Marian Benjamin

Collaborative networks of primary care practices are springing up all over the United States. These networks have the potential to provide a process and structure for sharing information between individual private practices, resulting in network-level advances in delivery of care. This is especially effective when applied to chronic disease, such as asthma.

The Cincinnati Children’s Physician-Hospital Organization (CCPHO)1 provides centralized technical support for quality improvement and a shared registry for 40 independent practices. The CCPHO uses innovative pay-for-performance approaches and incentives that focus on enhancing population level outcomes for 13,000 children with asthma across practices and have resulted in substantial improvement—including use of written self-management plans, controller medications, and influenza vaccinations.

Large organized health care organizations such as CCPHO have the resources and power to accomplish changes among its member practices, but more than two thirds of care in the United States is delivered by practices that are not part of such systems2; what about them?

The Institute for Healthcare Improvement’s Breakthrough Series is one model for improving care and spreading ideas among smaller practices; and around the country, in seven states, something like 1,400 primary care physicians in 350 practices are taking advantage of one such network, Improving Performance in Practice (IPIP), to improve care and spread ideas.

Convened in 2006 by the American Board of Medical Specialties and primary care societies and headed up by Sheldon Horowitz, MD, of Northwestern University, the IPIP aimed to have the state boards work together to improve the way primary care is delivered. Right now, the network is focusing on improving outcomes in two chronic diseases: diabetes and asthma.

The IPIP provides support, ideas for practice redesign, and learning collaboratives. It also provides quality improvement coaches to help set up registries, workflow improvements, and templates for care.

IPIP has four goals for asthma management3:control assessed, >90%; persistent asthma on anti-inflammatory medication, >90%; influenza vaccination, >90%; and receive three key strategies for asthma care, >75%. Optional measures are ED visit, <0.3%; hospitalization, <0.1%; action plan, >90%.

This is a great opportunity for RTs working in private practice to share their expertise and take advantage of that of others across many practices, thus improving asthma management and quality of life for their patients. You can learn more about IPIP at

Marian Benjamin
[email protected]


  1. Manedl KE, Kotaggal U. Pay for performance alone cannot drive quality. Arch Pediatr Adolesc Med. 2007;161:650-5.
  2. Commonwealth Fund Commission on a High Performance Health System. Framework for a high performance health system for the United States. Available at: Accessed October 15, 2009.
  3. Improving Performance in Practice. Measures and standards. Available at: Accessed October 19, 2009.