Quality Reporting to Improve Chronic Disease Care in Greater Cleveland

Better Health Greater Cleveland is an unprecedented local collaboration promoting quality chronic disease care through patient-provider cooperation, and health care quality data voluntarily reported by participating practice groups.

Better Health Greater Cleveland, founded by MetroHealth Medical Center, Center for Community Solutions and Health Action Council Ohio, is one of 14 organizations nationwide to receive funding from the Robert Wood Johnson initiative, Aligning Forces for Quality. The initiative aims to improve health care quality by helping providers measure and publicly report their performance, and helping patients to understand and expect high-quality care.

The Better Health Greater Cleveland website, http://www.betterhealthcleveland.org/, provides specific information for patients and providers on improving the quality of chronic disease care. A major innovation in transparency and collaboration, performance data from participating practice groups are published in Community Health Checkup reports, the first of which is available on the website.

The practice groups include The MetroHealth System, Care Alliance, The Cleveland Clinic, Huron Hospital Community Health Center, Kaiser Permanente-Ohio, Louis Stokes VA Medical Center, Neighborhood Family Practice, Northeast Ohio Neighborhood Health Services (NEON) and University Hospitals Family Practice. Better Health Greater Cleveland plans to recruit additional practice groups in the future.

First Community Health Checkup: Diabetes Care

The organization's first Community Health Checkup examines diabetes care in 2007, reflecting quality components defined by national diabetes authorities. Data were gathered from medical records in over 30 locations run by the participating practice groups, covering almost 25,000 patients, or about 25% of diabetic patients in Greater Cleveland. Patients' identities were not included.

The quality components were measured in two categories, care measures and outcome measures. Care measures reflect monitoring and prevention activities carried out by providers, considered crucial to diabetic care. Outcome measures reflect cornerstones of diabetic health status.

The results are reported for greater Cleveland as a region, and by patients' race, income, education, insurance type and practice location.

Opportunities for Better Care

The results indicate that care measures in Greater Cleveland were slightly better than the national average, and were similar among insured and uninsured patients overall. However, even the best-preforming practice locations provided all four care measures to only just over half of their diabetic patients. The highest-performing location had a rate of 60%.

For the lowest-performing locations it was about one out of four patients. The report's authors stressed that the variance in care quality is exactly what should spur patients and providers to work together to improve care.

Outcomes Linked to Societal Disparities and Other Factors, Not Just Quality of Care

In most practice locations, outcome measures lagged behind care measures, and higher performance on care measures did not always equate with higher outcome measures. These differences indicate that although providers must improve diabetic care, patients also have a larger role to fulfill in improving their health status.

When it comes to diabetic health status, like other diseases, the results also indicated larger forces at work than individual patients and practices.

Consistent with national trends, outcome measures varied significantly by race, income, education and insurance type. White patients had more favorable outcome measures than other races, and patients fared worse who had less income and less education. Patients also fared worse who had Medicaid or no insurance, as opposed to Medicare or commercial insurance.

Using the Reports to Improve Care

Clearly, the goal of openly reporting performance measures is to identify opportunities for improvement, and motivate practices to improve. While inevitably some practice locations must occupy the lowest rankings, even the top achievers have plenty of room, and therefore plenty of motivation, for improvement.

Better Health Greater Cleveland offers a Learning Collaborative for providers, in which they can learn and share best practices in chronic disease care. Educational materials for patients are provided by one of the project partners, NetWellness, and are linked from the website.

For patients, the Better Health Greater Cleveland website offers information on each of its participating practice locations, as well as checklists for provider visits that are designed to get patients involved in assuring their care includes all the important quality components.

Future reports

Better Health Greater Cleveland plans to issue future reports on hypertension, coronary artery disease and heart failure, and to update and compare the current figures for diabetes. Other planned issues include the quality of hospital care and planning for return to the community after discharge. As more and more practices participate, it is hoped that the reports eventually will cover all of the region's chronic disease care, not just a representative sample.

Websites

http://www.betterhealthcleveland.org/

http://www.forces4quality.org/