COVID-19's Effect on Practice Quality Improvement and Transformation Activities: Practice Survey Results

Background and objectives: The Transforming Clinical Practices Initiative (TCPI) was a 4-year, large-scale, collaborative, peer-based learning initiative for physician practices of all specialties with broad goals to improve the quality of patient care, spend health care dollars more wisely, and assist practices in being ready to succeed under value-based payment (VBP). We investigated whether the COVID-19 pandemic had erased or diminished practice transformation progress made during the TCPI program period, through a follow-up survey of participating practices fielded in October 2021.

Methods: In October 2021 to April 2022, we surveyed a probability sample of 2207 primary care and specialty practices that participated in the TCPI, receiving 610 responses. We asked about practice characteristics, financial and ownership stability, clinical performance, and quality improvement efforts, both now and prior to COVID-19. The COVID-19 content was part of a larger survey. Responses were weighted to account for sample selection, unknown eligibility status, and nonresponse. We generated weighted univariate descriptive statistics representative of practices with clinicians enrolled in TCPI. These estimated percentages have a 95% confidence interval of about ±5%. Multivariate analysis of unweighted data examined associations between practice characteristics and other variables of interest.

Results: For all but one of 13 practice transformation activities engaged in prior to the COVID-19 public health emergency, a majority of practices (at least 52%) reported that the progress on these activities were either not hurt or were helped by their COVID-19 experience. Compared to January 2020, only about 7% of practices reported that their quality of care or clinical performance was worse due to COVID-19, and 32% reported that their quality of care was better. More rural than urban practices reported that half or more of their transformation activities were hurt by COVID-19 (29% and 14%, respectively). Physician-owned practices were more likely to report quality is better today than prior to COVID-19 relative to practices with other ownership types such as hospitals or health systems (43% vs 24%).

Conclusion: Most practices have been able to recover from the deep stress of the COVID-19 pandemic and continue their efforts to improve patient care and performance to succeed under VBP. These results suggest a high perceived return on investment in value-readiness support along with emergency financial support in times of crisis, as well as room to continue preparation for any future pandemic and the national movement toward increased VBP, especially in rural settings.