JMIR Publications

ABSTRACT

Background:

Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers and patients.

Objective:

In this study, we introduced a novel QualityIQ tool to determine the extent it helps primary care physicians to align care decisions with the latest best practices included in MIPS.

Methods:

We developed the QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included work-up, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to CME and non-CME study arms. Physicians ‘cared’ for eight weekly cases covering typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were to measure evidence-based care scores within each case, adherence to MIPS measures, and practice variability among the PCPs caring for the same patient.

Results:

We found strong, scalable engagement with the tool, with 75% of participants completing at least six of eight total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<0.001) and osteoarthritis (+7.6%, P=.003), and with MIPS-related quality measures, such as diabetes eye exams (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). While the CME availability did not increase enrollment in the study, participants offered CME credits were more likely to complete at least six of the eight cases.

Conclusions:

Short, clinically-detailed case simulations with real-time feedback and gamified peer benchmarking lead to significant improvements in evidence-based care decisions among practicing physicians. Clinical Trial: ClinicalTrials.gov, NCT03800901, January 7, 2019. Trial participants were registered prospectively.