Healthcare administrators: Need help holding PCPs accountable? Here it is from focus-group research

Family physicians and other primary care providers don’t mind being held to account for care quality by healthcare administrators. The rub is that multiple other stakeholders often demand similar levels of answerability, pulling the doctors in different directions at once. 

When those kinds of conflicts arise, all involved parties should be held to task, the physicians believe. 

They also feel responsibility should be equally borne when common quality metrics get pitted against patient-centered care, causing moral distress.

These are among the challenging findings to emerge from a qualitative study that picked the brains of practitioners of family medicine. 

The research was led by investigators at JPS Hospital Family Medicine in Texas. It’s described in a paper published April 16 in JAMA Network Open.  

For the project, Richard Young, MD, and colleagues debriefed 36 participants using semi-structured interviews in focus-group settings. The sessions were held in the offices of select primary care providers practicing in five different cities. 

The discussions yielded several applicable observations, including these three: 

1. Participating physicians felt the complexity of primary care is not acknowledged in current standard metrics. 

A common theme was the disconnect between the metrics’ quantitative basis and the physicians’ lived experience of high-quality care in action. Participants commonly felt the metrics have some value but “should be used as a tool of practice self-reflection, not to be judged by outsiders or tied to payment.”
 

2. Many participants were unhappy with the current system of accountability and its associated metrics. 

“To some, the metrics included common tests and treatments that they thought were important in their direct patient care, and they had few suggestions for change beyond the common metrics,” Young and co-authors report. “Others thought there were too many flaws in the metrics to be meaningful and called for their elimination as tools for healthcare administrators to judge the quality of work of family physicians.”
 

3. The study adds to the literature on moral distress or injury. 

Young and team cite previous research enumerating factors that thwart family physicians and other PCPs from providing optimal care. 

The factors include hospitals’ culture of consumerism, families’ expectations for treatment intensity, disempowerment by medical hierarchies and “generally being demoralized” by the overall healthcare system.

“Our study adds to this literature,” Young and colleagues write, “particularly in the tensions between the physicians’ judgment on the best patient care or most patient-centric patient care—i.e., respecting their wishes to not receive certain services—vs. single disease measurements.” 

The researchers note this tension was exacerbated when participants’ professional ethics clashed with patient experience scores.
 

Going forward: Minor tweaks or major overhaul?  

In their discussion, Young et al. underscore that not a single participant felt fully satisfied with healthcare administrators’ existing means for evaluating their work as family-med specialists.

Looking ahead, the researchers propose two approaches for ensuring accountability in family physicians and, in fact, all primary care providers. 

One approach would make minor adjustments, preserving some existing systems. 

The other would introduce major changes, representing “a paradigm shift in the use of metrics to evaluate the work of primary care physicians and teams.”

Get the details of the dueling proposals here.