Opportunities for Accelerating Improvement

The data in this Checkup will be used to identify opportunities for improvement, and for accelerating improvement region-wide. Systems and their practice sites can target specific standards or population sub-groups for which intensified efforts are needed. Perhaps more important, as data accumulate, we are better able to identifier “outliers” whose achievement is Exceptional by comparison to others – perhaps overall, or perhaps on an individual standard. These outliers may be individual practice sites or they may be entire health care systems. In addition to identifying these Exceptional Achievers, we are now able to identify practices or systems that are outliers by virtue of their Exceptional Improvement over time – again, perhaps overall, or on an individual standard, or with a particular patient sub-group. If these “best practices” are shared throughout the region, more patients and practices can get better faster.

In this section, we provide three figures that identify methods for using Better Health data to identify Exceptional Achievers or Exceptional Improvers who will share their successes with others in the region.
 
Exceptional Improvers.
Figure 13 describes practice site-level percentage changes (from Calendar 2007 to July 2007 – June 2008) in patients meeting the composite Outcome (horizontal axis) and composite Care Process (vertical axis) Standards. Collectively, 33 practices provided data for both periods. Sites in the right upper (or “northeast”) corner (21 of 33) improved in both composite Outcome and Process Standards, including 3 with Exceptional Improvement on both standards (highlighted). What did these three sites do to improve so much in so short a time?

Figure 13. Percentage Changes (from calendar 2007 to July 2007 - June 2008) in Achievement on Composite Standards for Outcomes and Care Processes in 33 Practices reporting in both periods


Collectively, 33 practices provided data for both periods. Sites in the right upper (or “northeast”) corner (21 of 33) improved in both composite Outcome and Process Standards, including 3 with Exceptional Improvement on both standards (highlighted). Sites in the southwest corner (2 of 33) had slight declines in achievement for both composite standards; sites in the northwest corner (8 of 33) improved process scores but declined in outcome achievement; and, sites in the southeast corner (1 of 33) improved in outcomes but declined in achievement of their care processes.

 

Exceptional Achievers.

Figure 14 shows pneumococcal vaccination rates at 35 practices in the current report that vary from 0% to 92% across sites. The top 9 practices are part of the same health care organization (labeled “A” in the figure). Clearly, system “A” has figured out something that the others have not. What do they do?

Figure 14. Rates of Pneumococcal Vaccination at 35 practices for the current reporting period (July 2007 - June 2008)


Figure 15 shows achievement rates for kidney monitoring or treatment at 35 practices in the current report. Rates vary from 62% to 95% across sites. The top 7 practices are part of the same health care organization (labeled “B” in the figure – a different system than “A” above) It seems likely that other systems and practice sites can learn something from system “B.”

Figure 15. Rates of Kidney Screening or Medication (Urine microalbumin screening or ACE-inhibitor or ARB prescription) at 35 practices for the current reporting period (July 2007 – June 2008)