Measuring Health Care Quality Across The State

Barbra Rabson, executive director of the non-profit Massachusetts Health Quality Partners, details some of the findings in a new report released today; an interactive database that allows consumers to compare and contrast physician groups throughout the state based on specific medical measures:

As Massachusetts Health Quality Partners (MHQP) releases our sixth annual report on the performance of primary care physician groups across the state, I've been thinking about how we should measure the impact of our work. While MHQP is only one of many organizations in the state that is dedicated to advancing the quality and safety of health care, we have the longest track record of public reporting, so, with six years of data behind us, what can we say about the quality of patient care in Massachusetts? Here are a few thoughts.

Overall quality is very high: Statewide, primary care physician groups performed better than the national average on 28 of 29 adult and pediatric measures reported by MHQP, and above the national 90th percentile benchmark on 15 of these measures. Even more encouraging, we have seen improvements not just in process measures but in outcomes. For instance, more diabetes patients are getting appropriate screening for cholesterol and blood pressure and more are keeping their levels under control.

Unwarranted variation is being addressed: If we look at the data on a group-by-group and measure-by-measure basis, a more complex picture of quality emerges, with a great deal of variation in performance across the state and plenty of room for improvement. The great news is that, for some key measures MHQP has been tracking for several years, variation has narrowed as the lowest scoring groups have improved. For example, three years ago, the best performing groups met the standard for cholesterol screening of cardiovascular patients 100% of the time, while the lowest performers were at only 72%. Now, the lowest score is 83%, which means the variation statewide has dropped from 28 percentage points to 17 in three years.

Reducing overuse is a continuing challenge: The news is not as good, however, for the appropriate treatment of low back pain, a measure where high performance not only results in safer, better-quality care, but also helps reduce unnecessary medical spending. While, statewide, physicians scored above the national average in avoiding the inappropriate use of imaging studies (x-rays, CT scans and MRIs) for adults with low back pain, the highest performing group had a 97% score, while the lowest score was 52%, a 45 percentage point variation. What's more, the amount of variation has increased since last year, not decreased, for this important, value-related measure.

MHQP reports are integral to improvement efforts: Another key measure of success is the fact that physician groups are comparing their MHQP results with those of other groups across the state and acting on the data to make measurable improvements in clinical quality for their patients. Two excellent examples – physician groups that have used MHQP's data to address a major opportunity for improving the treatment of patients with severe depression – are highlighted in our press release for this year's clinical quality report.

Our work is far from done: As we turn our attention to taming health care spending through delivery system and payment system reforms, the measurement of value – the relationship between cost and quality-of-care – will become increasingly important. We also face the challenge of expanding measurement to assess the entire continuum of care – as patients move across the delivery system from a primary care provider to a specialist to hospital to home. MHQP's reports, which measure and track multiple dimensions of quality over time, can provide a solid foundation for targeted improvement efforts.

Equally crucial is the need to build on the multi-stakeholder process and methodological rigor that MHQP has used to ensure that our measurement efforts and reports are credible and meaningful. If we continue to build on the collaborative spirit that has given credibility to MHQP's quality measurement and reporting over the past six years, I have no doubt that Massachusetts will be able to make measurable, breakthrough improvements in health care quality and value, just as we have in expanding access to coverage.