Project to Measure Quality of Care: Goal is to Help Consumers, Doctors
By Guy Boulton, Milwaukee Journal Sentinel
Mar. 20–The Wisconsin Collaborative for Healthcare Quality, a group of health care systems and large physician practices, has been selected as one of six sites nationwide for a federal pilot project that will measure the quality of care provided in doctors’ offices and clinics.
The project’s goal is to develop a practical model for collecting information from thousands of physician practices and then put it in a form that can be useful for consumers and doctors.
“It’s a table we want to be at because we think we have something to contribute,” said Christopher Queram, the group’s chief executive.
The pilot project is significant because most health care happens outside of hospitals. So far, much of the effort to measure quality has focused on hospitals, nursing homes and home health care agencies.
The collaborative, formed in 2003 to improve health care quality in Wisconsin, was planning its own project to track the quality of care provided physicians in their offices, Queram said. Now it will be able to work with other groups on some of the inherent challenges in measuring the performance of physicians.
The project is being supported with money from the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality, a federal agency that supports research on improving the quality and efficiency of the health care system.
“What CMS and the project sponsors are trying to do is to develop an effective strategy to take physician performance measurement and improvement into every physician office in the country,” Queram said.
The group’s members include health care systems, large physician practices, employers and the United Autoworkers. In the Milwaukee area, they include Columbia St. Mary’s, Froedtert & Community Health System and the Medical College of Wisconsin.
Advanced Healthcare S.C., Medical Associates Health Centers, Wheaton Franciscan Medical Group and ProHealth Care Medical Centers — all large physician practices — also are members.
The pilot joins dozens of projects nationwide designed to measure health care quality. The ultimate goal is to provide better care and lower costs bringing more standardization to health care.
One study published in the New England Journal of Medicine in 2003 found that patients did not receive the recommended care 46% of the time, and that 11% of the time received care that was not recommended and potentially harmful.
“Most people acknowledge the gaps in the quality of care, and most physicians are aware that we need to do better,” said Michael Barr, a doctor and vice president of practice advocacy and improvement for the American College of Physicians. “The question is how to get from where we are to where we want to be.”
So far, the work has focused on developing accepted measures of health care quality. The underlying idea is the dictum that you can’t improve what you can’t measure. But just agreeing on what measures to use is a challenge, involving an alphabet soup of organizations, agencies and professional societies.
“It’s getting better because we are starting to get alignment across the country in the measurement sets,” said Jean Krause, chief quality officer for Gundersen Lutheran Health System in La Crosse.
So far, the measures focus on processes, such as whether a doctor consistently monitors a diabetic patient’s blood sugar. The goal is to lessen the widespread variation in health care encouraging doctors to follow what are considered best practices.
“You need to be consistently delivering the right care to the patient,” Krause said.
The next step will be to measure outcomes — such as whether a diabetic patient’s blood sugar remains under control. That will be more difficult. For one thing, some patients don’t do what their doctors recommend.
If a diabetic patient ignores his or her doctor’s advice, for example, how do you gauge the quality of care provided the physician?
“That’s one of the confounding factors, no doubt about it,” said James Ketterhagen, chief medical officer of Covenant Healthcare.
Despite the challenges, the various initiatives to measure quality eventually could become the foundation for Medicare to pay doctors for performance as opposed to set fees.
The collaborative and the other organizations in the pilot project were selected the Ambulatory Care Quality Alliance, a coalition of more than 125 organizations. Groups in Minnesota, California, Indiana, Massachusetts and Arizona also are participating.
The project, which will start with 26 performance measures, will get into details on how to collect information in a way that imposes a minimum burden on physicians.
Most medical records are still on paper. Flipping through medical charts to cull information on the 26 measures would be time-consuming and costly. Some of the data, though, could be collected from insurance claims.
Working out those kinds of details is one of the pilot project’s goals.
The project also must find the best way to give the information to consumers and doctors. Both are important — and in many ways the information could be as useful to doctors as it is to patients.
The Commonwealth Fund, which supports health care research, notes that most doctors don’t have access to their own performance measures, so they don’t know how they compare to their peers. They also don’t have quality information on the doctors they refer patients to.
There will be other challenges, but the group could have some data from the multi-year project the end of the year. And experts generally agree measuring performance will be essential in any effort to improve quality .
“That’s the ultimate goal here: to make health care work better,” Queram said.
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Copyright (c) 2006, Milwaukee Journal Sentinel
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