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Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance


Description: Patient registries at the physician level provide health plans, providers and disease management programs with a more accurate picture of the patient experience — individually or as a population. The patient registry is a cornerstone of Edward Wagner's chronic care model, the foundation of the patient-centered medical home (PCMH) and practically a prerequisite for participation in quality measurement and pay-for-performance (PFP) initiatives.

"Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance" illustrates how even the solo practitioner can simply and inexpensively implement a population-based registry that provides actionable information on patient needs. From a set of index cards in a shoebox to a clinical information system auto-populated from an electronic medical record, the patient registry guides the entire care team in the management of chronic illness and preventive care. Registries also have been shown to decrease per-member costs and reduce hospital admissions.

In this 25-page report, physician practices, health plans and quality organizations describe how they use patient registries to improve care coordination and compliance with preventive care, respond to ever-expanding external demands for data and prepare for the eventual transformation to a medical home. This report is based on survey responses from 159 healthcare organizations, in-depth interviews with existing users of patient registries, analysis of Web-based patient registry tools and resources and advice from industry thought leaders on the application of patient registries to the PCMH and physician quality improvement initiatives.

This report provides details on:
- Who's using patient registries to measure quality and performance on key health outcomes;
- The challenges and benefits of implementing a registry and its impact on patient satisfaction, compliance and preventive care;
- From registry to reporting — why registry use facilitates participation in PQRI and other quality and PFP initiatives;
- Suggested formats for patient registries;
- Sources for free and low-cost patient registry templates, support materials and implementation support;
- Training the care team in registry use and overcoming barriers to implementation;
- Supplementing registries with underutilized/untapped data;
and much more.

Additionally, three diverse organizations share their stories of patient registry adoption and use — Upper Peninsula Health Plan, a consumer-centered, provider service organization of physicians, hospitals, clinics and ancillary providers; the Wisconsin Collaborative for Healthcare Quality, a voluntary consortium of physician groups, hospitals and health plans; and Medical Network One, a Rochester, Michigan-based physician services organization with a focus on disease management prevention and chronic care.




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