287 Ambulatory Quality Improvement in Academic Medical Centers: A Changing Landscape Brian F. Leas, MS, MA Neil I. Goldfarb, BA Robert C. Browne, MPP Mark Keroack, MD, MPH David B. Nash, MD, MBA Efforts to improve the quality of ambulatory care have received tremendous attention as bold new initiatives aimed at influencing the environ- ment of care through financial incentives, public transparency, and information technology rapidly spread. Academic medical centers, which represent a long tradition of excellence and innovation in medical care, might be expected to lead the charge in these new arenas, but motivation for change may be mitigated by the unique complexity and multiple goals of these institutions. A survey conducted in the fall of 2006 examined the early impact of these major new influences on faculty practice plans. Respon- dents reported that many institutions have begun to develop key components of a quality infrastructure, but much work remains before a robust model emerges at most sites. Some academic medical cen- ters have also embraced pay-for-performance and public reporting efforts, but many are not equipped or eager to engage in these new initiatives. (Am J Med Qual 2009;24:287-294) Keywords: ambulatory; quality improvement; academic medical center; faculty practice plan INTRODUCTION Academic medical centers (AMCs) are often per- ceived as the elite strata of health care services in the United States. Flagship institutions in major urban centers provide cutting-edge research, out- standing education, and access to comprehensive medical services, including experimental and high- tech treatments. They also tend to perform better than community hospitals on a broad range of inpatient quality characteristics. 1 Their role in pro- moting patient safety and quality improvement in ambulatory care, however, has not clearly reflected their leadership status. A few recent studies have called attention to this paradox and highlighted the strengths and challenges that are unique to such institutions. 2-4 Multiple priorities, complex organi- zational structures, and competing interests may all contribute to an environment in which ambulatory quality improvement is often given short shrift. Improving ambulatory care poses a set of chal- lenges that are different from those addressing inpatient quality and safety. The clinical scope of ambulatory care is far greater than that of even the most diverse teaching hospital and includes crucial elements such as chronic disease management, prevention, screening, and wellness programs. Ambulatory care also involves an enormous uni- verse of caregivers in countless settings who rely on individual record-keeping systems and may be unlikely to demonstrate good coordination in their approach to any individual patient. The ambulatory setting is further affected by the entire universe of clinical, social, and economic factors that affect a person’s health, and these factors may be virtually impossible for a physician to monitor or influence. AUTHORS’ NOTE: No funding was provided for this study. The authors have no conflicts of interest to disclose. Mr Leas, Mr Goldfarb, and Dr Nash are at the Jefferson School of Popula- tion Health, Philadelphia, Pennsylvania. Mr Browne and Dr Keroack are at the University HealthSystem Consortium, Oak Brook, Illinois. Corresponding author: Brian F. Leas, Jefferson School of Population Health, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107 (e-mail: brian.leas@jefferson.edu). American Journal of Medical Quality, Vol. 24, No. 4, Jul/Aug 2009 DOI: 10.1177/1062860609334898 Copyright  2009 by the American College of Medical Quality at UNIV OF PENNSYLVANIA on May 11, 2016 ajm.sagepub.com Downloaded from