Use of Internal Performance Measurement to Guide Improvement Within Medical Groups

Peggy G. Chen, Michael I. Harrison, Linda R. Bergofsky, Denise St. Clair, Russ Mardon, L. Raaen, Mark W. Friedberg

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Public reporting of provider performance currently encompasses a range of measures of quality, cost, and patient experience of care. However, little is known about how medical groups use measures for performance improvement. This information could help medical groups undertake internal measurement while helping payers, policy makers, and measurement experts develop more useful publicly reported measures and quality improvement strategies. Methods: An exploratory, qualitative study was conducted of ambulatory care medical groups across the United States that currently gather their own performance data. Results: Eighty-three interviews were conducted with 91 individuals representing 37 medical groups. Findings were distilled into three major themes: (1) measures used internally, (2) strategies for using internal measurement for performance improvement, and (3) other uses of internal measurement. Medical groups used both clinical and business process measures, including measures from external measure sets and internally derived measures. Strategies for using internal measurement for quality improvement included taking a gradual, iterative approach and setting clear goals with high priority, finding workable approaches to data sharing, and fostering engagement by focusing on actionable measures. Measurement was also used to check accuracy of external performance reports, clarify and manage conflicting external measurement requirements, and prepare for anticipated external measurement requirements. Respondents in most groups did not report a need to assess costs of internal measurement or the capacity to do so. Conclusion: Despite challenges and barriers, respondents found great value in conducting internal measurement. Their experiences may provide valuable lessons and knowledge for medical group leaders in earlier stages of establishing internal measurement programs.

Original languageEnglish
Pages (from-to)487-494
Number of pages8
JournalJoint Commission Journal on Quality and Patient Safety
Issue number7
StatePublished - Jul 2019

Bibliographical note

Publisher Copyright:
© 2019 The Joint Commission


The authors thank Nabeel Qureshi, Kathryn Foster, Stephanie Fry, Andrew Hinzman, Lisa Lentz and Joshua Rubin; Steve Shortell and Lawrence Casalino, for rigorous internal review; and all medical groups that graciously gave their time to participate in interviews. All authors report no conflicts of interest. The research reported in this paper was funded by the Agency for Healthcare Research and Quality under contract HHSP233201500026I, Task Order HHSP23337002T. The views expressed in this paper are solely those of the authors and do not represent any US government agency or any institutions with which the authors are affiliated.

FundersFunder number
Nabeel Qureshi
Agency for Healthcare Research and QualityHHSP233201500026I, HHSP23337002T


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