See­ing clearly

Pub­lic re­port­ing on pro­cesses, out­comes shows clin­i­cians where they can im­prove

Modern Healthcare - - Opinions Commentary - John Lump­kin

In all the years I have prac­ticed medicine, I have yet to meet the physi­cian who didn’t want to do right by his pa­tients. Even so, in ev­ery com­mu­nity across Amer­ica, doc­tors and hos­pi­tals can and do fall short of pro­vid­ing the care their pa­tients need. Thanks to the grow­ing move­ment for greater trans­parency in health­care, we in­creas­ingly know where and who they are. But per­haps even more im­por­tant, so do they.

To take the mea­sure of the trans­parency move­ment, the Robert Wood John­son Foun­da­tion re­cently set out to find as many free, on­line pub­lic re­ports on the qual­ity of health­care as pos­si­ble. The re­sults can be seen in a new na­tional direc­tory that lists more than 200 lo­cal, state and na­tional re­ports—from the Maine Health Man­age­ment Coali­tion’s Get Bet­ter Maine “guide to qual­ity health­care” to the Puget Sound Health Al­liance’s Com­mu­nity Checkup.

The re­ports in­clude in­for­ma­tion about the process of de­liv­er­ing care (for ex­am­ple, did pa­tients get all the rec­om­mended care?), ac­tual out­comes for pa­tients (for ex­am­ple, did pa­tients die or have to re­turn to the hos­pi­tal?), what pa­tients said in sur­veys about their ex­pe­ri­ence with physi­cians or hos­pi­tals, cost or some com­bi­na­tion of these.

We are call­ing at­ten­tion to these ef­forts in hopes of spurring their use and spawn­ing im­i­ta­tors. We be­lieve mea­sur­ing and pub­licly re­port­ing on the qual­ity and cost of care physi­cians and hos­pi­tals pro­vide is cru­cial to im­prov­ing the qual­ity and low­er­ing the cost of care na­tion­wide. Thanks to Medi­care’s “Hos­pi­tal Com­pare” web­site, you can get re­ports on the qual­ity of hos­pi­tal care na­tion­wide. The fed­eral health re­form law also di­rects Medi­care to de­velop a par­al­lel web­site where peo­ple can com­pare doc­tors’ qual­ity by 2013.

But un­til that day ar­rives, there are far more com­mu­ni­ties where you can’t get in­for­ma­tion about the qual­ity of the care doc­tors de­liver than com­mu­ni­ties where you can. That needs to change, and we shouldn’t rely solely on Medi­care.

Is­su­ing pub­lic re­ports on the qual­ity of care isn’t a game of gotcha. It serves three im­por­tant pur­poses: First, it al­lows pa­tients to make in­formed choices about their care and be bet­ter part­ners with their doc­tors. Sec­ond, it al­lows health­care pro­fes­sion­als to see where they can im­prove. Third, it al­lows pay­ers to

The real chal­lenge is turn­ing the idea of trans­parency into the re­al­ity of qual­ity im­prove­ment.

see the value of the care they help pay for.

We’ve all heard the say­ing that you can’t im­prove what you don’t mea­sure. It’s just as true that you don’t lose weight by stand­ing on a scale. Mea­sure­ment is a tool, not a goal or out­come. The real chal­lenge is turn­ing the idea of trans­parency into the re­al­ity of qual­ity im­prove­ment on the ground.

In our foun­da­tion’s sig­na­ture qual­ity ini­tia­tive, called Align­ing Forces for Qual­ity, we are work­ing in 16 com­mu­ni­ties to get the peo­ple who get care, give care and pay for care to use these re­ports. And in clinic af­ter clinic, there have been “a-ha” mo­ments when physi­cians look at the re­ports and see that they can do bet­ter.

Af­ter the Ore­gon Health­care Qual­ity Corp., the leader of the AF4Q ini­tia­tive in Ore­gon, be­gan re­port­ing on whether women were screened for ch­lamy­dia, physi­cians in the area took note. “Providers just didn’t re­al­ize that it was a U.S. Preven­tive Ser­vices Task Force rec­om­men­da­tion,” said Dr. Su­san Clack of the Pa­cific Med­i­cal Group. “I did two screen­ings that I would have never done be­fore and both were pos­i­tive for ch­lamy­dia. So it ac­tu­ally did change my prac­tice.”

The re­ports is­sued by an­other founda- tion part­ner, Min­nesota Com­mu­nity Mea­sure­ment, spurred the Ellsworth Med­i­cal Clinic to reach higher. Af­ter learn­ing in MNCM’s 2009 re­port that only 47% of the clinic’s pa­tients re­ceived the rec­om­mended care for vas­cu­lar disease, the clinic took ac­tion. Clinic staff be­gan check­ing for miss­ing tests in physi­cians’ or­ders, con­tact­ing pa­tients about needed vis­its or screen­ings and call­ing them to en­sure they were fol­low­ing their treat­ment plans. In 2010, 68% of pa­tients at the Ellsworth Med­i­cal Clinic re­ceived op­ti­mal vas­cu­lar care. This made the small, ru­ral prac­tice with two physi­cians, one physi­cian’s as­sis­tant and a few clin­i­cal and of­fice staff the state’s top per­former out of 433 clin­ics.

An­other part­ner, the Wis­con­sin Col­lab­o­ra­tive for Health­care Qual­ity, has found com­pelling ev­i­dence that pub­lic re­port­ing leads to im­proved per­for­mance. In a re­cent study funded by the Com­mon­wealth Fund, it found that clin­ics fo­cused on qual­ity im­prove­ment ef­forts on as­pects of care that WCHQ pub­licly re­ports on. More­over, the study found that the clin­ics that par­tic­i­pate in the pub­lic re­ports out­per­form those who don’t.

We re­cently asked peo­ple work­ing with Align­ing Forces to tell us how the trans­parency move­ment has changed care in their com­mu­nity. Dr. Peter McGough of the Univer­sity of Wash­ing­ton summed it up nicely. “What’s in­cred­i­ble is when you gather up a set of mea­sures that the providers will ac­knowl­edge are ac­cu­rate. … They can see how they’re do­ing rel­a­tive to the rest of the clinic, one clinic against an­other, and gen­er­ally docs are mo­ti­vated to change if they see they’re not at the top of their game.”

As our new direc­tory shows, the trans­parency move­ment is gain­ing mo­men­tum, but it still has a long way to go for physi­cians ev­ery­where to see where their game is.

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