.
To ensure reasonable comparisons, additional items captured disparities in practice
resources (e.g., number of midlevel providers) and patient volume.
Establishing a link between those office system characteristics and quality-of-care
called for an independent quality metric. For that purpose, we used publicly
available data from the Blue Compare profiling tool offered by Blue Cross Blue
Shield of Texas. This online tool is designed to assist members in their selection of
healthcare providers. The website contains information showing how physicians
compare with their physician peers on a measure derived from aggregated evidencebased medical (EBM) indicators of care. At the time of our data collection, a dark
blue ribbon represented outstanding performance on aggregated EBM indicators
whereas commendable performance earned a light blue ribbon. The absence of a
ribbon indicates insufficient data, failure to meet performance standards, or electing
to “opt out” of the EBM ribbon display. Based on the sample of respondents, 39.7
percent achieved dark blue status, 37.6 percent achieved light blue status, and 22.8
percent were designated as no ribbon status.
Sample Description
Approximately, one-fourth of the sample (24.1 percent) consisted of osteopathic
physician practices, while the remaining three-fourths were allopathic physician
practices. The table below presents mean, median (50th percentile), and 75th
percentile values for patient volume and the key health care providers across the 250
respondents. Given that extreme values can skew estimates of the mean, the median
values offer the more reasonable depiction of this sample. Thus, we note that half of
the responding practices reported up to 38 patient visits/encounters per day with
two or less full-time physicians and no midlevel providers (i.e., nurse practitioners
and physician assistants). Roughly one-third of the responding practices reported
using midlevel providers .
Full-Time Physicians
Part-Time Physicians
Nurse Practitioners
Physician Assistants
Patient Encounters
Per Day
Mean
4.85
1.07
0.62
0.71
50th percentile
2
0
0
0
75th percentile
5
0
1
1
64
38
75
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Associating Office Systems and Tools with Evidence-Based Quality
Using a statistical tool called factor analysis, we effectively reduced the 70
items composing the survey to 9 specific dimensions. Thus, we examined the use of
(1) physician reminders, (2) flow sheets, (3) disease registries, (4) risk assessment
profiles, (5) engaged patient interventions, (6) passive patient interventions, (7)
techniques for supporting CPG and preventive care, (8) information technology (IT)
capability, and (9) personal digital assistants (PDA) or IT enhancement. In
particular, we analyzed whether changes or differences in these dimensions were
related to differences in respondents’ EBM profile (ribbon color) using the Blue
Compare tool. The statistically significant factors or combinations of factors that
predicted respondents’ EBM category are listed below. Specifically,
1. Respondents possessing own sizeable IT resources (whether strong IT
capability or high use of personal digital assistants) were more likely to have
earned a dark blue (high performance) ribbon.
2. A high performance classification was associated with the use of flow sheets.
3. Superior IT capability combined with the use of disease registries increased
the likelihood of achieving a high performer (dark ribbon) status.
4. Paradoxically, practices characterized by superior IT capability and extensive
PDA use were more likely to fall into the lower EBM performance category.
Though speculative, it is conceivable that poorly integrated IT resources or a
disproportionate emphasis on IT hinders or distracts practices from focusing
on those clinical procedures and activities capable of enhancing EBM quality.
Office Tools and Resources: Suggestive Benchmarks
The remaining pages of this report contain charts portraying reported frequencies
for the individual items comprising the survey. We advise the reader to interpret
these data with caution. These qualify as “suggestive” benchmarks simply because a
change in any one item is unlikely to influence the EBM quality of the practice. And
while a pattern of modifications across several items (e.g., upgrading and increasing
IT capabilities) may benefit actual quality-of-care; the performance status of the
practice (ribbon color) may remain unaffected. At the same time, we believe it is
reasonable and constructive for practice administrators to compare their application
of these tools and procedures against these data as a way of gauging potential
strengths and weaknesses.
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Physician practices can enhance quality-of-care through information technology.
To what extent does your practice rely on computerized applications to perform the
following tasks?
Input and retrieve patient information
5 = Very High Use
53.5
4 = High Use
15.4
3 = Moderate Use
9.1
10.6
2 = Some Use
10.6
1= No Use
0 = No Response
0.8
0
10
20
30
40
50
60
Percentage of Respondents
Input and retrieve clinical notes
41.7
4 = High Use
5.5
3 = Moderate Use
6.3
2 = Some Use
7.9
1= No Use
37.8
0 = No Response
0.8
0
5 = Very High Use
5
10
15
20
25
30
35
40
45
Percentage of Respondents
Writing prescriptions and ordering medications
5 = Very High Use
39.4
4 = High Use
6.3
3 = Moderate Use
5.1
2 = Some Use
7.5
1= No Use
41.3
0 = No Response
0.4
0
5
10
15
20
25
30
35
Percentage of Respondents
40
45
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Physician practices can enhance quality-of-care through information technology.
To what extent does your practice rely on computerized applications to perform the
following tasks?
Ordering lab tests
5 = Very High Use
38.6
4 = High Use
13.4
3 = Moderate Use
7.5
2 = Some Use
9.1
1= No Use
30.7
0 = No Response
0.8
0
5
10
15
20
25
30
35
40
45
Ordering lab tests
Review laboratory and/or pathology reports
32.7 5 = Very High Use
4 = High Use
13.8
3 = Moderate Use
14.6
2 = Some Use
11.8
1= No Use
26.8
0 = No Response
0.4
0
5
10
15
20
25
30
35
Review laboratory and/or pathology reports
Research and review drug information
5 = Very High Use
29.5
4 = High Use
22.0
3 = Moderate Use
24.4
2 = Some Use
11.0
1= No Use
12.6
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Research and review drug information
35.0
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Physician practices can enhance quality-of-care through information technology.
To what extent does your practice rely on computerized applications to perform the
following tasks?
Research and review clinical guidelines
5 = Very High Use
26.8
4 = High Use
20.1
3 = Moderate Use
24.4
2 = Some Use
12.6
1= No Use
15.7
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Research and review clinical guidelines
Personal Digital Assistants (PDA) are hand-held computers that have medical and scientific uses
(e.g., to aid diagnosis and drug selection). To what extent does your practice employ PDAs to perform the
following tasks?
PDA to research and review clinical guidelines
5 = Very High Use
5.1
4 = High Use
5.9
3 = Moderate Use
9.8
2 = Some Use
14.6
1= No Use
63.4
0 = No Response
1.2
0
10
20
30
40
50
60
PDA to research and review clinical guidelines
70
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Personal Digital Assistants (PDA) are hand-held computers that have medical and scientific uses
(e.g., to aid diagnosis and drug selection). To what extent does your practice employ PDAs to perform
the following tasks?
PDA to perform medical calculations
5 = Very High Use
7.5
4 = High Use
9.4
3 = Moderate Use
11.8
2 = Some Use
12.6
1= No Use
57.5
0 = No Response
1.2
0
10
20
30
40
50
60
70
PDA to perform medical calculations
PDA to access medical dictionary
5 = Very High Use
5.1
4 = High Use
2.8
3 = Moderate Use
9.1
2 = Some Use
13.4
1= No Use
68.1
0 = No Response
1.6
0
10
20
30
40
50
60
70
80
PDA to access medical dictionary
PDA to research and review drug information
5 = Very High Use
15.7
4 = High Use
8.3
3 = Moderate Use
10.6
2 = Some Use
8.7
1= No Use
55.5
0 = No Response
1.2
0
10
20
30
40
50
PDA to research and review drug information
60
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Personal Digital Assistants (PDA) are hand-held computers that have medical and scientific uses
(e.g., to aid diagnosis and drug selection). To what extent does your practice employ PDAs to perform
the following tasks?
PDA to input and retrieve patient information
5 = Very High Use
2.4
4 = High Use
1.6
4.7
3 = Moderate Use
4.3
2 = Some Use
1= No Use
85.8
0 = No Response
1.2
0
10
20
30
40
50
60
70
80
90
100
PDA to input and retrieve patient information
PDA to input and retrieve clinical notes
5 = Very High Use
2.8
4 = High Use
1.6
3.1
3 = Moderate Use
3.5
2 = Some Use
1= No Use
87.8
0 = No Response
1.2
0
10
20
30
40
50
60
70
80
90
100
PDA to input and retrieve clinical notes
PDA to enter prescription orders
5 = Very High Use
4.3
4 = High Use
1.6
3 = Moderate Use
3.5
2 = Some Use
2.0
87.0
0 = No Response
1.6
0.0
1= No Use
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
PDA to enter prescription orders
90.0
100.0
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Personal Digital Assistants (PDA) are hand-held computers that have medical and scientific uses
(e.g., to aid diagnosis and drug selection). To what extent does your practice employ PDAs to perform
the following tasks?
PDA to enter lab testing orders
5 = Very High Use
2.4
4 = High Use
1.2
3 = Moderate Use
3.1
2 = Some Use
1.6
1= No Use
90.6
0 = No Response
1.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
PDA to enter lab testing orders
Clinical Practice Guidelines are systematically developed statements designed to assist clinician decisions about
appropriate health care for specific diagnosis and circumstances (e.g., diagnosing and treating diabetes or asthma).
To what extent does your practice use the following methods to encourage the implementation of and
compliance with clinical practice guidelines?
Regularly scheduled meetings to discuss standards
5 = Very High Use
9.4
4 = High Use
12.2
3 = Moderate Use
23.6
27.6
1= No Use
26.0
0 = No Response
1.2
0.0
2 = Some Use
5.0
10.0
15.0
20.0
25.0
30.0
Regularly scheduled meetings to discuss standards
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Clinical Practice Guidelines are systematically developed statements designed to assist clinician decisions about
appropriate health care for specific diagnosis and circumstances (e.g., diagnosing and treating diabetes or asthma).
To what extent does your practice use the following methods to encourage the implementation of and
compliance with clinical practice guidelines?
Participation in continuing medical education
5 = Very High Use
30.3
4 = High Use
34.3
3 = Moderate Use
25.6
2 = Some Use
7.5
1= No Use
2.0
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Participation in continuing medical education
Persuasion by colleagues using guidelines
5 = Very High Use
7.9
4 = High Use
16.5
3 = Moderate Use
31.1
2 = Some Use
26.0
1= No Use
16.5
0 = No Response
2.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Persuasion by colleagues using guidelines
Practice memos encouraging guideline use
5 = Very High Use
6.3
4 = High Use
13.4
3 = Moderate Use
19.7
2 = Some Use
23.6
1= No Use
35.4
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Practice memos encouraging guideline use
35.0
40.0
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Clinical Practice Guidelines are systematically developed statements designed to assist clinician decisions about
appropriate health care for specific diagnosis and circumstances (e.g., diagnosing and treating diabetes or asthma).
To what extent does your practice use the following methods to encourage the implementation of and
compliance with clinical practice guidelines?
Integrate guidelines into computerized applications
5 = Very High Use
10.6
4 = High Use
13.8
3 = Moderate Use
15.4
2 = Some Use
14.6
1= No Use
43.3
0 = No Response
2.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Integrate guidelines into computerized applications
Offer financial incentives for guideline compliance
5 = Very High Use
4.7
4 = High Use
5.9
3 = Moderate Use
9.4
2 = Some Use
8.7
1= No Use
68.9
0 = No Response
2.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Offer financial incentives for guideline compliance
Distribute guideline information to patients
5 = Very High Use
7.5
4 = High Use
11.4
3 = Moderate Use
25.6
2 = Some Use
29.5
1= No Use
24.4
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
Distribute guideline information to patients
30.0
35.0
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Clinical Practice Guidelines are systematically developed statements designed to assist clinician decisions about
appropriate health care for specific diagnosis and circumstances (e.g., diagnosing and treating diabetes or asthma).
To what extent does your practice use the following methods to encourage the implementation of and
compliance with clinical practice guidelines?
Focus quality assurance activities on guideline use
5 = Very High Use
7.5
4 = High Use
20.5
3 = Moderate Use
24.0
2 = Some Use
21.7
1= No Use
25.2
0 = No Response
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Focus quality assurance activities on guideline use
Practices develop disease registries - special databases or lists that contain information about people diagnosed
with specific types of disease – to monitor particular patient groups. To what extent does your practice generate
disease registries to monitor patients from the following diagnostic groups?
Disease Registry ‐Diabetes
5 = Very High Use
9.8
4 = High Use
8.7
3 = Moderate Use
12.6
2 = Some Use
13.4
1= No Use
54.7
0 = No Response
0.8
0.0
10.0
20.0
30.0
40.0
Disease Registry ‐Diabetes
50.0
60.0
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Practices develop disease registries - special databases or lists that contain information about people diagnosed
with specific types of disease – to monitor particular patient groups. To what extent does your practice generate
disease registries to monitor patients from the following diagnostic groups?
Disease Registry ‐Coronary Heart Disease
5 = Very High Use
5.5
4 = High Use
6.7
3 = Moderate Use
10.6
2 = Some Use
15.4
1= No Use
61.0
0 = No Response
0.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Disease Registry ‐Coronary Heart Disease
Disease Registry ‐ Asthma
5 = Very High Use
4.3
4 = High Use
7.9
3 = Moderate Use
10.2
2 = Some Use
13.8
1= No Use
62.2
0 = No Response
1.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Disease Registry ‐ Asthma
Disease Registry ‐ Hypertension
5 = Very High Use
7.5
4 = High Use
5.9
12.2
3 = Moderate Use
12.6
2 = Some Use
1= No Use
61.0
0 = No Response
0.8
0.0
10.0
20.0
30.0
40.0
50.0
Disease Registry ‐ Hypertension
60.0
70.0
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Practices develop disease registries - special databases or lists that contain information about people diagnosed
with specific types of disease – to monitor particular patient groups. To what extent does your practice generate
disease registries to monitor patients from the following diagnostic groups?
Disease Registry ‐ Depression
5 = Very High Use
5.5
4 = High Use
4.7
3 = Moderate Use
6.7
2 = Some Use
18.1
1= No Use
63.4
0 = No Response
1.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Disease Registry ‐ Depression
Disease Registry ‐ Congestive Heart Failure
5 = Very High Use
5.5
4 = High Use
7.1
3 = Moderate Use
11.4
2 = Some Use
14.2
1= No Use
61.0
0 = No Response
0.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Disease Registry ‐ Congestive Heart Failure
Disease Registry ‐ Chronic Obstructive Pulmonary Disease
5 = Very High Use
4.3
7.5
4 = High Use
7.9
3 = Moderate Use
2 = Some Use
15.7
1= No Use
63.4
0 = No Response
1.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Disease Registry ‐ Chronic Obstructive Pulmonary Disease
70.0
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Chart reminders or flags (e.g., post-it note or electronic reminders) alert the clinician to patients with
specific diagnoses (e.g., asthma or diabetes) or to prompt preventive healthcare services (e.g.,
immunizations or screening tests). To what extent does your practice use reminders to draw attention
to the following health issues?
Chart Flag ‐ Diabetes
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
18.5
20.9
20.1
15.7
24.8
0.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Chart Flag ‐ Diabetes
Chart Flag ‐ Coronary Heart Disease
5 = Very High Use
14.6
4 = High Use
13.8
3 = Moderate Use
19.3
2 = Some Use
20.1
1= No Use
31.9
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Chart Flag ‐ Coronary Heart Disease
Chart Flag ‐ Asthma
5 = Very High Use
13.4
4 = High Use
11.0
3 = Moderate Use
20.9
2 = Some Use
22.0
1= No Use
31.9
0 = No Response
0.8
0.0
5.0
10.0
15.0
20.0
25.0
Chart Flag ‐ Asthma
30.0
35.0
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Chart reminders or flags (e.g., post-it note or electronic reminders) alert the clinician to patients with
specific diagnoses (e.g., asthma or diabetes) or to prompt preventive healthcare services (e.g.,
immunizations or screening tests). To what extent does your practice use reminders to draw attention
to the following health issues?
Chart Flag ‐ Hypertension
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
15.4
16.5
18.9
18.9
29.9
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Chart Flag ‐ Hypertension
Chart Flag ‐ Depression
11.0
8.3
20.5
22.4
37.0
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
40.0
Chart Flag ‐ Depression
Chart Flag ‐ Congestive Heart Failure
13.8
5 = Very High Use
13.8
4 = High Use
3 = Moderate Use
19.3
2 = Some Use
17.3
1= No Use
35.0
0 = No Response
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Chart Flag ‐ Congestive Heart Failure
35.0
40.0
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Chart reminders or flags (e.g., post-it note or electronic reminders) alert the clinician to patients with
specific diagnoses (e.g., asthma or diabetes) or to prompt preventive healthcare services (e.g.,
immunizations or screening tests). To what extent does your practice use reminders to draw attention
to the following health issues?
Chart Flag ‐ Chronic Obstructive Pulmonary Disease
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
13.8
11.4
20.5
19.7
33.5
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Chart Flag ‐ Chronic Obstructive Pulmonary Disease
Chart Flag ‐ Mammogram
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
20.5
20.5
16.5
18.1
24.0
0.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Chart Flag ‐ Mammogram
Chart Flag ‐ Pap Smear
5 = Very High Use
20.5
4 = High Use
18.9
3 = Moderate Use
19.3
2 = Some Use
17.3
1= No Use
24.0
0 = No Response
0.0
0.0
5.0
10.0
15.0
20.0
Chart Flag ‐ Pap Smear
25.0
30.0
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A patient activation card displays a list of screening tests needed or questions for the patient to ask about his
diagnosis and treatment. The card is one of several patient interventions used to motivate responsibility for
and compliance with medical care. To what extent does your practice use the following patient
interventions?
Patient Activation Cards
5 = Very High Use
2.4
4 = High Use
5.1
3 = Moderate Use
7.5
2 = Some Use
9.8
73.6
1= No Use
0 = No Response
1.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Patient Activation Cards
Individual Counseling or Patient Education
5 = Very High Use
22.4
23.6 4 = High Use
3 = Moderate Use
22.8
2 = Some Use
9.4
1= No Use
21.3
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
Individual Counseling or Patient Education
Group Education Programs or Classes
5 = Very High Use
3.1
4 = High Use
4.3
3 = Moderate Use
12.6
2 = Some Use
19.7
1= No Use
59.4
0 = No Response
0.8
0.0
10.0
20.0
30.0
40.0
50.0
Group Education Programs or Classes
60.0
70.0
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A patient activation card displays a list of screening tests needed or questions for the patient to ask about his
diagnosis and treatment. The card is one of several patient interventions used to motivate responsibility for
and compliance with medical care. To what extent does your practice use the following patient
interventions?
Postcard/Mail Reminders to Patients
5 = Very High Use
6.3
4 = High Use
11.0
3 = Moderate Use
16.5
2 = Some Use
19.3
1= No Use
45.7
0 = No Response
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Postcard/Mail Reminders to Patients
Telephone Reminders to Patients
5 = Very High Use
17.3
4 = High Use
20.5
3 = Moderate Use
21.3
2 = Some Use
16.5
1= No Use
22.8
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
Telephone Reminders to Patients
E‐mail Reminders to Patients
2.0
5 = Very High Use
2.4
4 = High Use
3 = Moderate Use
7.1
2 = Some Use
14.2
1= No Use
73.2
0 = No Response
1.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
E‐mail Reminders to Patients
70.0
80.0
21 | P a g e
A patient activation card displays a list of screening tests needed or questions for the patient to ask about his
diagnosis and treatment. The card is one of several patient interventions used to motivate responsibility for
and compliance with medical care. To what extent does your practice use the following patient
interventions?
Self‐Management / Self‐Care Brochures
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
8.3
15.0
29.1
25.6
21.3
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Self‐Management / Self‐Care Brochures
Self‐Management / Self‐Care Posters
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
3.5
8.3
20.5
33.9
32.7
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Self‐Management / Self‐Care Posters
Self‐Management / Self‐Care Videos
5 = Very High Use
0.8
4 = High Use
3.5
3 = Moderate Use
6.3
2 = Some Use
23.6
64.6
0 = No Response
1.2
0.0
1= No Use
10.0
20.0
30.0
40.0
50.0
Self‐Management / Self‐Care Videos
60.0
70.0
22 | P a g e
A patient activation card displays a list of screening tests needed or questions for the patient to ask about his
diagnosis and treatment. The card is one of several patient interventions used to motivate responsibility for
and compliance with medical care. To what extent does your practice use the following patient
interventions?
Patient Education through Practice Newsletter
5 = Very High Use
0.4
4 = High Use
1.6
3 = Moderate Use
3.5
2 = Some Use
9.8
83.5
0 = No Response
1.2
0.0
1= No Use
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Patient Education through Practice Newsletter
Patient Education through Practice Website
5 = Very High Use
2.4
4 = High Use
3.1
3 = Moderate Use
10.6
2 = Some Use
17.3
65.4
0 = No Response
1.2
0.0
1= No Use
10.0
20.0
30.0
40.0
50.0
60.0
Patient Education through Practice Website
70.0
23 | P a g e
A patient care flow sheet is a one- or two-page form to help office staff and clinicians monitor and
document clinical services provided to individual patients. Important data regarding a patient's condition which services have been ordered, and when; which services have been provided, and when, and which
results are still pending and might need follow-up – are captured on the flow sheet. To what extent does
your practice employ flow sheets to monitor and document clinical services related to the following
health issues?
Preventive Care Flow Sheet
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
25.2
17.3
19.7
15.0
22.4
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Preventive Care Flow Sheet
Diabetes Flow Sheet
5 = Very High Use
24.8
4 = High Use
18.9
3 = Moderate Use
16.1
2 = Some Use
16.9
1= No Use
22.8
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Diabetes Flow Sheet
Coronary Artery Disease Flow Sheet
5 = Very High Use
18.1
4 = High Use
13.8
3 = Moderate Use
15.0
2 = Some Use
19.3
1= No Use
33.5
0 = No Response
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Coronary Artery Disease Flow Sheet
35.0
40.0
24 | P a g e
A patient care flow sheet is a one- or two-page form to help office staff and clinicians monitor and
document clinical services provided to individual patients. Important data regarding a patient's condition which services have been ordered, and when; which services have been provided, and when, and which
results are still pending and might need follow-up – are captured on the flow sheet. To what extent does
your practice employ flow sheets to monitor and document clinical services related to the following
health issues?
Asthma Flow Sheet
13.4
11.0
17.7
19.3
37.4
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
40.0
Asthma Flow Sheet
Chronic Obstructive Pulmonary Disease Flow Sheet
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
13.0
9.1
18.5
18.9
39.8
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Chronic Obstructive Pulmonary Disease Flow Sheet
Congestive Heart Failure Flow Sheet
5 = Very High Use
14.6
4 = High Use
11.8
3 = Moderate Use
16.1
2 = Some Use
18.1
1= No Use
38.6
0 = No Response
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Congestive Heart Failure Flow Sheet
40.0
45.0
25 | P a g e
A patient care flow sheet is a one- or two-page form to help office staff and clinicians monitor and
document clinical services provided to individual patients. Important data regarding a patient's condition which services have been ordered, and when; which services have been provided, and when, and which
results are still pending and might need follow-up – are captured on the flow sheet. To what extent does
your practice employ flow sheets to monitor and document clinical services related to the following
health issues?
Depression Flow Sheet
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
12.2
9.1
12.2
22.4
42.9
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Depression Flow Sheet
Adult Immunization Flow Sheet
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
24.4
22.0
18.5
14.2
20.5
0.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Adult Immunization Flow Sheet
Child / Adolescent Immunization Flow Sheet
5 = Very High Use
30.3
4 = High Use
24.0
3 = Moderate Use
15.7
2 = Some Use
8.7
1= No Use
20.5
0 = No Response
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Child / Adolescent Immunization Flow Sheet
35.0
26 | P a g e
A health risk profile consists of a series of questions and basic medical tests to help clinicians identify
whether age, gender, or health-related behaviors put the patient at risk for developing certain diseases or
conditions. To what extent does your practice use the following health risk profiles to assess
patient health?
Adult Health Risk Profile
16.1
15.7
17.7
21.3
28.3
0.8
0.0
5.0
10.0
15.0
20.0
25.0
5 = Very High Use
4 = High Use
3 = Moderate Use
2 = Some Use
1= No Use
0 = No Response
30.0
Adult Health Risk Profile
Children's Health Risk Profile
5 = Very High Use
12.6
4 = High Use
12.2
3 = Moderate Use
18.9
2 = Some Use
22.4
32.3
0 = No Response
1.6
0.0
1= No Use
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Children's Health Risk Profile
Diabetes Health Risk Profile
5 = Very High Use
15.4
4 = High Use
16.5
3 = Moderate Use
19.3
2 = Some Use
17.7
1= No Use
29.9
0 = No Response
1.2
0.0
5.0
10.0
15.0
20.0
25.0
Diabetes Health Risk Profile
30.0
35.0
27 | P a g e
A health risk profile consists of a series of questions and basic medical tests to help clinicians identify
whether age, gender, or health-related behaviors put the patient at risk for developing certain diseases or
conditions. To what extent does your practice use the following health risk profiles to assess
patient health?
Cardiovascular Disease Health Risk Profile
5 = Very High Use
15.0
4 = High Use
16.9
3 = Moderate Use
21.7
2 = Some Use
17.3
28.3
1= No Use
0 = No Response
0.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Cardiovascular Disease Health Risk Profile
To what extent does your practice use the following methods to support quality-of-care and preventive
care?
Thorough follow‐up of patient referrals
5 = Very High Use
15.7
4 = High Use
29.9
3 = Moderate Use
25.2
2 = Some Use
20.5
1= No Use
7.1
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
Thorough follow‐up of patient referrals
30.0
35.0
28 | P a g e
To what extent does your practice use the following methods to support quality-of-care and preventive
care?
Systematic chart audits to assess clinical quality
5 = Very High Use
12.6
4 = High Use
19.3
3 = Moderate Use
24.8
2 = Some Use
22.4
1= No Use
19.3
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Systematic chart audits to assess clinical quality
Non‐physician staff to perform preventive care activities
7.1
4 = High Use
11.8
20.1
2 = Some Use
26.0
33.5
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Non‐physician staff to perform preventive care activities
Designate staff to manage specific preventive care services
5 = Very High Use
5.1
4 = High Use
9.8
3 = Moderate Use
20.9
2 = Some Use
27.6
1= No Use
35.4
0 = No Response
1.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Designate staff to manage specific preventive care services
40.0
29 | P a g e
To what extent does your practice use the following methods to support quality-of-care and preventive
care?
Provide clinical (quality) performance feedback to physicians
5 = Very High Use
9.4
4 = High Use
13.0
3 = Moderate Use
20.1
2 = Some Use
23.6
32.3
1= No Use
0 = No Response
1.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Provide clinical (quality) performance feedback to physicians
Provide clinical (quality) performance feedback to midlevel providers
5 = Very High Use
9.1
4 = High Use
14.6
3 = Moderate Use
18.5
2 = Some Use
14.2
1= No Use
40.6
0 = No Response
3.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Provide clinical (quality) performance feedback to midlevel providers
45.0