Primary Care Practice Productivity and Efficiency: Qualitative Evaluation of a Novel Clinic-Based Measure

Abstract Background Existing primary care productivity and efficiency measures focus on the quantity of care delivered, without accounting for interprofessional teamwork invested or quality of care produced. We previously developed a novel productivity measure called Interprofessional Technical Efficiency Measure (ITEM) and tested it quantitatively across Veterans Affairs (VA) primary care practices. ITEM measures primary care practice efficiency in producing four primary care output measures (access, clinical quality of care, patient care experiences, and number of patients served) given staff time invested (inputs), while accounting for patient population complexity. Objective To qualitatively assess ITEM’s validity and potential usefulness through feedback from VA primary care directors, data experts, and frontline clinical team leaders. Design We used rapid qualitative analysis of data from semi-structured interviews and focus groups to assess feedback on ITEM results. Participants A convenience sample of 34 interprofessional primary care leaders, managers, and frontline clinical team members from nine geographically dispersed VA medical centers and affiliated community-based outpatient clinics (CBOCs). Approach Participants reviewed graphic data visualizations comparing their scores to national VA averages. Qualitative thematic analysis focused on face, construct, and content validity, and usefulness for primary care efficiency improvement. Results Overall, participants perceived the ITEM measure as having face, construct, and content validity, and viewed ITEM and its data visualization approach as potentially useful for primary care practice efficiency improvement. Participant concerns focused on lack of measures of team functioning or burnout, data time lags related to practice team composition or output changes, potential alternative measures of ITEM outputs, and potential additional local context measures. Conclusions Primary care leaders and clinicians were receptive to a new productivity and efficiency measure that integrated quality and quantity of care goals, and to ITEM as a promising approach. Findings support continued ITEM development for use in primary care practice efficiency improvement initiatives.