Chapter 2: Literature Review
Theoretical Foundation
The Physician Quality Reporting System (PQRS) was introduced in 2007 by the Centers for Medicare & Medicaid Services as a value-based pay-for-reporting system with the aim of increasing the quality of healthcare and simultaneously reduce costs (Berman et al., 2013). Several studies have sought to investigate the effectiveness of the system and the best way to implement it within a group practice EMR. However, none has established a clear theoretical framework upon which the system can be thoroughly analyzed. This section reviews some of the theories that can be applied in the analysis of the PQRS, with particular focus on the systems theory and the continuous quality improvement theory.
The Systems Theory
This is an interdisciplinary framework focusing on the different systems that exist in nature and upon which phenomena can be investigated from a holistic perspective. The main governing principle behind this theory is that a phenomenon cannot be fully understood by simply dividing it up into elementary parts and then re-building it, but by applying a wholesome vision, which underlies its functioning. The idea is that although it is possible to investigate a phenomenon by first analyzing its individual components, full comprehension of the said phenomenon requires it to be observed from a holistic perspective. The theory covers a vast field of research and mainly adopted in the fields of management and marketing where organizations are viewed as a system. The focus of the systems theory is on the relationship and interaction between the different parts that make up a system in a bid to understand how it is organized, its functions as well as outcomes.
Mele, Pele and Molese (2009) investigate the systems theory and stipulate that systems can be found in diverse settings, including nature, economic context, science, the society as well as within information systems. They point out that a unique characteristic about the systems theories is that they have developed at the same rate across the different fields they are applied, and scholars working from its perspective have been successful in building upon the knowledge and concepts proposed across the different fields. Given the widespread application of the theory in different academic fields, there are several types of systems perspectives, including service systems, living systems, institutional systems, and technological systems to name but a few (Mele, Pele & Molese, 2009).