DOES PQRI MAKE A DIFFERENCE?

Purpose: To compare quality measure reporting and actual quality measure values before and after the Medicare Physician Quality Reporting Initiative (PQRI) was implemented at the University of Nebraska Medical Center (UNMC).

Methods: The Centers for Medicare and Medicaid Services (CMS) launched PQRI on July 1, 2007.  The premise was that if physicians were required to report certain clinical measures for various diseases, this would improve health care.  Of the 216 such quality measures which may be reported, the Divisions of General Internal Medicine (GIM) and Diabetes Endocrinology Metabolism (DEM), and the Department of Family Medicine (FM) chose to report on the osteoporosis quality measure (bone density scan), and the diabetes quality measures (HbA1c, blood pressure and LDL cholesterol).  We obtained informed consent from clinicians to extract their billing data from our computerized medical record.  Data extracted included the number of PQRI-eligible patients seen, the frequency that providers reported PQRI measures and the actual values of the measures.  This information was collected from the time that PQRI was implemented up to the time of analysis (three years), and for an equal time prior to PQRI reporting.  We report the results of the diabetes measure LDL at this time.

Result: 45 clinicians provided informed consent for extraction of their billing data for the study.  The graph below shows the frequency that LDL cholesterol levels were tested for PQRI-eligible patients before initiation of PQRI and after.

We compared the actual LDL value before and after PQRI implementation using generalized estimating equations.  The average LDL level was 93.2 mg/dL for patients seen before July 2007, as compared with average LDL of 91.0 mg/dL for patients seen after July 2007 (p < 0.01).

Conclusion: We observed a difference in reporting the PQRI measure LDL for patients with diabetes.  Ordering frequency of LDL decreased with implementation of PQRI.  The overall number of patient visits did not decrease over the same time period.  We did not identify another explanation for such an abrupt decrease in LDL testing.  We also found that the average LDL level decreased with PQRI implementation.  While this difference was statistically significant, it did not represent a clinically significant change.