Publicly Reporting Quality Data to Identify "Bright Spots," Motivate Improvement

In 2007, a group of healthcare providers and payors established Better Health Greater Cleveland, a quality improvement organization under Robert Wood Johnson Foundation's Aligning Forces for Quality initiative. The organization started in the outpatient setting with physician practices, but has recently expanded to include hospitals.

Better Health providers use electronic medical records to publicly report quality data to drive improvement in the care for patients with chronic conditions, such as diabetes, heart failure and high blood pressure.

Measuring and reporting quality of care for chronic conditions
Better Health tracks nationally endorsed and locally vetted outcome of care and process measures related to chronic conditions. For diabetes outcomes, for example, the group measures and reports patients' body mass index, blood sugar levels, blood pressure, cholesterol and smoking status. For diabetes process of care, the group measures the percent of physicians who performed an annual hemoglobin A1c test; tested urine for kidney function or prescribed an angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker; performed an annual eye exam; and vaccinated patients for pneumonia.

Better Health reports data gathered from practices' EMRs at the practice and regional level on its website twice a year. The group uses the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set as a benchmark to compare results. HEDIS includes data on 76 measures across five domains of care gathered from more than 90 percent of U.S. health plans.

Better Health Greater Cleveland identifies Identifying "bright spots" through reported data
Coinciding with the twice yearly reports of data is Better Health's learning collaboratives, in which participating practices meet to identify top performers, or "bright spots." Bright spots are practices that performed the best in the region or had the greatest documented improvement.

One example of a bright spot that Better Health identified is primary care practices that used electronic health records when caring for diabetes patients. In 2011, Randall Cebul, MD, director and president of Better Health Greater Cleveland, and colleagues published a study in The New England Journal of Medicine showing that primary care practice partners of Better Health using EHRs had better diabetes care and outcomes than Better Health practices that were based on paper.

Once these bright spots are identified, Better Health leaders learn the bright spots' strategies to achieve high quality and determine if they are replicable across providers. Better Health then disseminates the strategies and later measures quality to determine if the strategies were effective at other sites. Two strategies that were effectively adopted across different healthcare systems included EHR-facilitated approaches to improving vaccinations and monitoring kidney function among their diabetic patients, according to Dr. Cebul.   

Driving improvement through public reporting
Public reporting is important not only because it helps leaders identify high performers and disseminate best practices, but also because it taps into providers' pride and sense of competition, according to Dr. Cebul.

"Even though people are partnering and collaborating across the system, providers care about winning," he says. Public reporting also motivates providers to improve their quality because they know that payors, including Medicare, Medicaid and commercial insurers, have access to their data and will support practices with higher quality. "Since everybody knows the results, there's an understanding that payors, purchasers and patients may begin to [identify] some of the practices that are performing better," Dr. Cebul says.

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