Opportunities to Improve

Figure 7 summarizes the individual performance of our 30 partner practices that use electronic medical records (EMRs) to measure, report, and improve achievement on their patients with diabetes. Information to link practices with their achievement level is found in Part Three. Collectively, these 30 practices care for 23,461 patients with diabetes. The top panel describes each practice’s score on Better Health’s Summary Outcome Standard; the bottom panel describes each practice’s score on Better Health’s Summary Process Standard. The plots describe the percentage of each practice’s adults with diabetes who meet the Summary Outcome Standard (top) or Summary Process Standard (bottom). The overall region-wide percentages for each Summary Standard are identified in the middle of each chart (38% for Outcomes; 46% for Processes.)

Several points about Figure 7 are notable. All identify opportunities to improve our achievement.

1. Wide variation across practices.
On our Summary Outcome Standard, patients in the top 10% of our practices achieve 45% of our standards, while patients in the lowest 10% of our practices achieve 26% of our standards, a 70% difference between the achievement of the highest and lowest ranked practices.

On our Summary Process Standard, patients in the top 10% of our practices achieve 55% of our standards, while patients in the lowest 10% of our practices achieve 27% of our standards, a two-fold difference between the achievement of the highest and lowest ranked practices.

2. No practice achieves 100% on either Summary Standard.
We have set high bars for achievement on both of our Summary Standards, but we are striving to attain perfection, or close to perfection! Even the highest ranked practices still have a long way to go.

3. No practice does equally well on both Summary Standards.
The figures highlight two practices (identified as A and B) and their comparative rankings on our Summary Outcome Standard and our Summary Process Standard. Practice A, highest ranked on the Summary Outcome Standard, has room to improve on its Summary Process Standard. Practice B, highest ranked on our Summary Process Standard, has room to improve on its Summary Outcome Standard.

4. Improvement targets and strategies will vary across sites.
Practice leaders representing all partner practices have been provided with details about their achievement on our two standards, on each of our 9 component standards, and how they are doing with subgroups of patients by insurance and other measures. Each practice is motivated to improve, but the target strategies for improvement will vary somewhat across sites. As an example, practices with better Process achievement than Outcome achievement may want to target ways in which to better engage their patients, whether by improving their programs for smoking cessation or weight management, or by testing new approaches to activating their patients in better self-care.

Figure 7. Percentage of Patients in Each of Our 30 Electronic Medical Records-based Practices achieving our Summary Outcome Standard (top panel) and Summary Process Standard (bottom panel), with two highlighted practices. 2007