Quality holds steady, but care is still inconsistent
Clinic-level data is now available for diabetes care
ST. PAUL, Minn., Nov. 15 /PRNewswire-USNewswire/ -- The overall quality of health care in Minnesota and border communities held steady in 2006 with no dramatic gains in any category monitored by MN Community Measurement, a St. Paul-based nonprofit group dedicated to improving health care quality, according to its annual ratings announced today.
"We observed modest declines in the quality of some types of care and modest increases in others. The net effect across our measures was 'status quo,'" said Jim Chase, executive director of MN Community Measurement. "This should be a wake-up call to medical providers, payers, purchasers and patients. We must all put more energy and resources into making health care better."
MN Community Measurement's performance ratings for health care delivered by 128 medical groups during 2006 -- up from 103 groups rated last year for care delivered in 2005 -- are available at www.mnhealthcare.org. Copies of the written report may be downloaded from the site beginning Monday, Dec. 3. The ratings include data from nearly all of the health systems that serve Minnesotans, as well as some medical groups in North Dakota, South Dakota and western Wisconsin.
Variation still a quality improvement challenge
Consistent with its four previous annual reports, MN Community Measurement noted wide variation in the performance of medical groups. For example:
-- The percentage of children aged 2-18 with sore throats who received a strep test and were appropriately given an antibiotic ranged from 99% at the highest-performing medical group to 26% at the lowest.
-- The percentage of women aged 16-25 who identified themselves as sexually active and received at least one screening test for the sexually-transmitted disease Chlamydia ranged from 66% to 3%.
-- Even the measure with the smallest range of variation - Optimal Diabetes Care, which focuses on tight control of blood sugar, blood pressure, cholesterol, daily aspirin use and tobacco-free status for patients with diabetes - had a 19 percentage-point spread, from 20% to 1%.
"The range between the medical groups with the highest and lowest rates on any given measure hasn't changed much in the four years we've been tracking these data," Chase said. "The low-performing medical groups need to adopt some of the systems that the high-performing groups have used to improve their care. But that will only get us so far. The top-performing medical groups may have accomplished all they can within the constraints of the current health care system. Our findings point to a need to redesign the health care system to unleash its full potential to give the best quality and value to all patients, as well as to provide more support to medical groups that aren't performing well."
The most promising initiatives to increase health care quality and value are efforts by hospitals, medical groups, health plans and purchasers to increase the involvement of patients in their care and to change payment systems to enable innovative health care delivery. MN Community Measurement is working with the Institute for Clinical Systems Improvement, the Buyers Health Care Action Group and others to provide measurements that support initiatives focused on these issues.
Several groups maintain highest rates; others show significant improvement
In other findings, MN Community Measurement observed this year that several medical groups have achieved consistently high ratings on multiple measures. Park Nicollet Health Services earned three stars for results above the medical group average on 11 of this year's 12 quality measures, while HealthPartners Medical Group scored three stars on 10 of the measures.
Other medical groups have achieved dramatic improvements. On the Optimal Diabetes Care measure, four medical groups showed dramatic improvement during the last two years. Three of these groups are among just five medical groups that earned three stars this year for achieving results that were above the average of all participating medical groups:
-- Neighborhood Health Care Network, a group of community clinics that serves economically and ethnically diverse populations in the Minneapolis-St. Paul metro area, improved from 1% in 2005 to 19% in 2007
-- MeritCare, which is based in Fargo, ND, and serves northwest Minnesota, improved from 0% in 2005 to 13% in 2007
-- Park Nicollet Health Services improved from 3% in 2005 to 17% in 2007
-- Fairview improved from 9% in 2005 to 20% in 2007
Chase explained: "Dramatic improvement clearly is possible for medical groups of all sizes, and across very different patient populations. The overall challenge is to remove the barriers to providing high quality care in a consistent manner. One of the biggest barriers is that many consumers are not very engaged in managing their health to quality standards. We are focusing intensively on this issue as we work to accelerate improvement."
Consumers encouraged to view quality ratings online
"Consumers should understand that the quality of health care is a tangible thing that can be measured, and that it's not the same everywhere you go," said Chase.
Because provider group performance varies widely, consumers are encouraged to visit MN Community Measurement's Web site (www.mnhealthcare.org) to search for quality ratings by provider group, quality measure or geographic area. They can learn about the standards of care for illnesses such as diabetes and asthma, as well as for preventive care like cancer screenings and childhood immunizations.
"The quality ratings can help you choose a provider group with a good track record with patients who have concerns like yours. The ratings also can prepare you to talk with your physician about how to make your care even better," said Chase. "When patients bring up quality ratings, it motivates and reinforces the importance of continual quality improvement, right at the point of care."
New diabetes data enables consumers to compare clinics
New this year on www.mnhealthcare.org are ratings that enable consumers to compare the diabetes care at some individual clinics within larger medical groups. For example, a consumer who lives in Maple Grove can now compare the quality of diabetes care at clinics in Maple Grove instead of across large multi-clinic groups. Through a newly piloted process called direct data submission (DDS), clinics provided data to MN Community Measurement on their diabetes patients. Because it comes directly from the medical groups, this data is more representative of the clinics' total patient base than is data collected from the health plans on a sample of the patients with insurance coverage. It also better meets the needs of consumers, who have told MN Community Measurement in focus groups that they want information at the clinic or individual physician level that focuses on their specific health issues and conditions.
MN Community Measurement has also introduced a "micro" Web site just for people with diabetes. The site, www.theD5.org, describes the five components of quality diabetes care and provides the clinic-level diabetes care results. "We're trying new methods to deliver information and messages that are tailored to specific medical conditions," Chase said.
Quality measures based on accepted standards
MN Community Measurement uses data from health plan claims and patient chart reviews to determine whether the clinical standards for quality were met across 12 measures in chronic disease, ambulatory and preventive care categories. The measures are aligned with the care guidelines that medical groups have agreed upon through the Institute for Clinical Systems Improvement and most are also aligned with national standards of quality endorsed by the National Quality Forum and established by the National Committee for Quality Assurance.
MN Community Measurement is increasing its focus on measures that demonstrate the results of care and composite or combination measures that provide a quality snapshot for very complex care. For Optimal Diabetes Care credit, sampled patients must have received all recommended diabetic screening exams, achieved very tight blood sugar, cholesterol and blood pressure control, as well as be tobacco-free and taking aspirin daily, if appropriate. If any of these individual measures were not achieved for a sampled patient, credit for the combination measure was not given to the medical group or clinic.
About MN Community Measurement
MN Community Measurement is a nonprofit organization dedicated to improving the quality of health care in Minnesota by publicly reporting quality results. Founded by Minnesota's health plans and the Minnesota Medical Association, MN Community Measurement is a collaborative that works with health plans, clinics, employers and consumers to spur quality improvement, reduce health care costs and maximize value.
SOURCE MN Community Measurement