title: Getting performance metrics right: a qualitative study of staff experiences implementing and measuring practice transformation.
abstract: BACKGROUND
  Quality improvement is a central goal of the patient-centered medical home (PCMH) model, and requires the use of relevant performance measures that can effectively guide comprehensive care improvements. Existing literature suggests performance measurement can lead to improvements in care quality, but may also promote practices that are detrimental to patient care. Staff perceptions of performance metric implementation have not been well-researched in medical home settings.
  
  
  OBJECTIVE
  To describe primary care staff (clinicians and other staff) experiences with the use of performance metrics during the implementation of the Veterans Health Administration's (VHA) Patient Aligned Care Team (PACT) model of care.
  
  
  METHODS
  Observational qualitative study; data collection using role-stratified focus groups and semi-structured interviews.
  
  
  METHODS
  Two hundred and forty-one of 337 (72 %) identified primary care clinic staff in PACT team and clinic administrative/other roles, from 15 VHA clinics in Oregon and Washington.
  
  
  METHODS
  Data coded and analyzed using conventional content analysis techniques.
  
  
  RESULTS
  Primary care staff perceived that performance metrics: 1) led to delivery changes that were not always aligned with PACT principles, 2) did not accurately reflect patient-priorities, 3) represented an opportunity cost, 4) were imposed with little communication or transparency, and 5) were not well-adapted to team-based care.
  
  
  CONCLUSIONS
  Primary care staff perceived responding to performance metrics as time-consuming and not consistently aligned with PACT principles of care. The gaps between the theory and reality of performance metric implementation highlighted by PACT team members are important to consider as the medical home model is more widely implemented.
authors.affiliation: Portland VA Medical Center Health Services Research & Development/VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Mailcode R&D63, PO Box 1034, Portland, OR, 97207, USA, Devan.Kansagara@va.gov.
authors.forename: Devan
authors.initials: D
authors.lastname: Kansagara
authors.forename: Anaïs
authors.initials: A
authors.lastname: Tuepker
authors.forename: Sandy
authors.initials: S
authors.lastname: Joos
authors.forename: Christina
authors.initials: C
authors.lastname: Nicolaidis
authors.forename: Eleni
authors.initials: E
authors.lastname: Skaperdas
authors.forename: David
authors.initials: D
authors.lastname: Hickam
mesh_terms: D004650:Employee Performance Appraisal / Q000592:standards / Q000639:trends; D006282:Health Personnel / Q000592:standards* / Q000639:trends; D006801:Humans; D010348:Patient Care Team / Q000592:standards* / Q000639:trends; D018802:Patient-Centered Care / Q000592:standards* / Q000639:trends; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D058996:Quality Improvement / Q000592:standards* / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards* / Q000639:trends