Computer-assisted quality improvement in an ambulatory care setting: a follow-up report.
BACKGROUND: The Quality Care Program (QCP), introduced into the Swedish Family Medicine Clinic in 1992, is a comprehensive computer-assisted program of quality improvement for the medical office. Its goal is to improve specific aspects of ambulatory patient care: disease prevention, cancer detection, immunization compliance, risk management, outcomes monitoring, and patient education. METHODOLOGY: The QCP uses a computer-generated worksheet that is attached to the medical record at each patient visit. It is a multipurpose worksheet that displays important clinical information and functions as part of an overall strategy to manage key aspects of the patient's care. The system enhances patient and physician performance of health maintenance and continuity of care, and it allows for the quantification and display of performance indicators without exclusive reliance on chart review. RESULTS: Physician reliability in recommending health maintenance interventions has improved to nearly 100%, and patient compliance with these recommendations has significantly increased. The test results tracking system has found test data that would have otherwise been lost, and the outcomes monitoring has resulted in measurable system improvements. There has been a modest increase in provider workload to meet these aggressive QCP goals, but measures of provider satisfaction have increased nonetheless. CONCLUSIONS: Ambulatory care, increasingly the focus of attention in the United States, can be difficult to perform well. The QCP, part of an overall quality improvement initiative, gathers and displays clinical information, reminds patients and physicians to do health maintenance, and refuses to let physicians and patients forget about specific aspects of patient care.