Improving Access to Improve Quality: Evaluation of an Organizational Innovation

Can quality be improved by creating patient-centered delivery systems? The researchers evaluated an initiative comprising six patient-centered changes in Group Health Cooperative's (GHC's) delivery system. The six changes, designed to improve quality by increasing enrollee access to physicians and information, were: 1) same-day appointments with primary and specialist physicians; 2) direct patient access to specialist physicians (removal of gatekeeping); 3) patient-physician email messaging (with physician compensation for responding to patient emails); 4) physician compensation with productivity and quality incentives; 5) patient internet access to GHC electronic medical record; and 6) health promotion information on the GHC Web site. The researchers estimated enrollee utilization of same-day appointments, direct access to specialists, email with physicians and nurse practitioners, and electronic medical records. They also examined the percentage of physicians' salaries from incentives. Physician awareness of changes, as well as physician and enrollee satisfaction, was assessed and utilization statistics and continuity of care, before and after the changes, were compared. The objective of the project was to better understand the impact of new IT and payment incentives on patient and provider health care decisions and utilization.