Additional Challenges to Greater Cleveland

Greater Cleveland’s care is under the national quality-of-care microscope as one of 14 health care markets supported in Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative. In particular, data relevant to important diabetes outcomes among patients covered by Medicare have been assembled and published by faculty of the Dartmouth Atlas Project, a long-standing and highly visible initiative that examines variations in care and health outcomes in regions across the United States. Figure 11 compares Medicare hospital discharges for “ambulatory care sensitive conditions” – conditions, such as diabetes, for which optimal outpatient care can dramatically reduce hospitalizations – across the 14 AF4Q regions. Figure 12 compares rates of amputations among Medicare beneficiaries – for which diabetes is the leading cause in the United States – across the 14 regions.

The message in both cases is clear: Greater Cleveland has much room to improve. In addition to improving lives by improving diabetes care, doing better also would save money. In this case, the savings would accrue to taxpayers through Medicare payments. And, while we have no evidence that these same results apply to our uninsured patients, or to our patients covered by Medicaid or Commercial insurers, we have no reason to believe otherwise. Indeed, the data provided in this Checkup suggest that, if there are important cross-payer dofferences, Medicare patients in Greater Cleveland fare better than others.

Figure 11. Rates of Hospital Discharges (for Medicare patients in 2003-2006) for “Ambulatory-Care Sensitive” Conditions – also considered “Preventable” Hospitalizations across the 14 Aligning Forces for Quality regions.

Data Source: Dartmouth Atlas Project

Among these “ambulatory-care sensitive” conditions, diabetes is one of the most common. The message is clear: Greater Cleveland has much room to improve. 

Figure 12. Rates of Leg Amputations (for Medicare patients in 2003-2006) across the 14 Aligning Forces for Quality regions.

Data Source: Dartmouth Atlas Project

Poorly controlled diabetes is the most common cause of leg amputations among adults in the United States. Again, the message is clear: Far from being “best in class,” Greater Cleveland can do better.