Measurement and Public Reporting

by Dr. Gail Amundson, Quality Quest for Health

A 2010 survey of over 4,000 healthcare consumers conducted by the Deloitte Center for Health Solutions found:

  • 76 percent of consumers grade the healthcare system as a “C” or below.
  • 48 percent believe more than half of healthcare money is wasted.
  • Only 23 percent of consumers believe they understand how the healthcare system works.

The truth is, each one of us is a consumer of healthcare services. The numbers above suggest that many of us believe the healthcare system needs simplification, better outcomes for patients, and higher quality and value for the dollars spent. All of this requires being able to “see” inside the healthcare system.

  • Patients and families need information about the quality of care that doctors and hospitals provide if they are going to make informed choices about their own care.
  • Doctors and hospitals need information about the quality of care they provide if they are going to improve it. You cannot improve what you do not measure.
  • Employers, health plans and consumers need information about the value they are getting for their healthcare dollars.

Everyone who gets care, gives care and pays for care has the opportunity to affect lasting change by working together to make healthcare better. Quality Quest for Health of Illinois serves as a neutral forum and convener to bring all healthcare stakeholders together to work on multiple issues. We also work with health plans and healthcare providers to collect data related to specific projects and report information to the medical community and the public.

Our first public report focused on the generic prescribing rate of clinics across seven specialties in central Illinois. The use of generic medications saves patients money and helps them stay on their medications because they are affordable. As a region, the generic prescribing report has gone from 65 percent in 2007 to 74 percent in 2009. If the state as a whole reached a 74-percent generic prescribing rate, we estimate the savings across the board would be one billion dollars a year.

In addition to the interactive Generic Prescribing Report available on our website (qualityquest.org), we are pleased to share performance results for a number of nationally standardized quality measures available for many primary care practices in central Illinois. The measures were developed by the National Committee for Quality Assurance (NCQA) and are commonly referred to as HEDIS (Healthcare Effectiveness Data and Information Set) measures. Many health plans report HEDIS measures, but results have not been widely available for physician practices in Illinois.

Some of the measures listed on our website include:

  • Well child care measures how frequently babies have six well-care visits by age 15 months.
  • Treatment of children with upper respiratory infections (URI) measures how often children with URI avoided a prescription for antibiotics.
  • Testing of children with sore throats assesses the practice of testing for strep before prescribing antibiotics.
  • Follow-up care for children prescribed medicine for ADHD tracks whether they had a follow-up appointment with the person who started them on medication.
  • Cervical cancer screening tracks how many women between the ages of 21 and 64 have had a Pap test in the past three years.
  • Breast cancer screening measures whether women between the age of 40 and 69 have had a mammogram in the past two years. The lower age of this measure is likely to change to reflect the updated evidence-based screening recommendations.
  • Adult bronchitis measures how often antibiotic treatment is avoided.

Lack of performance information has been a missing link in healthcare. As one expert said, “Trying to improve something when you don’t have a means of measurement and performance standards is like setting out on a cross-country trip in a car without a fuel gauge. You can make calculated guesses and assumptions based on experience and observations, but without hard data, conclusions are based on insufficient evidence.” Primary care practices in central Illinois now have a basic “fuel gauge” for several common conditions. Visit our website at qualityquest.org to learn more. iBi