As cost and quality move to the forefront in Massachusetts health reform,
report highlights strengths and improvement opportunities
BOSTON, April 2, 2008 /PRNewswire-USNewswire/ -- A report released today by Massachusetts Health Quality Partners (MHQP) finds that, overall, primary care physicians in Massachusetts continue to excel in providing preventive care and in helping patients manage chronic conditions, but that there are still significant opportunities to improve health outcomes and control unnecessary health care spending.
MHQP compiled quality data for 150 medical groups across the state for their fourth annual Quality Insights: Clinical Quality in Primary Care report. The results can be viewed at mhqp.org, where a simple web tool allows people to look up clinical quality measures that are important to them and compare the ratings of medical groups by name or location.
Massachusetts physicians perform better than the national 50th percentile on 24 of 25 quality-of-care measures reported by MHQP this year, and above the national 90th percentile on 12 of 25 measures. For instance, on measures for managing chronic diseases like diabetes and adult asthma, Massachusetts physicians performed well above the 50th percentile national benchmark but below the 90th percentile.
"Massachusetts physicians continue to earn high marks for key quality measures, but we also found sizable variations among medical groups throughout the state as well as gaps between quality performance for some chronic conditions and measurable improvements in patients' health outcomes," said Barbra Rabson, executive director of MHQP. "These gaps represent important opportunities for doctors and patients to collaborate in improving quality and controlling costs."
Clinical outcome data included for the first time
This year's MHQP report includes, for the first time, statewide "outcome" measures that indicate how well certain risk factors related to patients' chronic conditions are being managed. For instance, 47 percent of diabetic patients in this report are keeping their LDL (bad) cholesterol levels below the recommended threshold of 100, and 66 percent are meeting the standard for blood pressure control. In all of the six outcome measures reported, statewide performance was above the NCQA national 50th percentile, but only one was at the 90th percentile - avoiding poor blood sugar levels (HbA1c above 9) by patients with diabetes. [Editorial Note: See attached checklist for how doctors and patients with diabetes can work together to control high blood pressure.]
"MHQP's outcome measures highlight how important it is for physicians and patients to work in partnership on health improvement," said Marilyn Schlein Kramer, Executive Director of the Partnership for Healthcare Excellence. "Physicians can provide diagnoses, test results, prescriptions and recommendations that will help patients control their chronic conditions; patients can then engage in addressing the often difficult clinical and lifestyle changes that will improve their own health."
Report addresses costly overuse of care
The MHQP report includes data on the appropriate use of antibiotics for the treatment of childhood colds and other upper respiratory infections and imaging studies such as X-rays, CT scans and MRIs for assessing acute low back pain in adults. Health experts agree that overuse or misuse of tests, procedures and medications can contribute to rising health care costs without improving quality of care, and, in some cases, at the expense of quality.
-- MHQP found that Massachusetts physicians avoid the inappropriate prescribing of antibiotics 90 percent of the time, which means that one child in ten who is taken to the doctor for a cold, cough or upper respiratory infection receives an antibiotic prescription that is unnecessary.
-- The NCQA standard for adults with acute low back pain for most patients is to follow a course of general medical care and self treatment for at least four weeks before doctors use imaging tests as a means of further diagnosis. Massachusetts physicians met this standard 80 percent of the time, which is just below the national 90th percentile benchmark. Results among medical groups varied by over 30 percentage points, from a low of 64 percent of patients avoiding potentially inappropriate care to a high of 95 percent.
"These results suggest that many Massachusetts physicians are skilled at helping patients understand when certain drugs and procedures are not necessary and that reducing variations among medical groups will be good for both quality and cost," said Rabson. "An important message for the entire community is that high-quality care does not always mean more care."
Physicians use MHQP reports for improvement
Even in areas where Massachusetts rates are above the national 90th percentile benchmark, there is significant variation among groups. For instance, the state rate for cholesterol screening for diabetics is 89 percent, but rates among medical groups range from 61 to 98 percent; and the state rate for colorectal cancer screening is 69 percent, but medical group rates range from 40 percent to 93 percent, a variation of more than 50 percentage points.
"Accurate reporting lays the foundation for quality improvement," said B. Dale Magee, M.D., M.S., president of the Massachusetts Medical Society. "MHQP encourages continuous quality improvement with trusted information and a spirit of collaboration. Physicians, along with other stakeholders, have a voice in the measurement process, which sets MHQP's reporting apart from other programs."
MHQP's results are based on widely accepted standards developed by the National Committee for Quality Assurance (http://www.ncqa.org) to assess the quality of care delivered to members of health insurance plans nationally. MHQP analyzes and reports on performance data for patients covered by Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, and Tufts Health Plan. [Editor's note: You can use the zip code function at mhqp.org to look up medical groups in your area.]
Massachusetts Health Quality Partners is an independent, not-for-profit organization established in 1995 by a group of Massachusetts health care leaders who identified the importance of using valid, comparable quality measures as a way to drive improvement. Its membership reflects a broad-based coalition of physicians, hospitals, health plans, purchasers, consumers, government agencies and academics working together to promote improvement in the quality of health care services in Massachusetts. MHQP provides reliable information to help physicians improve the quality of care they provide their patients, and help consumers take an active role in making informed decisions about their health care.
Checklist: Diabetes and High Blood Pressure - What You Can Do/What Your Doctor Can Do
Diabetes is a serious disease. If not well controlled, diabetes can lead to death or disabilities such as vision problems, kidney failure, or amputations of the foot or leg. Diabetes can also cause problems in a woman's pregnancy. About 17 million adults in the United States have diabetes. Almost one million people are diagnosed with this disease each year.
Three out of four (73%) adults with diabetes have high blood pressure or use prescription medications to lower blood pressure to more healthy levels. When a person's blood pressure is under control, he or she is at lower risk for cardiovascular disease (heart disease), kidney disease, eye disease, and other health problems related to diabetes.
Costs are high to treat diabetes and its problems. These include "indirect costs," such as when employees miss work because of health problems. In the U.S., these costs are about $40 billion each year. "Direct costs" of diabetes include doctor's visits, screening tests, and medications. These total about $92 billion each year.
If you have diabetes and high blood pressure, you and your doctor can work together to help control you blood pressure and better manage your diabetes. Here are some things you and your doctor can do:
Ways your doctor can help...
-- Teach you about diabetes. This includes problems that can happen if your blood pressure levels get out of control.
-- Teach you ways to control blood pressure. This includes eating healthy foods and being active each day.
-- Check your blood pressure at each visit.
-- If needed, prescribe medications and explain what they do and how to take them.
-- Talk with you about diabetes problems, ways to notice them, and what to do if they occur.
-- Ask you to have eye exams and other tests that check whether your diabetes is under control.
-- As needed, refer you to a dietician, diabetes educator, or specialist who can help in your diabetes care.
Ways you can help...
-- Make a diabetes plan with your doctor. This should include which foods to eat, ways to be active, and how often to visit the doctor.
-- Take all medication as your doctor prescribes. This includes medication to control blood pressure. Tell your doctor if you have problems with any of your medications.
-- Eat the foods you are supposed to eat. A healthy diet is one of the best ways to control diabetes and high blood pressure.
-- Be active each day. This can be taking walks, going to a gym, or doing other types of exercise.
-- Know that health problems (such as high blood pressure) can make diabetes worse.
-- Visit the doctor at least once a year. Some people with diabetes see their doctors even more often, maybe once every 3 to 4 months. Make sure to go to all your doctor's appointments -- even when you are feeling well.
Visit http://www.mhqp.org for more information and links to resources on controlling high blood pressure and other preventive care and chronic disease topics.
CONTACT: Barbara Lambiaso, firstname.lastname@example.org
|SOURCE Massachusetts Health Quality Partners|
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