• R Loeppke and J W Howell.
• PhyCor Institute for Healthcare Management, Nashville, TN 37215, USA.
• Jt Comm J Qual Improv. 1999 Feb 1; 25 (2): 55-67.

BackgroundThere is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement; adopt local clinical and operational performance indicators; and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics.ResourcesKey resources supporting CPI initiatives include information/knowledge management, education and training, and patient education and consumer decision support.Preliminary Results And ObservationsLocalized efforts in both the asthma care and diabetes management initiatives have led to some preliminary improvements in quality of care indicators.Critical Success Factors And ChallengesPhysician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.

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